Bioethics Discussion Blog: Patient Modesty: Volume 40





Sunday, April 24, 2011

Patient Modesty: Volume 40

So now we move on to Volume 40. I started the thread on patient modesty concerns back in August of 2005--approaching 6 years ago. Much has been written to this thread in the intervening years but I think it is interesting to go back and read the initial Volume of the thread named "Naked"and then compare with the more recent Volumes. I think what you will find is that there has been a shift in conversation about solution to the patient modesty concerns from one of frustration and futility to currently more about some success by patients "speaking up" to their healthcare providers to express their need and even to have their requests satisfied. I look forward toward more optimism than despair or is this just wishful thinking? ..Maurice.



At Sunday, April 24, 2011 11:57:00 AM, Anonymous Anonymous said...

I would like everyone to visit this site. PLEASE be
sure to list your complaint as a privacy violation. I will
explain later. It's easy to register and you can remain
anonymous. Please be sure to put the name of the hospital
or other medical facility.



At Sunday, April 24, 2011 4:53:00 PM, Blogger Joel Sherman MD said...

Please look at our newest article concerning men's reluctance to seek medical care. Is embarrassment a factor?

At Sunday, April 24, 2011 5:50:00 PM, Blogger Maurice Bernstein, M.D. said...

I strongly suggest that my visitors here go to Dr.Sherman and Doug's blog on patient modesty and privacy issues and to the article posted today "Why Don't Men Visit Doctors,Is Embarrassment a Factor?" The link is above in Dr. Sherman's posting.

To start considering a question of mine related to that topic, I will copy here the response I gave to that blog. Maybe this will initiate further discussion on either or both blogs!!

To understand how physicians evaluate their patient's modesty embarrassment would be to find whether there are surveys which document to what extent physicians themselves seek routine medical care or disclose modesty issues which lead to gender selection for their own healthcare providers. If physicians of both genders have such gender selection tendencies for themselves, wouldn't and shouldn't the doctor be less ignorant and more "in tune" with their patients who make similar requests?

I know there are surveys which show that physicians themselves may be living "unhealthy" lives despite what they tell their patients about health issues. What I am still trying to find is how modesty, either intellectual shyness to admit life-style or actual physical modesty fears play a role in the behavior of those physicians with regard to their own health. Anyone have any data regarding this aspect of the patient modesty issue? ..Maurice.

At Monday, April 25, 2011 4:11:00 AM, Anonymous Anonymous said...

I posted on Dr. Sherman's blog as well, it is excellent. To paraphrase my response I have started copying the articles and sending them to many of the providers in the area. Some I sign, some I don't but give an explaination why such as I have family working there etc. I am always respectful and try to point out the benefits of following the articles. While it may not be perfect and I fully realize it would be more effective if I signed all of them. But as I stated earlier, a step at a time. If everyone did a little it could have a huge impact.....alan

At Monday, April 25, 2011 5:55:00 AM, Anonymous Anonymous said...

I would like to APOLOGIZE for a earlier post.I was WRONG and out of line.I let events of the past week get the better of me.I'm sorry for that.Dr. Bernstein was right to set me straight and get us back on tract.I hope everyone will except my apology. AL

At Monday, April 25, 2011 8:42:00 AM, Anonymous Anonymous said...

Apology accepted. I would like to add that these times are especially difficult for everyone in our society and that when we have needs that seem to be on the fringes (at least that's what the medical community would like us to believe), that it creates even more stress for all of us. It's times like this when we can take comfort that (despite our different motivations) we all want the same things. It is also my observation that while we are on different political planes to some extent, that we must be responsible to look at both sides of the equation and that we all be motivated by fact instead of fear.

At Monday, April 25, 2011 8:43:00 AM, Anonymous Anonymous said...

PT, great site. Does anyone know the legal ramifications of posting and identifying specific people and places with regard to liable?

At Monday, April 25, 2011 9:03:00 AM, Anonymous Anonymous said...

I shouldn't post this early in the morning.And you should read it before you hit send.I should have said accept not except. al

At Monday, April 25, 2011 9:10:00 AM, Anonymous Anonymous said...

I have recently encountered a new blog that may provide a new forum for our concerns. The blog is moderated by a journalist, Laura Newman, titled "Patient POV". She is soliciting stories from patients on their experiences and thoughts on how to improve the health care system to be more patient centered. If anyone is interested in presenting the modesty issue it may be a worthwhile endeavor. If you visit the blog be especially sure to scroll down and read the section titled "Listening to Patients: Voices from the Underground". Jean

At Monday, April 25, 2011 5:01:00 PM, Anonymous Anonymous said...


There would be no hipaa violations as long as you
or your family members are involved in the complaint.


At Monday, April 25, 2011 7:07:00 PM, Anonymous Anonymous said...

Although the horrific story linked below does involve a physician as a patient, it isn’t “routine care” nor is the issue of modesty or gender in healthcare specifically mentioned by the author. I am sure that personal modesty was on this patient mind as it is with all patients to one degree or another.

The article is unique in that it tells the story from 3 different points of view: the patient, the doctors & nurses (the chart) and the hospital. It illustrates the vast differences between what patients think is important and what the healthcare profession thinks is important in terms of respectful treatment. If you are mistreated and you don’t speak up at the time, when the records are reviewed there will be nothing to back up your claim of mistreatment. The medical staff will also have conveniently forgotten all about you.

At Monday, April 25, 2011 7:24:00 PM, Anonymous Anonymous said...

I’m curious to ask the regulars here who would only accept intimate care from the same gender if they would also accept it from a transgendered doctor, nurse or technician. Let’s complicate the issue a bit by adding that the doc, nurse, tech has just changed their name, is taking hormones & has the outward appearance of the new gender but is pre-op. ~Curious~

At Monday, April 25, 2011 9:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today 7:07pm--what an experience---and for a physician to self-experience!

I am sure that a lot of the failure of the medical system response to the modesty issues and requests written on this thread may be logistical but but I think a lot of responses by the doctors, nurses and others can be simply uncaring out of ignorance and lack of personal experience. There is no substitute for personal experience, unfortunately, as exemplified by the female pediatrician's experience in the Pulse article, which may sensitize the healthcare providers to the need to really care for the patient, not just "act like caring", the latter action which can be quickly documented in the medical notes as "done". ..Maurice.

At Tuesday, April 26, 2011 6:13:00 AM, Anonymous Anonymous said...

PT, I'm not sure about that. It could be considered liable from their perspective even if you feel you have an iron clad case. The law is so ambiguous, you don't know. The only time you cannot be sued is if proven that you are telling the truth. It could mean a lawsuit even if you win but the horrific fall out might not be worth the price of identifying specific places and people.

Curious...I probably would accept the transgender professional as long as the gender they show outwardly is female. My reasoning isn't because they look female but because they feel they are female and there would be no sexual component to the care received. No matter how professional a male provider is to a female patient, there is an underlying sexual issue from the patient's perspective and sometimes from the physicians although they would want to deny it. However, it's not a true professional that doesn't have those feelings; it's a true professional who does show them. Afterall, we are all sexual beings and we are all human.
Regarding the article...The entire episode is horrific and I think the most frightening part for me is that I've been in medical situations where I feel like I'm in twilight zone and no matter what I say or do, the cooperation isn't there, I am not there (as they would like you to think) and all the yelling and screaming won't change it.

At Tuesday, April 26, 2011 11:29:00 AM, Anonymous Anonymous said...

Correction to my last post..."It's a true professional who does NOT show them"

At Tuesday, April 26, 2011 1:54:00 PM, Anonymous Anonymous said...


One cannot seek damages for a hipaa violation.The
facility receives a fine and/or someone could receive
jail time.


At Tuesday, April 26, 2011 5:12:00 PM, Anonymous Anonymous said...

There is a running argument going on today at allnurses between advocates and nurses at

They seem to believe sharing embarrassing patient stories is ok and they are doing nothing wrong. Why cant they see the harm in this?

At Tuesday, April 26, 2011 7:48:00 PM, Anonymous Anonymous said...

I agree with gd, I would probably be Ok with a transgender that appeared male as their sexual orientation would be male. just my two cents, doesn't mean it makes sense.Alan

At Tuesday, May 03, 2011 12:19:00 PM, Anonymous Anonymous said...

Regarding the humor section and the joking about patients
on all nurses it is interesting to note that there are no
such forums for policemen,fireman and other such
Could you imagine if there were such a humor section
for policemen where they actively made jokes about
using deadly force or the use of the taser on people.
I'm not sure or how we as a society tolerate this
attitude.I realize this is freedom of speech but it is in
extremely poor taste.
Another thread that is disturbing on that site is the thread
" things you would love to say to a patient ". If you read
through that thread you would see the number of references made about a patients penis. Disturbing.


At Tuesday, May 03, 2011 12:45:00 PM, Anonymous colin said...

About 4 years ago I had a Hip replacement. I suffered PTSD after the procedure due to concerns about female nurses having been present throughout the time in the OR. Many people would consider my having PTSd about this as being wholly irrational. I cannot personally explain why it matters so much to me. Tomorrow, I am due to have my other hip replaced. I have asked repeatedly for an all male team in the OR. I have explained how much stress i felt preoperatively last time and said how much more relaxed I will be about surgery if I know no females will be present. I rang today to double check that my request would be satisfied. I was assured in absolute and clear terms that an all male team had been arranged. I am so glad I will not have to go into the OR feeling very stressed. I don't fear the actual surgery at all, not in the slightest! I am now so glad I stood by my principles. I will let you know if they are as good as their word.

At Tuesday, May 03, 2011 3:26:00 PM, Anonymous Anonymous said...

Lets get some nurses and techs to read some pertinent posts on this site...they become de-sensitized and are completely ignorant of patient modesty, especially the techs that have hardly any training... I guess six weeks of EKG training and a high school diploma entitle you to see a woman's breasts. Sad. Lorie

At Tuesday, May 03, 2011 5:31:00 PM, Anonymous Anonymous said...


I know of a housekeeper that went right into endoscopy
as a tech and that's with no training. Btw,she's female!


At Wednesday, May 04, 2011 5:10:00 PM, Anonymous Anonymous said...

There is an interesting thread on all nurses, go to the site click on any of the articles and go to the side article. On the side is one titled nurses tell all what nurses wish you knew. The article basically is a nice message to patients telling them things like don't be afraid to buzz etc. What is really telling and relates to this thread is a post by a nurse who basically seems to feel patients are pain in the butts for asking and expecting anything and finishes with a comment in response to the last point of the article which encouraged patients to send a letter with suggestions of how they could do better, only this nurses suggestion is, send a letter telling us how much you appreciate what we do. The thing that is disturbing is the number of nurses who give him "kudos" indicating they agree. If this is the prevailing attitudes of these nurses, is it representative of nurses as a whole, and is it any wonder the issue of modesty is looked upon as a nusiance at best.

At Thursday, May 05, 2011 6:20:00 AM, Anonymous Anonymous said...

It's a wonder how quickly that would change if gross violators of patient modesty were fired on the spot? The potential for damaging the patient is as real and relevant as a physical injury and should be dealt with as such.

At Thursday, May 05, 2011 8:28:00 AM, Anonymous Anonymous said...

While I agree with much of the sentiments here of late, I have never been convinced that caregivers actually become de-sensitized to patient's modesty needs. They may become de-sensitized to caring about it, since it seems they find it counter productive to their job.There is a difference between not realizing anymore and not caring anymore. But as long as people have their own modesty standards they simply do not forget others have them as well. It's disingenuous when caregivers act surprised at modesty when they admit to it themselves.
I find it a bit like a Chef cooking everyone a meal and only giving a knife and fork to himself. Would he ever really forget that everyone else needs one as well? Or just not care since his own needs are met?

You just can not focus on the results and forget the basics it takes to appreciate or find value in it.

At Thursday, May 05, 2011 7:17:00 PM, Anonymous Anonymous said...

annom. may 5, 8:28 that was very well put. I agree, I think they aren't bothered by it AS MUCH as they used to, but I do not believe cleaning or examining a penis/vagina is no different to them than examinging an arm. While I fully believe it isn't like it was at first, I do not believe it means nothing to them. More to the point, how can they not understand it means a heck of a lot to the patient. They recognize it means a completely different thing when they are the one who is naked, how can they not recognize what it means to the patient. Further they recognize it in certain areas, for instance in mamography, but not elsewhere? I don't buy it either, it may be for good intentions, but i do not believe it.....alan

At Friday, May 06, 2011 5:15:00 AM, Anonymous Anonymous said...

It is disturbing that after speaking to someone who specializes in health psychology that sometimes these situations are purposely construed as a control tactic to dehumanize the patient to obtain control and cooperation. Sometimes (as unthinkable as it seems) people with sadistic tendencies gravitate to medicine. I'm not saying that everyone in medicine is a pervert. What I'm saying is that perverts will gravitate to accessibility to the vulnerable whether it be children, sick people or the elderly. This is a fact and unfortunately, the medical community protects their own instead of "outing" them.

At Friday, May 06, 2011 8:26:00 AM, Blogger Maurice Bernstein, M.D. said...

gd,response of the medical boards to the occasional "bad apples" is not as dire as you may feel. For example, our Medical Board of California regularly publishes their bulletin to physicians but also to the public which contains description of all the legal actions taken. You can read the
April 2011 issue pdf file . The Administrative Actions are detailed in pages 12 to 19. ..Maurice.

At Saturday, May 07, 2011 10:20:00 AM, Anonymous colin said...

earlier this week I posted that i was due to have a Total Hip replacement and had requested an all male team. I had the procedure on Wednesday as planned and the theatre team was indeed entirely male. I was also nursed in all aspects of personal care by a male nurse.

I am so glad I spoke up.

At Saturday, May 07, 2011 5:25:00 PM, Anonymous Anonymous said...

Thanks, Maurice...very commendable!
Colin, I'm so glad you spoke up and got what you needed. I do the same thing and it made me think that this is more than accommodation. They realize the emotional impact on violating your needs. I like to think it's human decency but it's probably more like legal liability if they agree and then don't provide the care. Things ARE changing!!!

At Sunday, May 08, 2011 7:06:00 AM, Anonymous said...

I am a physician and have had a couple of experiences as a patient. Perhaps I am a bit of an exhibitionist, since I never had a problem with any exposure per se. I accepted it as part of the act of receiving care. I had a varicocoelectomy under local anesthesia. The surgeon asked me why, and wanted to know if i was fearful that a junior resident might perform the surgery, to which i stated no, but i wanted to have some control even if I was the patient. As usual in most operating rooms, most of the staff assisting were female. I chose to be opertaed upon in the hospital i worked, because I believed the doctors and staff were the best around. Did I fear that there would be embarrassment later when I saw the female nurses who were in the OR later in more social activities, not at all, I considered them as professionals and never really gave it a thought. My one difficult experience was having had a cystoscopy, where my urologist inserted a cystoscope up through my urethra, there is no way to be modest in that situation and the entire OR crew were females, some younger than my daughters. I refused to have general anesthesia, and had an spinal instead, so I was awake, but really could feel nothing below my waist. At the end of the procedure, they took down the drape which had prevented me from seeing the procedure, and a young attractive nurse was given the responsibility to clean me off. I watched as she scrubbed my penis and scrotum clean of all of the betadine used to clean the area prior to the procedure. It was weird watching her do her job and not feeling anything. I saw her several times later in the hospital corridor, cafeteria. It was always very professioonal.
I have certainly heard horror stories, but my personal experiences over 40 years of practice, have all been good, I never experienced any of what has been described.

At Sunday, May 08, 2011 10:21:00 AM, Anonymous Anonymous said...

Well big chief consider yourself lucky


At Sunday, May 08, 2011 11:27:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, what you wrote seems like sarcasm to me. I wonder if writing in this way to one of the few physicians writing to this thread is productive to the doctor's further participation and discussion. Sarcasm can be effective at times for emphasis as part of a full discussion of the issue at hand. But an isolated sarcastic jab which may be fully out of context is not helpful for promoting needed discussion. ..Maurice.

At Sunday, May 08, 2011 3:12:00 PM, Blogger Doug Capra said...

I want to second Maurice's comment to the doctor who wrote the recent post. I do want to add this, and ask the doctor to respond.
Your reasoning seems to be the "We're all professionals" argument, which is valid for many people. They trust in the professionalism of the staff and that mitigates the embarrassment. You will agree, I'm sure, that a significant number of caregivers deliberately go to other hospitals for treatment. They don't doubt the professionalism of the staff they work with, but just don't feel comfortable with people they know. Some caregivers also prefer same gender care.
Non caregiver patients may still trust the professionalism of both male and female staff, but still feel more comfortable with same gender care for the most invasive, intimate procedures like the one you describe.
A few questions:
1. I think the expectation from most (not all) is professional behavior. What would consider unprofessional behavior in such situations? Have you ever seen it?
2. What if you had requested an all male staff for the cystoscopy? Do you think it would have been take seriously? You don't seem to have modesty issues, but what about another doctor at your hospital who requested an all male staff. Would that have been honored? If yes, would it have been because the the doctor's status at the hospital? Could anyone have requested the same and gotten it?
3. How do you personally feel about patient gender choice in these matters?
Hope to hear from you again.

At Sunday, May 08, 2011 4:19:00 PM, Anonymous Anonymous said...

Just another observation...Doctors know what to expect when they enter an operating room. The posting doctor was ready to receive the care, knew what to expect and decided that this was what he wanted.

Patients are not afforded the same luxury. What seems so proper and expected in the office equipped with drapes and privacy is what has come to be expected. What isn't expected is the sometimes public stripping of said patient who was not told what to expect when they entered the operating room. Sometimes (in the case of C section) arms are restrained and patients are not told. Next they are paralyzed, shaved, stark naked with an audience. Humiliating at best; traumatic with lifelong problems dealing with trust worst.
Before you know it; it's over and you are helpless and your consent hasn't entered the picture because you weren't informed; therefore consent could not be given.

At Sunday, May 08, 2011 6:11:00 PM, Anonymous Anonymous said...

Bigchief, its good to have someone from the other side, and I don't mean enemy, I mean the other side of the patient/provider relationship. There are so many questions I would like to ask, I will venture a few and hope you stay with us long enough for some follow ups.
1. You are in an environment that you are familuar with, do you think that helped you be comfortable vs a patient whom has no idea what to expect
2. How have other providers you work with, Dr's, Nurses, etc approached situations where they were going to be the patient. Have they made special requests, gone elsewhere
3. What is the thought/conversation when you and your team run accross a patient who is uncomfortable with exposure to the opposite gender in a procedure, what do you do, what is the thoughts of the team,eel a patient is uncomfortbale do you pretend not to notice, just expect them to deal with it, ask.
I would appreciat your thoughts and comments, just like some patients do not care, i am sure some providers do and don't care when they are the patient. Look forward to hearing from you....alan

At Sunday, May 08, 2011 8:44:00 PM, Anonymous Anonymous said...


No sarcasm intended,just matter
of fact. Truth of the matter is with
big chief's post,if he was ok with
the circumstances then why post
here. Apparently,if he was willing
to seek this site out and take the time to post then I'd say he had
some reservations about the events.
If his post was to say,well I
went through this and I came out
ok then one must ask the question,
was it because he was on staff there? There is becoming considerable pressure I believe on
the health care industry to "shape
up." Impending cuts by the federal
quality and cut costs. Many within
the industry don't like it.


At Sunday, May 08, 2011 9:29:00 PM, Anonymous Anonymous said...


As you may know my position
on physician visitors. I don't
expect to learn,progress nor
deam any such discussion of
relevant value.

Would Big Chief be seen as a
sexist if he demanded an all male
team? After all most likely he cares for female patients as well.

How would his demands affect his standing within the hospital
and as such he and I are very much different indeed.

I'm willing to bet that deep
inside he wishes for an all male
team. It is instances like this
that we can predict the outcomes
in that he is a physician within the facility and second he is known
and as you know this makes a difference.

The nursing staff have no obligation to see him as their
physician and in fact most female
nursing staff prefer NOT to be
patients at the facility of their

Some do seek mammograms at their facility of employment but
what if there were male mammographers working at their facility. ( we all know there is
no such thing,however,for the sake
of my argument lets pretend.)

Would nursing staff seek a mammogram at their facility of
employment if there were males
providing the exams. I think not.

I've heard most say they prefer
to go where no one knows them. Many
even prefer not to utilize even the
L&D where they work whereby all
the nursing staff are female and
there are female obgyn's,go figure.


At Monday, May 09, 2011 11:33:00 AM, Anonymous Anonymous said...

I'd like the men on this blog to read carefully the allnurses thread I have posted below. A patient complains about rude treatment at a clinic and asks if she should report. The overwhelming consensus is that she should.
Now, I'm not suggesting that most health care professionals are rude. Most are not. But my point in posting this is that I think most men don't report incidents where they are treated unprofessionally with rude behavior. Why? Don't know. Do they think it unmanly to complain. Probably. We're socialized from a young age to man-up, don't complain.
Several responders on this thread make the point that you'll be doing other patients a favor it you complain. You'll help prevent future unprofessional behavior. And, be certain, that those running the clinics and hospitals, want this information.'s the thread:

At Monday, May 09, 2011 2:35:00 PM, Blogger Joel Sherman MD said...

I have a new article on It's not directly on topic here but it's a general article on how to achieve a rational health care system in this country. Take a look if you're interested.

At Monday, May 09, 2011 4:36:00 PM, Blogger Maurice Bernstein, M.D. said...

And with changes in healthcare system practices along with so much more time available to the physicians by this system, Joel, they will begin to be more free to listen and talk to their patients and be able to provide more patient modesty comfort! ..Maurice.

At Thursday, May 12, 2011 11:13:00 AM, Anonymous Anonymous said...


A number of volumes back you may recall we had a
discussion about the absolute lack of male assistants
In urology clinics.

Please review this thread on allnurses under general
discussion, thread titled "duties of an lpn in a urology

Make note of "unhappy old guys" and ma's are not
supposed to insert urinary catheters in California but
they do anyway.


At Friday, May 13, 2011 11:41:00 AM, Anonymous colin said...

A few days back I posted about having had an all male team for my hip replacement. Right up until i reached theatre I was not convinced it would really happen. When i reached theatre, the staff involved, including the surgeon did not once mention the special accommodation they had given me, they behaved as though things were "normal". The whole experience meant i felt so much less "violated" post surgery. I felt completely relaxed about the hip replacement and my recovery has been far quicker than was the case 4 years ago when I had a mainly female team. There has to be a case for considering the impact of anxiety both pre and post operatively, some research needs to be done and it MUST address the issue of gender of providers versus the wishes of patients. I would VERY much like to see this happen.

At Friday, May 13, 2011 1:03:00 PM, Anonymous said...

How did I find the site and why did I post? I became interested in the issue of patient modesty when I became involved in teaching medical students about taking patient histories and doing physical examinations. I became interested in how we go about educating future physicians. I became upset at what I saw on the hospital wards and in the emergency rooms. What I saw was what I believe to be bad medicine, examining patients without having them undress. For example, examining a patient’s chest without having them take off their shirt or through the hospital gown. I saw several young woman who suffered from GYN problems of an advanced stage because no one had properly examined them before I saw them in the ED, similarly, men who had problems go undetected because the portion below the belt was rarely examined by previous physicians. I then looked at our educational program. When I went to medical school, the first person I examined was a classmate. I innocently asked a group of medical students assigned to me as their preceptor, if they still do this and was told that no they do not. They also told me that the physical examination preceptorship was not really very good because the preceptors they were assigned to, generally practitioners in the area, do not really do full physical examinations and patient modesty requires the student to leave the room often. They did state that there are some standardized patient experiences. These are individuals paid to be patients so that students can learn these skills. I searched the internet and found an article written by a woman who complained that when she posed as a standardized patient she was forced to remove her bra. The response from the supervisor at the school she worked for was that this was inappropriate. In fact, when I searched other such programs, I found that generally this was the case, standardized patients are generally told to keep their underwear on! This led to further research and this blog. I am working on an essay about how medicine is deteriorating because of the loss of the skill acquisition by physicians of these fundamental physical examination skills. I do understand that some individuals are very modest and this should be dealt with. Some of the issue is a “material” one,for example, the standard hospital gown just is not good for examining patients, I do not understand why this has not been dealt with. The design of many examination rooms present a challenge to patient modesty. There are examination rooms that I have used that do not have modesty curtains in them, that have the examination table situated so that the opening door exposes an individual on the table. These are relatively simple issues to deal with, but they are not often dealt with. I agree that there needs to be a dialogue between the health care provider and the patient that opens this discussion up as well. But, and this is important, modesty should not end up as a deterrent to good care.

At Friday, May 13, 2011 7:18:00 PM, Anonymous Anonymous said...

bigchief, I think most of us would agree modesty should not compromise health, where we disagree is how you deal with it. Providers most often think and try to force patients to deal with it in a manner the provider feels best, which is ususally what is easiest for the provider. Yes the things you mentioned are important, but what about what is important to the patient. I noticed you did not mention gender, and I am not surprised. This is usually not something providers want to recognize even though many patients and most on this thread feel it is THE issue. So if the goal of both is patient health, doesn't it make sense to provide what the patient feels is important, since it is the patient who will or won't seek health care based on how comfortable they feel, not how comfortable the provider feels? If you think the patient should be fine if you put curtains up, move the table, or provide a differnt gown, and the patient feels none of these things matter if the issue of gender of the provider isn't addressed...have you really solved anything? To often this issue is addressed from the providers point of view, not the patient..I think the intentions are right and honorable, I just don't agree with the means..alan

At Friday, May 13, 2011 7:49:00 PM, Anonymous Anonymous said...


Would you agree and perhaps share with our readers
the discriminatory practice of specialists, general
practitioners to hire only female medical assistants and
As an example, this being prevalent in urology
clinics despite the fact that the majority of urology
are male!


At Friday, May 13, 2011 8:23:00 PM, Anonymous Anonymous said...

This is to bigchief.Define what you mean by modesty should not end up as a deterrent to good care.Are you saying the patient should just accept whoever is there to do the intimate exam.Gender shouldn't matter.Or are you saying once the patient has told you they want same gender intimate care,you should respect their request.Respect is a two way street.If you want it you must earn it.If you can't trust the provider to honor your request,how is the patient supposed to trust you with there life.The world is not gender neutral.Same gender care is not the problem.Opposite gender is.If the health care field would ask the patient their preference and follow it,most of your modesty complaints wouldn't exist.I believe good care and patient modesty should be a given.You didn't say if the students or the examining doctor's were of a different gender than the patient.Was that omitted on purpose or doesn't the medical field see a connection. Just my opinion. AL

At Friday, May 13, 2011 8:28:00 PM, Blogger Doug Capra said...

bigchief42 -- Thank you for your informative post. I agree that there seems to be less thorough exams today in many cases. Perhaps due to patient modesty (could there be physican's too?); perhaps due to time constraints/time=money. Perhaps for other reasons.
Recently Dr. Joel Sherman published an article showing there is evidence that modesty issues play a role in why men don't seek more medical care -- the fact that some want same gender intimate care and exams when it isn't available.
How do you feel about patient choice in the area of physician gender? How about nurse or cna gender? What about patients who would like same gender in the OR? What are you thoughts on these issues from at least two perspectives -- the ethical point of view, and the realistic, financial/staffing point of view? Should more males be actively recruited into nursing? Should we go back to the days of male orderlies?
I appreciate you expressing your views here and would like to read your opinions.

At Friday, May 13, 2011 9:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Pertinent to bigchief42's explanation today about the writer's motivation, I would like to state again (as I have already noted in one detail or another on this thread an other threads on my blog) my observations as teaching first and second year medical students "Introduction to Clinical Medicine" (ICM)for 25 years and what goes on at the University of Southern California Keck School of Medicine with regard to education these students in the skills of history taking and physical examination of patients.

We teach the students to examine (inspection, auscultation, percussion and palpation) on bare exposed skin, if possible and set by the patient's modesty issues after explanation to the patient about the necessity and value to examine in this way. The necessity they and the patients are taught is to not miss skin lesions or subcutaneous or deep masses and to hear the important sounds of the body without the sound damping effect or adventitial sounds ("rubbing") of underlying clothing. This is an ongoing teaching.

At our school, the students examine each other regularly and throughout the years and may examine each other regardless of gender and in degrees of undress. Our school is, however, attuned and responds to the modesty issues of the students both in terms of gender pair examination and degree of skin exposure. Examination of the bare chest in male students and females wearing sports bras are encouraged. Usually, there is no modesty issues express about examining the bare abdomen in either gender.

Though examination of the bare female breasts of patients is emphasized, female student breasts are not inspected or palpated directly by their colleagues. Students of both genders are given the opportunity to directly examine the bare breasts of standardized patient-teachers along with practicing pelvic/rectal and male genitalia/rectal exams on standardized patient-teachers during their second year.

This is what is taught and emphasized and this is the student experience. What is most important in all examinations of patients is that the patient should be educated about the benefit and value in making a diagnosis for the examination on bare skin. Once the patient is educated, the student (and later as the doctor) must then obey the patient's decision regarding the degree of exposure the patient will allow as part of physical modesty concerns. The students are warned, to do otherwise, may represent a legal battery or sexual abuse.

How our USC students in ICM follow our guidelines in later years when pressures of time and responsibilities for other patients are present and where there is limited time for patient education and the apparent need to move along in the exam, I am unable to write about here. I am sure some students will try to remember what we taught them in ICM. ..Maurice.

At Friday, May 13, 2011 9:38:00 PM, Anonymous Anonymous said...

I appreciate Big Chief's comments and interest. I have been reading patient modesty comments for some time without posting anything. However, Big Chief's final comment is what has prompted me to respond. He is definately right to say that modesty should not end up as a deterrent to good care. However, it just does and the medical profession should recognize that. It seems that many men do not seek care because of the liklihood of embarrassment. This should be a topic of major discussion and a reason for reform but it seems that the medical community is unmoved. Many people are like me in that they are extrememly modest and will avoid any situation that cannot be handled with same gender care. I am a totally straight elderly male that has always been modest around the opposite sex. I don't mind being examined by a male physician or nurse at all. To be put in a situation where I am viewed nude by a strange female gives me the sensation that I have been molested or abused. It feels like I am a victim of a crime. It is real to me and very uncomfortable. I simply hate it and take every measure available to avoid it. Incidentally, I don't choose to be this way. I wish that I wasn't but I am. I don't mind being viewed as a difficult patient if that's what it takes to avoid humiliation. I can report that being up front with the issue and absolutely stubborn with my resolve has been very effective for me so far. I just tell them it ain't gonna happen. I would like to ask Big Chief to explain to his students that there are simple things that can be done that avoid so many modesty violations. To site one example: When having a testicular x-ray, my friend told me that the female tech removed the sheet covering his genitals and then as she looked with her peripheral vision, placed a cloth over his penis. She pretented to be protecting his modesty but she got her look in first. Now explain to me why she couldn't have handed him the cloth while he was covered and told him to cover his penis before she removed the sheet? Is she really that stupid? This is the kind of thing that makes patients feel that medical staff are exercising their power and makes patients very distrustful. There is some good news. Two men's clinics have opened in south Florida employing only male staff. They deal primarily with erectile disfunction. It's a start.


At Saturday, May 14, 2011 4:35:00 PM, Blogger Doug Capra said...

Warmouth -- Would you provide us with the names and perhaps websites of the two men's clinics that have opened in South Florida -- the ones employing only male staff?

At Saturday, May 14, 2011 6:06:00 PM, Blogger Al said...

Doug.I've seen the add's all over the country for these clinic's.Goggle Scroll down almost to the bottom and it say's (our all male staff).Isn't it great that some people are listening to the patient.I hope this helps us guys. AL

At Saturday, May 14, 2011 6:09:00 PM, Anonymous Anonymous said...

Dr. Berstein I think this is a really interesting section. I think it shines the light on a root issue that has been touched on before. To me this dismisses the providers are evil and malicous, thats the problem. I feel you are a very good man, you are truely concerned about this issue, and I have a ton of respect an appreciation for you. But, your discription of what is taught and how to me highlights the problem. Obviously the focus is on the physical aspects of the training as it should, however I think (and I would bet many of the posters would agree) the fact that you would not expect students to expose themselves to other students for learning is very telling to me. The facility, professors, and students recognize how uncomfortable this would be for the students, I agree. However while it is recognized and provided for the students, these same students will EXPECT patients to compromise their modesty in the very same ways ther were accomodated. Respecting thier modesty was not about curtains, draping, what and how you say things, it was about accomodating what THEY needed to be comfortable. It is obvious all involved recognize exposure, especially exposure to the opposite gender is uncomfortable. Yet, many act as it they don't reognize or are surprised that it matters to patients. I am not saying you should force students to bare all in the role of the patient, I am saying they should be taught to give their patients the same respect and accomodation they expect and recieve. And this is where I know we depart and the issue becomes obvious to me. If a provider who is as concerned and involved in this as you are do not see the hypocracy, how would we expect others to. The students were asked to remove their clothes and if the resisted or refused their request was honored like they are taught, there was a proactive effort made to spare them the embaressment in the first place. If the prof had acted like he EXPECTED them to partcipate a large percentage would have done so just because they would have been to intimidated to this not exactly the position they will be putting patients in. And sorry, I am not buying its different because they know each other, if you are going to expect me to believe i should be fine because you are a professional, you should be fine with other students because your all professionals....alan

At Saturday, May 14, 2011 6:26:00 PM, Blogger Al said...

Ok.This one is for the ladies.Goggle Womancare of Waukesha.Their slogan is health care for women by women.It will show you the 4 female Doctors that make up the clinic.You need more clinic's like this.What you see is what you get.Ladies,how do you feel about them.(all female staff).I hope this helps you to. AL

At Saturday, May 14, 2011 7:00:00 PM, Anonymous Anonymous said...

Florida Men’s Health Center
Phone numbers:
Dade: 305.466.3131
Broward: 954.509.9111
Toll Free: 877.616.3131
Web Site:


At Saturday, May 14, 2011 9:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, the explanation is simply one of context. In what context is the personal physical modesty being expressed. The context in which it is appropriate to expose parts of the bare body is illness or to screen for illness. For any other purpose, the action could be open to professional question. In other words, in the case of medical school education, it is appropriate for the medical school to set guidelines which allow students a certain degree of personal privacy based on their desires. The reason for not challenging those students who do not wish to have parts of their bodies exposed to their colleagues is that the students are not ill and it is felt they can learn techniques satisfactorily when examining themselves with the degree of modesty they desire. The case is different when dealing with an ill patient or one who comes for an evaluation of health. There is a trust developed between patient and doctor that the doctor will use the best knowledge and skills to make a valid evaluation and diagnosis. This responsibility to the patient may not be accomplished by the limitations set by the patient's physical modesty requests. Nevertheless, if the patient is educated about the need for a proper exam and still refuses, as I said in the previous comment, the physician must follow the patient's wishes just as we instructors in medical school follow the students' wishes. It is not that physicians are ignoring a patient's "NO!", what I think is happening most of the time is that the patient is not speaking up to the doctor with the personal modesty concern: "NO!" and then moans later that the doctor didn't care.

I still say that the patient should SPEAK to the doctor and then listen to the response but then feel confident that a professional physician will do whatever is available and practical to accommodate the patient, following the patient's wishes. ..Maurice.

At Saturday, May 14, 2011 11:33:00 PM, Blogger Doug Capra said...

Interesting discussion, alan and Maurice. You both make your points very well. I see both sides. But since the focus is on physicians, we're only covering part of the issue. Patients usually "book" exams and thus have a chance to choose a doctor. But they don't choose the doctor's assistants. You two aren't speaking about the ER or LTC or IC. Physicians don't do the kind of intimate care that nurses and cna's do -- and the lack of male gender availability is the issue.
I must say, though, that I do see alan's point. Yes, as Maurice says, context is important. And medical school is a school context not a hospital context. And the students aren't sick. But alan's point about "professionalism" is significant. A "professional" should be able to navigate these contexts or, if they can't, should ask themselves about why they can't. I cannot believe that all medical students who don't feel comfortable with opposite gender intimate exams in class, will feel just fine about opposite gender care in the hospital. With strangers it's okay; with other "professionals," even if you know them as colleagues, it isn't okay? I can see why non medical professionals don't grasp that paradox.
If that's the case, then I can see why doctors expect patients to accept opposite gender care with no problem. It's either the "stranger" effect with most nurses or cna's -- i.e. -- the patient doesn't know the nurse or cna so it's okay -- or with a trusted doctor-patient relationship, it's the "trust" effect. The patient knows and trusts the doctor so it's okay.
I'm not sure I'm making this clear, so I'll stop here to read any responses or questions.

At Sunday, May 15, 2011 1:07:00 AM, Anonymous Anonymous said...

Dr. Bernstein.While I agree with you in principle,I don't think most physician's follow their patient's wishes.I beleive they are focused on their patient's physical health and totally out of tune to their mental health.You read all the time about how the treatment left them with mental issue's for the rest of their life.I mentioned earlier that my wife needed a stent.She asked for a female.They have 2.They sent a male.She refused.Chemo done.She was sent home.Called clinic to have female do it.She was told 3 weeks.She said she needed it now.Still 3 weeks.She called cancer doc to call down for a sooner appointment.He refused.He scolded her and told her to just come in and have it done by whoever is there.She asked if he would refer her to a different female urologist.He said it wouldn't be ethical to refer her outside his group.He scolded her and told her to just come in and have it done by whoever is there.Thats when she called me crying about the situation.MY TURN.2 hours later she had a appointment with a different female urologist at a different group.She asked me to bring her records.The attitude I received really opened my eye's.After several hours I had the records and delivered them to her.The stent was placed the next day.Took 20 minutes.From then on she was flagged female only.What I don't understand is why don't they hear us.We don't want opposite gender intimate care.You can study it all you want.It is what it is.Why don't you hear us.Must we continue to fight and walk away with our money?We know what we are comfortable with.PLEASE LISTEN AND FOLLOW OUR WISHES.If we are ill and need your help,don't rob us of our modesty in the name of good care.Just my opinion again. AL

At Sunday, May 15, 2011 12:08:00 PM, Anonymous Anonymous said...

Dr. Bernstein I agree wtih much of what you say however. While the context is different, the basic issue of modesty is the same. It is providers who have set the concept that the context makes it different. It was providers who changed the way this was traditionally handled when they eliminated orderlies, prohibited men from entering nursing around the war, this argument that different from female reporters who claim special priviledges when they enter male locker rooms as professionals? I also do not think the students should be forced to do this, however asking them to and allowing them to opt out if they ask like a patient has to does give them the other side of the equation and does provide a teaching opportunity. But the second part is more to the issue, while in theory patients can say no, the power dynamics and a history of patients, especially male patients being either subtly or aggressively pressured into accepting what is offered hardly makes this a fair, or level playing field that is conducive to the patient feeling comfortable doing so. It is fairly well known that the power daynamic is on the providers side therefore, knowing as students they were proactively accomodated, it would seem the logical thing would be for the providers to actively ask patients who they should know feel the same about their modesty and may not be in the position to express this. So yes, the patient should speak up you are 100% right, and how many people here have said they were intimidated or unsure if they could ask until they got invoived in this thread, but now know differently. It took this and Dr. Shermans thread for us to understand that. How many people do not understand its ok to say no. A couple quick examples, the issue has surfaced several times on allnurses, basically the nurses say they try to talk the patient into letting them do the proceedure, a minority actually admit trying to intimidate them though they do not call it that, if they insist they accomodate when they can, but many do so begrudgedly This is hardly giving the patient a fair shot at expressing their wants and needs. Second, I have had several friends who had vasectomies, is there any doubt this is a embaressing and humiliating procedure for the majority of men. Yet, most dr's routinely bring in a female nurse who serve a very minimal function, one that can and is when asked easily done by the Dr. I find it difficult to believe Dr's would not know this would be easier on the male without a female watching. So, my arguement is, providers do know this is an issue at some level for their patients because they recieve accomodation when they are students for the very same thing, and I also can not believe providers not only are unaware of the embalance in the power dynamic but routinely use if to their benefit for work flow, time management, and scheduling. I would further ask, how do we sort out trust from need, how much of what a patient accepts is based on trust, and how much is based on need....again I am not at all in the provider is evil camp, I do however believe there is fair about of self delusion and justification involved....alan

At Sunday, May 15, 2011 8:29:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I believe that you are correct regarding patients needing to speak up. That is so important and probably where men hurt themselves the most. To site an example, one of my kin had to have a urological stint removed and prior to the procedure, he was humiliated by having to lay on the exam table while a female tech (No one else in the room) washed and prepped his genitals. He is a church pastor and was so embarrassed. He confided in me that it was the worst day of his life. However, he didn't speak up. He should have made an issue of how outrageous the notion of being prepped like this was and demanded a male tech but he didn't. Like you say, he should have said, "No!" I say that if the patient catches some attitude from the medical staff so what? Be difficult if need be or walk away and take your money elsewhere. I've found that you can shop around and usually find a medical provider that you can reason with. However, I think where most of the frustration comes from and I believe that my fellow bloggers may agree, is when the medical community has the patient in a situation where walking away is unwise. Perhaps where walking away could allow your disease to progress needlessly such as in the case of cancer patients that need radiology. In these situations or in the case of important surgeries, stories abound where the medical staff basically show little sympathy and tell you that's the way it is. The patient has to decide to be miserably sick or die, verses being embarrassed to no end and living with that and the psychological harm it causes. The medical community needs to understand that there are gross implications associated with nudity in our society. It just isn't considered normal and society has taught that it's inappropriate. Exposing ones self has extreme consequences in every venue except medical. In my state, if you get caught outside urinating behind a bush (It happens) you can be arrested and will forever be classified as a sex offender. Expose yourself in public and go to prison but in the medical community, they have the gall to bring children into medical procedures where patients are exposed and they think this is ok. (Re: the book My Angels Have Come) It's insane. Anytime there are privacy issues in society, measures are taking (Without asking) Separate dressing rooms, restrooms, etc. Yet in medical situations, it is something patients literally have to fight for. Even in prison, gender modesty is protected. At least in my state. This is something I know about because I worked in the prison system for 30 years, held a prominent post, and was assigned to several different facilities. In all those years, I never heard of a male staff member strip searching a female or a female staff member strip searching a male. It just doesn't happen despite what I read in some other blogs. At least it doesn't happen in my state and I doubt it does anywhere else. So if even convicts get their modesty respected, and I assure you that they do, that must say something about this issue. In my opinion, the overall medical community is out of control. To give you an example, the notion that a female patient under anesthesia after an operation would be used as a training tool for intimate exams is the most outrageous thing I've ever heard of. If the medical community thinks that's ok then they are definitely out of control. All of those responsible for such a thing should be rounded up and taken to jail and be required to have psychological testing. That stuff is just crazy. I agree with you that physicians are not ignoring a patient's "NO!", in the office setting but they are where patients are most vulnerable. That's the issue. At the local level, if we don't speak up, (like my kin folk) then that's our own dumb fault. But when patients are vulnerable, then respect, honor, decency and just doing the right thing should prevail. We shouldn't have to ask.


At Monday, May 16, 2011 6:47:00 AM, Anonymous Anonymous said...

Back to the issue of all male clinics. I heard an ad on the radio the other day for a Male Medical Clinic in the large city I live near. They specifically mentioned that there is an all male staff. This clinic was advertising treatment for low testerone (low T: the latest psuedo disease that the pharma companies are using to sell more drugs, IMO!) but perhaps they addressed other male related problems, too. Encouraging anyways to hear that someone may be getting it.

And, by the way, I agree so much with the basic drift of the last several posts. If only the medical community would offer patients same gender care for intimate procedures a lot of this issue would be resolved. Jean

At Monday, May 16, 2011 11:15:00 AM, Anonymous Anonymous said...

"that a professional physician will do whatever is available and practical to accommodate the patient, following the patient's wishes"

That's where the rubber meets the road, Maurice. That's where patient and doctor/nurse often disagree upon definitions -- What is "available?" What is "reasonable?" If nothing's "available," then is anything "reasonable?"
My personal experience combined with my research is this: The medical profession generally doesn't want to talk about this. They won't bring it up -- theory being that if we don't bring it up, by the time the patient is confronted with the gender situation, it will be too uncomfortable for most patients to either complain or insist upon a change. And probably, by that time, it will neither be "available" or "reasonable" to make a change anyway. Now, I'm not saying this is necessarily a conscious tactic. It's been embedded with in the medical culture. For some it may be conscious, but I don't think for most. experience and research also convinces me of this: Patients who DO bring up the topic ahead of time, and DO insist upon a serious discussion of the matter, and won't take NO for an answer, and DO say they'll go somewhere else and perhaps write a letter of complaint -- most of these patients DO get accommodated.And most of these patients don't have to go to the extremes I mentioned above. Just insist upon the discussion right away. Find out where you stand with the particular caregiver right from the start. Find out what their definition of "available" and "reasonable" is as compared with yours.
The medical profession most often won't bring this subject up. But they are very well aware of the issue. As the patient works his/her way into the system, the further they get in without bring up the topic, the more difficult it may become to get accommodation. In my opinion, when medical professionals are themselves forced into a corner to do these kinds of opposite gender intimate exams or procedures over a period of years -- and this happens with some female nurses -- they rationalize the experience. "It didn't take long. The patient didn't complain. Yes, they were uncomfortable, embarrassed, maybe humiliated -- but they'll get over it. I did my job. I helped them. They're better. It's okay."
It helps the medical professional survive to rationalize the experience for themselves. It's a psychological defense mechanism, and after a while it becomes so embedded within their behavior that they don't even "see" it as relevant.

At Monday, May 16, 2011 12:45:00 PM, Anonymous Anonymous said...

Women do strip search men, routinely.

At Monday, May 16, 2011 5:30:00 PM, Anonymous Anonymous said...

There is a concept in law related to diminished capacity. It basically states that if a person is under duress or placed under excessive stress it may be used to negate a contract. While this is hardly a legal issue, the principle of consent does come into question considering it would be reasonable to assume a good number of patients are under stress when they are in many medical situations which would give some credance to placing at least part of the burden of asking on the provider

At Monday, May 16, 2011 7:24:00 PM, Blogger Maurice Bernstein, M.D. said...

I wish there were some validated statistics regarding what percent of the United States patient population has such physical modesty issues that they would avoid examination or procedure regardless of provider gender or would have requested an opposite gender provider.

The data would not in anyway diminish the importance of these patient's modesty concerns but might explain why there seems to be ignorance or inertia on the part of the medical profession to take an initiative to remedy the situation. As I have written many times here, I was never led to believe that the issue of modesty and gender selection was so profound and prevalent that many patients would avoid medically necessary evaluation because of their concerns. As I have written, it was only since starting this thread over 5 years ago that the problem might be more prevalent than I was aware.

Yes, I have always considered patient physical modesty issues in my practice and discussed the importance for my medical students to be aware about them and act in their patients' comfort in this regard. But I was unaware of the intensity of such feelings to the point of avoiding necessary care until reading the responses to this thread. I have since warned my students about the matter and their need to be alert to this issue. But what I really don't know is the population magnitude and whether, instead of waiting for the patient to speak up, one of the first questions which I (and my students) should ask my (their) patients when first seen is to the effect "tell me about any physical modesty issues or concerns you might have and what should I do about them." Is this opening question within the introduction to the interview be the proper question to ask? If the population of patients with such concerns are extremely minute, should this still be one of the first questions a doctor should ask when the patient comes for medical help for an illness? I await some comments. ..Maurice.

At Monday, May 16, 2011 9:32:00 PM, Anonymous Anonymous said...

Dr Bernstein.If neither the patient or the physician bring it up,how will anyone know.You wrote about the patient not speaking up and moaning about it later,wouldn,t it be better to just get it out there.Someone needs to break the ice so to speak.If the patient say's they have no modesty needs they can just move on.If they do have modesty concerns,it gives them the opportunity to address them.That way neither party can say they didn't know.It can also be logged in their files so there is no confusion later.Why not put on the form that you fill out, if you have a gender preference.Male,female, or doesn't matter.That way the physician can say, I see you checked this.Now they have a reason to discuss it.Even some hospital web sites ask you your choice of gender for physician selection.You read that the medical field have a hard time reaching the over 50 male.I saw on tv about a free prostate exam being given.The door opens from the DRE room and it shows a man walking out and 2 women standing there smiling.If that was a free breast cancer exam , would they show a woman walking out from the breast exam and mammogram with 2 men smiling.If anyone is interested I may call them and ask what they do for the modest male.So to your question,yes definitely bring it up.I see nothing but good coming from it. Thankyou for letting us post our opinions. AL

At Monday, May 16, 2011 11:02:00 PM, Anonymous Anonymous said...

"instead of waiting for the patient to speak up, one of the first questions which I (and my students) should ask my (their) patients when first seen is to the effect "tell me about any physical modesty issues or concerns you might have and what should I do about them." Is this opening question within the introduction to the interview be the proper question to ask?"

Here's something to think about, Maurice. The question you propose needs to have a specific context. It's too vague. It needs to be asked along the way as the patient goes through whatever medical process the patient is undergoing. And it depends upon how savvy the patient is about what's going to happen to him/her. And frankly, it depends upon how specific the doctor is in describing the procedure.
Example #1
-- Man goes in for a physical to his trusted male doctor.
-- I need to refer you for this or that exam. Do you have any modesty issues? Do you want a male or female doctor. How he answers may depend upon how specific the doctor is in describing exactly what procedure the specialist will do. Let's say the doctor isn't very specific.
-- Doesn't matter, the patient says.
-- So, he gets a gets a male doctor who arrives in the exam room with a female assistant. Now it may matter. Or, he gets a female doctor who arrives in the exam room with a female chaperone. Now -- it may matter. My point is that if the doctor is going to ask the question you propose, Maurice, and also ask -- what should I do about your concerns -- then the doctor should be prepared to deal with the situations I mentioned above.
Example #2
-- A man is referred to a urologist by his male doctor. Do you have any modesty concerns and wht can I do about them? The man has never been to a urologist, but after having the procedure explained to him he decides he wants a male urologist. The doctor sets him up with a male urologist. But, as we all know, that may not be enough.
-- His doctor assumes the modesty problem has been solved.
-- Man goes to the urologist and finds out the male doctor's assistants are females and NOW it matters.
Some patients who have had little experience with intimate care and/or with hospitalization in general, may think they have no problem until they come face to face with the situation. The questions may need to be asked along the way.

Some patients may not really understand how specific the procedure may be and who will be doing what. They may assume a kind of privacy and modesty that won't exist. Doctor's usually explain what will be done during procedures, but they rarely explain who might be doing what specifically.
I dont know -- does this make sense?
As I've said before, as a patient moves from his trusted, personal doctor to a specialist and then into the OR and recovery and/or ICU, the patient moves further and further away from any kind of personal, trusting relationship with caregivers.

At Tuesday, May 17, 2011 5:10:00 AM, Anonymous Anonymous said...

Dr. Bernstein, I do not think the percentage that completely avoid medical care is a large number, it is there but just guessing probably not huge. The number that delay seeking care, and therefore often compound issues, some to the point where they may end up dying from them is I feel much much larger, especially with men. I know for myself and from numerous conversations and comments from other men I know, this is significant. Even among educated men, my dentist and I were talking one day and I talked about the rite of passage into my 50's of getting a colonoscopy. He said no way am I getting that done, I told him they hurt me less than they do, he told me "I don't care, I am not going to lay there while a bunch of nurses watch a know the rest. I think it is a huge factor in men delaying seeking care or avoiding it until they absolutely have to. I know another guy who died of colon cancer in his late 40's, his son works with me, he said it turned out the had blood in his stool for a long time but didn't tell anyone because he was embaressed and didn't want to have to go through all those test, this was a guy who was not afraid of pain. I think as someone stated before, there is a very easy answer to this, on the intake form, have a line do you have a preference for provider gender male, female, no preference or simply please list anything we can do to make your visit more comfortable such as listing any modesty concerns if any. It doesn't have to be a big effort, just provide the opportunity to say in a manner that allows the patient the ablity to do so without any outside pressure, percieved or real....alan

At Tuesday, May 17, 2011 6:38:00 AM, Anonymous Anonymous said...

I think Al's suggestion of stating a gender preference on your initial paperwork is an excellent one. The patient always has to fill out extensive paperwork before seeing a new doctor and that would be a good time to bring the issue to the foreground. Of course sometimes I wonder if the doctor even looks at the forms before seeing the patient. Do they? It always seems like such a rush job when you go to a doctor I can hardly see them taking the time to read through the paperwork before seeing a patient. I also think the doctor could ask the patient a more generic question, like "Is there anything that can be done to make the exam more comfortable for you?" That would at least open the door to the modesty issue.
One advantage to having the question on the incoming paperwork would be that it would allow the patient the opportunity to state their preference for same gender care for any procedures that would have to be referred, etc.
As Maurice said, there is no way to know what percentage of people care about this issue and to what extent. But I do know that, like myself, there is probably a significant number of both men and women who have a concern but just haven't ever thought they could bring it up. They just accept what is offered and get through it. Also, you do have more choice when choosing a primary care doctor but then if you are eventually thrown into a situation where you need a procedure, surgery, etc. you discover that the whole issue is terribly upsetting to you (and usually after the fact!) In other words, there are probably a lot of people out there that are bothered by this but have not yet been placed in a situation to experience it and/or they just don't realize that they may be able to make the situation better if they just speak up. Instead they just live with the embarrassment and try to get over it. I do think that by asking patients about this they would help those of us who are modest and patients who do not have a modesty issue would just say it did not matter to them. Jean

At Tuesday, May 17, 2011 11:59:00 AM, Anonymous Anonymous said...

Interesting posts of late, but what I find to be a disconnect in understanding and true communication is the difference between caregiver's opinions and actual facts.
Many providers (and posters) may very well believe that " modesty should not end up as a deterrent to good care.", but that is still an opinion. The fact is that it IS a deterrent, and once the medical community realizes this, they need to be prepared to help those mitigate circumstanses in order to recieve good care. Will the 'fact' that people are avoiding care create a heart felt concern to answer the need of all patients to find comfort within the skewed system? All people deserve solutions to respectful care.
We are often told that 'educating the patient that gender should not matter' is the solution, but you can not expect to 'educate' someone out of their modesty,moral, and ethical beliefs.The truth is that it rarely works, and the emotional damage is simply delayed until they are away and out of your care.

Dr. Bernstein: Now that would be the sort of communication that people are looking for. Asking someone how they feel about their OWN body, instead of imposing your own value system upon them would go a long way in building trust and respect. I believe asking upfront regarding modesty and gender issues is an excellant idea. People/patients/clients will believe that you actually do care about their emotional well being, and not just the physical vessel they are stored in.
Should someone actually tell you "about any physical modesty issues or concerns (they) might have and what should ( you) do about them.", is your hospital set up to accomodate them....even if thier concern is same gender intimate care?


At Tuesday, May 17, 2011 4:32:00 PM, Anonymous colin said...

I live in the UK. I was watching a TV programme tonight called "surgery school". It follows surgical students through a year of their training. Revealingly tonight, a female student (already a qualified doctor) who had been assigned to Urology as part of her rotation, commented that she did not want to stay in a discipline which was mainly focussed on men, most of whom felt embarrassed to be examined by her. Her own words, MOST OF WHOM were embarrassed to be examined by her. If they know what they are putting people through, why do they persist in doing it?

If the TV series becomes available to view on the web, I will post the link here.

At Tuesday, May 17, 2011 6:27:00 PM, Anonymous Anonymous said...

Dr. Bernstein:

I feel that the modesty question should be one of the first questions asked by the doctor. As a man, I would greatly respect you for it and appreciate it.

Also, on the patient intake form I
would ask patients to be frank about any modesty concerns they have.


At Tuesday, May 17, 2011 8:35:00 PM, Anonymous Anonymous said...

Regarding the post, “Women do strip search men, routinely."

That cited case law is an old ruling. Prisons in America have completely changed in the last twenty years. The federal courts have ruled that although modesty or privacy does not prevail over security interests, or the right for a particular gender to have equal access to employment, prison administrators are required to provide reasonable accommodations for inmate privacy such as privacy screens for showering, gender specific strip searches, etc. There have been enough rulings in favor of the inmates that any administrator who wants to keep their job, pension, and their bank account, wouldn't risk it. Trust me on this. Just to be sure though, I called the Eastham unit of the Texas Department of Corrections which is where the posted court case originated as well as their regional office. The officials that I talked to assured me that all strip searches are gender specific. Times have changed which gets back to the point I originally made. Prison inmates get reasonable levels of privacy as a result of established policy. Why isn't there established policies regarding the modesty of patients? How has the medical establishment conned its way so far from societal norms. Being in law enforcement for so many years I am astonished that what would be an arrestable offense for anyone in any other venue is accepted by the medical community. Digital rape is a serious felony in my state; yet, an intern at a teaching hospital is encouraged to do it on patients that are still under anesthesia after an unrelated surgery. In my view, it becomes rape when it is done without the expressed consent of the patient and in absence of any medical need. To violate a person this way for the sake of training is absurd. Again I say, the overall medical community is out of control. Whose child or wife is next? How can this happen in a civilized society? My wife is terrified of hospitals for that reason. What have we done when we make people afraid to seek help?

Regarding Dr. Bernstein’s question: yes, I think physicians should ask if there are any modesty concerns that should be addressed. However, if you can't accommodate their concerns by employing assistants of both gender then you won't appear very sincere about the inquiry. You might be surprised at how many patients will speak up when asked.


At Tuesday, May 17, 2011 11:20:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, I would think that to ask a personal physical modesty question or request a description on an office entry form before the patient was seen by the doctor would be inappropriate. These questions, like those of sexual nature, should be part of private conversation between the physician and patient. ..Maurice.

At Wednesday, May 18, 2011 5:39:00 AM, Anonymous Anonymous said...

Dr. Berstein, I completely agree with Jean's suggestion of putting it on the intake form. For several reasons. First off if providers are telling us they AND THIER STAFF are professional enough to see us naked and do various humiliating but needed things to us, they sure should be professional enough to read something like: Do you have any specific modesty concerns? OR Is there anything we can do to make your visit more comfortable or less stressful. I mean I have been asked if I had a STD on an intake...that is pretty sexual. My preference for gender or modesty concerns are a lot less embarassing and personal than that. The other thing we have to keep in mind, these Dr's are under incredible pressure and time constraints, quite honestly I do not see them being able or perhaps willing to take the time to spend on discussing modesty. Every office visit I have had involves the "nurse" starting the visit by taking me back to the room, sitting down with the file or opening the file on the PC doing a quick review, asking what I am there for, making a couple quick notes for the Dr and going on. Being given the opportunity make some notes on the intake that the nurse would/could review prior and note that to the Dr would help, after all many of these issues involve the nurses or staff. My post would read "When any procedure or exam involves exposing my genitals or nudity I request either the Dr. and I are the only one involved or the Dr has a male assistant. If this is not possible I ask that I be informed well ahead of the appointment. Simple, gives me the opportunity to state it, nothing sexual about it, and does not require the Dr. to spend a lot of time. It also opens that door if they need to refer me to another provider....alan

At Wednesday, May 18, 2011 6:32:00 AM, Anonymous Anonymous said...

Dr. Bernstein:

You are absolutely right. To ask a patient to write a modesty response on an intake form is inappropriate. I admit that I did not think this through.

Instead, how to you feel about including a statement on the form inviting the patient to discuss any modesty concerns with the doctor. This statement should be written in such a way that the patient will trust that his/her concern will be taken seriously and with sensitivity.

I am very grateful to you for this blog and for the attention you have given this issue.

Best Regards,

At Wednesday, May 18, 2011 10:27:00 AM, Anonymous Anonymous said...

Recently spoke with a mental health counselor who
worked in a mens prison. He relayed a story about
the male inmates who were awakened each morning
by the particular female guard who would wake them
early every morning. Most of course would sleep nude
or with the their boxers on. They would then have to
stand at attention by their bed. After complaining to
the counselor about this, the counselor went to her
supervisor and she was reassigned.


On yahoo groups induction physicals the
Moderator as posted a " postcard " of a female
nurse peeping at men receiving induction physicals
and making some comment in the caption.

Proof that this was known about. Circa 1950's.


At Wednesday, May 18, 2011 8:22:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I think the question should be on the form. Hey, I'll put anyone on notice. I don't mind telling any staff member how I feel about my personal modesty. I'm not the least ashamed of it. Working in the prison system, I worked along side many medical professionals and the topic came up from time to time. I never met a medical provider who said they weren't modest. In fact, I think they saw so many modesty violations over the years that they generally agreed that such a thing wasn't going to happen to them. Consequently, I feel that when you tell the medical staff in the initial form that you have those concerns, they may get huffy but they probably feel the same way themselves. Besides, I'll tell them like they tell us, "You'll get over it." Regarding those who may think the issue too embarrassing to discuss with line staff, rest assured that if they have an issue with it, everyone in the office will know anyway. Besides, so what? I want them all to know and I want it on the form. Prior to the initial staff member exiting the room, I will tell them I expect a copy of that form on my way out that day. I want them to know I'm serious and that I want it in writing because if some thoughtless nurse comes busting in the room at that awkward moment, it will be hell to pay. I don't want to sue anyone but I don't mind making the physician think I'll sue or make trouble if that's what it takes to be treated with respect. Lawsuits are the one thing physicians fear. Not one of those staff members want me to see them naked and that doesn't hurt my feelings. I want them to know that I feel the same way about my body.

Regarding the story of the female corrections officer having the inmates stand at attention in the morning, that's not unusual. However, all prisons in my state require women to wear underwear and pajamas to bed. Men are required to wear a minimum of boxer shorts. Sleeping in the nude is not tolerated. Most prison systems in this country are monitored and audited by the American Correctional Association which have them all following the same basic rules. I admit though, there are bad people in every profession that makes the rest of us look bad.

By the way, I went to a dermatology clinic for an annual check up. I was asked to undress and put on a gown. Later, a female PA entered with two young females, one an assistant and the other a trainee. I threw a big fit and had the two females dismissed immediately demanding a male chaperone. I kept my bottom covered and had some work done on my chest only. I informed their administration of how mad I was about the incident and that I would not be coming back. I received a written apology in the mail and was told that if I would remain their patient, I would always see only male physicians. I could have avoided that headache if it was mentioned on the form.

Dr. Bernstein, what is your opinion of an invasive non-consensual pelvic exam done under anesthesia solely for training purposes?


At Wednesday, May 18, 2011 9:27:00 PM, Blogger Maurice Bernstein, M.D. said...

The word, Warmouth is "non-consensual" and if that is the case I reject such behavior on the part of the training staff and those being trained even if the goal is education of a student, intern or resident. My view is now a common view though only a couple of decades ago this behavior was accepted. No woman should be subjected to a pelvic exam even for the best of education intentions without specific permission prior to the exam as to who and with what experience is going to participate in the exam. Period! ..Maurice.

At Wednesday, May 18, 2011 9:59:00 PM, Anonymous Anonymous said...

Unless medical students are made to expose themselves to each other (including opposite sex) for exams then they will never have any real understanding of how patients feel.

Also, most modesty violations take place with technicians and assistants. They should be given the same lectures on patient modesty that student doctors get. I feel this is a real problem that needs to be addressed.

At Thursday, May 19, 2011 1:29:00 PM, Anonymous Anonymous said...

I don't think we should force students to expose themselves, but I do think there is a lesson to be learned by asking for volunteers or going through the motions of asking them to partcipate and then giving them the option to opt out before they have to expose anything. The lesson would be if they were not comfortable with doing it, but did not ask to opt out, they need to remember that is the way the patient comes in. It isn't the only way to address it, just one way.
I think techs and other staff including nurses are a HUGE part of the problem. A tech can have very little training, same with a CNA and they are allowed in to see the same things as a Dr. That is probably my biggest complaint, and especially when there is opposite gender exposure to support staff that does not have to happen, its just for the convenience of the Dr. I have used several men i know getting vasectomies with nurses they knew present, my Dr did mine by himself, as did a friends Dr after he ASKED, same Dr had a nurse in for another friend who didn't ask. So he didn't have to have the nurse there, it was just easy for him and it came at the expense of the patients comfort, he either didn't care or didn't even think about it, even though I can not imagine any guy, Dr or not would not know how guys feel about vasectomies...alan

At Thursday, May 19, 2011 1:49:00 PM, Blogger BJTNT said...

I totally agree with Anne.

At Thursday, May 19, 2011 7:46:00 PM, Anonymous Anonymous said...

Maurice: I have to agree with Anne, too. Considering the kinds of intimate, personal questions asked on all kinds of forms patients have to fill out, what's so personal about modesty considerations. If the receptionist regularly asks: What do you need to see the doctor for? (right at the front desk) and expects a male patient to say something like, My testicle is swollen -- what' s so inappropriate about asking -- on a written form -- about modesty concerns?

Not wanting modesty questions on intake forms just goes to show what an "elephant in the room" issue this issue is. We know it exists but let's just not talk about it. As Anne suggests, the doctors are busy. Unless it's part of a protocol, or checklist, most doctors won't ask. And the ones who are aware of it and are planning to protect protect patient modesty, perhaps just assume that the patient assumes that the doctor will do this. Assume, assume, assume. Let's just talk about it.


At Thursday, May 19, 2011 8:37:00 PM, Anonymous Anonymous said...

Dr. Bernstein, Thank you for your comments and for your interest in this issue. I feel honored that you spend time listening to us. By the way, I want you to know that in general, I respect physicians as individuals that have worked very hard for their credentials. I also know that their busy schedules include long hours, late night rotations etc., and a lot of them are probably strapped with huge student debt. It's not all yachts and corvettes. I just get upset about modesty violations. That seems to be my mental firing pin. As noted by Anne, most modesty violations seem to involve the technicians and assistants. I agree that they should be given the same lectures on patient modesty that student doctors get. I feel that there should be universal rules that govern how things are done. As I noted earlier with the technician that could have handed the man a towel to cover his own penis prior to her removing the sheet. Why don't they get it?


At Friday, May 20, 2011 9:56:00 PM, Anonymous Anonymous said...

I have been dating a former doctor for several months now. Interesting for me as I have such issues with medical nudity because of past experiences. We have had some frank discussions about men examining women which, if anyone is interested, I will be sharing in my next couple of posts. It would be far more relevant for a current doc or student to post, but as there is a lack of docs posting here, thought I'd offer some things he's told me. Thanks, Anne

At Saturday, May 21, 2011 10:10:00 AM, Anonymous Anonymous said...

That's great Anne

I once dated a nurse and on a few occasions
overheard comments she made to her friends about
her male patients. So what else is new!


At Sunday, May 22, 2011 3:45:00 PM, Blogger Maurice Bernstein, M.D. said...

"The result, many therapists argue, is that the profession is at risk of losing its appeal for a large group of sufferers — most of them men — who would like to receive therapy but prefer to start with a male therapist."

Golly! Seems I heard something to same effect but dealing with physical modesty. Where did I hear this concern previously?? Here?

For an interesting analogy of the problem with regard to those discussed on this blog thread go to today's New York Times article with regard to the profession of mental health therapy.

Let us know what you think of this analogous issue. ..Maurice.

At Sunday, May 22, 2011 5:59:00 PM, Blogger Doug Capra said...

That article is an excellent find, Maurice. It confirms what we're talking about here. But notice how the article is framed -- it frames this as male "perception." Not about reality. That is, males perceive that it's best to talk about some things with other men. But it really doesn't matter. A good therapist is a good therapist.
Now, granted, there is some truth to that. A good nurse is a good nurse, male or female. And a good nurse can treat anyone. But is all this about perception? That is, we can't have actually, true feelings. They're just perceptions?
But implicit in the article is that males better just get used to this. It's almost the idea that now we have to resocialize males in this area, too. You know, like we're talking about with modesty issues:
"This is just the way it is."
This is all connected to the problem with men in American education, beginning in elementary school. See "The Trouble With Boys" by Peg Tyre. This is all connected with the lack of males in college, the lack of BA's, MA's and PhD's men are getting. Women are way ahead of males -- and esp. in communication areas. And, there are many funded programs to get women into male dominated academic fields, like science and math. But few if any programs designed to get men into the now dominated female fields like what we read here -- psychology, or what we're talking about here -- nursing.
The problems men face with gender care in medicine will continue and get even more difficult, because in many fields of medicine, except surgery for now, women will continue to advance and take over. This will happen as few men go on to get to get higher degrees, while at the same time funded programs will continue to get more women in to the science and math fields, like medicine. Meanwhile, women will continue to advance in fields that focus on communication strengths. That's where, it seems tome, things are going.

At Sunday, May 22, 2011 6:16:00 PM, Anonymous Anonymous said...

I think there are a lot of similarities. There is a Weslyan College near me that did a study on bringing males into nursing, they realized that everything from the decor to the magazines in offices were female oriented. This follows through to patients, I know I feel like an outsider in the medical arena. If you go in for a procedure at the hospital, odds are from the receptionist, to the person that takes you back, to the nurse that preps you etc will all be female. I know I used to avoid care if I knew it was going to involve exposure and require a 2nd person becasue I knew that person would be female. I do believe they hit on a root cause of the challenge for men, the fact that we have pushed so hard to correct the wrongs women faced in the past we have not only gone by it in some areas such as health care, we do are not even open to discussing it for fear of being labeled sexist. We allow double standards against men to stand rather than risk being seen as not PC. The most obvious is female reporters in locker rooms but failing to address the fact that they apply a different standard to female locker rooms. In medicine is it really so different, we would never think of having a male mammographer or male assistant to a male gyn, but having multile females for male exposure is Ok unless the male protests and then it is iffy. I think the two situations are really similar,...and yet, what are we doing about it?....we pushed to correct inequity in education for girls, now males lag far behind in advanced education, anyone worried?...I read an article about the lack of medical care for females in areas such as heart care, almost as a side note they mentioned the spread in life expectancy between men and women has widened over the last decade...hear anything about that..advertising by hospitals, how much to men, compared to women..not saying women have it made, but 70% + of the profession is female....I do think many men feel like outsiders, I know I do...alan

At Monday, May 23, 2011 10:08:00 AM, Anonymous Anonymous said...


The magazine, the Atlantic discussed the issue
in great depths. The article,the end of men.

Google the Atlantic the end of men for a brief


At Monday, May 23, 2011 11:10:00 AM, Anonymous Anonymous said...

alan said: “I do think many men feel like outsiders, I know I do”.

We have to consider that social media plays a huge part in this problem. Beyond the always present female nurse, we see the always present female patient. Most medical issues I have viewed in the media have “feminized” issues that are actually common to both genders. Most (not all) commercials for incontinence, for example, will show a female running from the car while "gotta go" plays in the background, then discussing the issue with her doctor and later shopping for the product. Mail order catheters will most often show a woman discussing not needing to reuse them at home anymore. And when calling to order, she will again speak with a smiling and helpful female.

Psychologically, I believe advertising agencies are not doing this just to market to the female patient. They believe that “feminizing’ an issue somehow makes it more palatable to the viewing public. The theory is that we do not want to see stark reality….we want to see gentle reminders. Using women as these types of marketing tools may lend a more gentle expression of these issues, but what does it do psychologically to men? Do they feel less masculine for having what is often portrayed as a ‘female’ issue?
Anti-depression advertising will usually show more women than men, while she stares sadly out of a window watching her family live life without her. What of men? Do they subconsciously see this as a female issue and therefore avoid seeking care?
Media is more often than not leaving men out of medical advertising, and therefore out of the arena of concern. It is no wonder that, as alan said, they feel like outsiders. That is the way they are portrayed and most often marketed to.
And the cycle may continue that men are less inclined to enter the medical arena of feminized care.


At Monday, May 23, 2011 12:06:00 PM, Anonymous Anonymous said...

The only thing not mention on informed consent forms IS the gender of the providers. If this issue is important enough to most, it would alter their informed consent. Consequently, the psycho social/nudity issues are not discussed on informed consent explanations and people sign their forms not knowing that they will be exposed during a procedure. This, too, implies lack of informed consent. Comments anyone?

At Tuesday, May 24, 2011 6:09:00 AM, Anonymous Anonymous said...

A different version of don't ask don't tell. We aren't going to ask or tell so we don't have to deal with it. If you read the allnurse threads, it is obvious the majority of nurses know this is an issue, but it is one they really want to deal with like they want to. I have little doubt they are aware of it, I think it is the let sleeping dogs lay.....alan

At Tuesday, May 24, 2011 9:35:00 AM, Anonymous Anonymous said...

If you look at this issue legally, you cannot consent to something where the information for consent has been withheld.

At Tuesday, May 24, 2011 10:58:00 AM, Anonymous Anonymous said...

Alan said " I do think many men feel like outsiders, I know
I do".

Exactly, that's why you never see core values posted
In the lobby of any hospital. Furthermore,you never see
a nursing advertisement with the pic of a young female nurse next to a young male patient. It's always with an
elderly female patient. They don't want to get people

According to the ARRT (American registry of radiologic
technologists), 76.3 percent of all x ray techs are female,
and 94.5 percent nurses are female. 99 percent of all er
registration personal are female. Now that adds up to
89.3 percent female. I haven't checked the statistics yet
for respiratory therapists yet but I do know the numbers
are equally high. What's the significance,I'll explain later.

Sometimes I just cannot fathom the hypocrisy and
ignorance that surrounds these discussions. On this site
some people actually believe that it is a crime for there to be male mammographers.

Before this disappears on eBay please review this so
called lovely little postcard. Item number 220784015782

Http://'ll pass-risqué-nurse-postcard.

At Tuesday, May 24, 2011 11:03:00 AM, Anonymous Anonymous said...

Sorry Dr B

Forgot to initial post above


At Tuesday, May 24, 2011 12:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous wrote the following today. Non-functioning URL's are deleted. ..Maurice.

Alan said " I do think many men feel like outsiders, I know I do". Exactly, that's why you never see core values posted In the lobby of any hospital. Furthermore,you never see a nursing advertisement with the pic of a young female nurse next to a young male patient. It's always with an elderly female patient. They don't want to get people thinking. According to the ARRT (American registry of radiologic technologists), 76.3 percent of all x ray techs are female, and 94.5 percent nurses are female. 99 percent of all er registration personal are female. Now that adds up to 89.3 percent female. I haven't checked the statistics yet for respiratory therapists yet but I do know the numbers are equally high. What's the significance,I'll explain later. Sometimes I just cannot fathom the hypocrisy and ignorance that surrounds these discussions. On this site some people actually believe that it is a crime for there to be male mammographers.

At Tuesday, May 24, 2011 5:55:00 PM, Anonymous Anonymous said...

I think of a male mammographer just like I do a female conducting a testicular sonogram. It's not right. A man has no business conducting mammograms just like a female has no business in a male urology clinic. If your stance is that the females are conducting intimate radiographs on the males so females suck it up and let the males do your mammogram, then I don't think you're standing by your principles. That is if your position is that modesty should be respected. It shouldn't happen either way. No man is going to do a mammogram on my wife. I guarantee that. And I'm going to do everything I can to avoid any exposure in front of a female tech. My job will be harder because of the lopsided numbers but I'll shop around and do the best I can. Why would a man want to be a mammographer or a male nurse in a maternity ward? Why would a women want to work in a male urology clinic? They’re all weird, creepy and suspect. I don’t trust any of them. At the birth of my niece, my sister in law confided in me that a male nurse came from no where and looked at her while she was in labor. He was not helping in any way, he was just looking. She was very embarrassed. She asked why the hospital would allow some creep who just wanted to look, spoil what was supposed to be the most memorable event in her life. She’s still upset over the incident and that was three years ago. I hope he’s happy. If my wife goes to the hospital, I'll stand guard over her and proactively and viciously defend her.


At Tuesday, May 24, 2011 7:42:00 PM, Anonymous Anonymous said...

gd writes: "The only thing not mention on informed consent forms IS the gender of the providers."
Gender is rarely if ever mentioned on any medical forms. Some clinics and hospitals, and medical advertisements, don't even mention the first names of the doctors -- it's Dr. Jones and Dr. Smith. The lack of gender consideration is so blatant that it's clearly a point of view, a philosophy. It's become so embedded, this "gender neutral" position, that it's not even consciously recognized by some. It's just the way it is. It's the "elephant in the room," as I've written before.
One can tell as much about where people stand by what they don't include as by what they do include. What's left out represents a position just as what's put in.

At Wednesday, May 25, 2011 4:42:00 AM, Anonymous Anonymous said...

I haven't heard anyone say it's a crime to have any opposite gender personnel. What I have read and said is that upon refusal and the legal right of title 7 to use gender as a bona fide job qualification are reasons why we don't see male mamographers as well as others. This is not a gender issue; it's a privacy issue and we are all on the same side. It boggles my mind that people see it any other way. I do agree that we need more male techs, nurses, etc to equal the playing field. It's probably because women refuse the men and men don't refuse the women that might equate to some of the inequality of the genders in hiring.

At Wednesday, May 25, 2011 4:58:00 AM, Anonymous María said...

I may seem paranoid, but that's not the case. Why then, the new trend for the few men who do become nurses to work in L&D, and women in urology dept???
A male nurse wouldn't work in L&D decades before, simply because unless he became a doctor, women would distrust him. As for females working in nusing, they're most unwilling to change matters. BTW, I agree sometimes their employers only want them to smile and look pretty. (Which might even be OK; if they're only desk clerks) But lately, rather than acknowledging the modesty issue, MO seems set on making everyone fit the gender neutral model.

At Wednesday, May 25, 2011 7:20:00 AM, Anonymous Anonymous said...

SW is right. America has feminized healthcare. Its like they don't want men to seek care anymore or act like they dont care about them anymore. Its no wonder we dont go to the doctor! Maybe they get enough money from our sisters and mothers.


At Wednesday, May 25, 2011 8:49:00 AM, Anonymous Anonymous said...

While I feel strongly about this issue and what is right for me, I don't feel opposite gender in those positions is wrong. For some people it is of no concern, for some they may actually prefer opposite gender. We have no real way to tell what the actual percent of preference is since we are not really asked in a manner that is conducive to honest answers. Providers prefer to use the fact that most don't protest as a sign of consent. We know that is not true. We may be a very small minority, I do not think so, but have no way to prove it. We should not judge those who don't care or prefer opposite gender anymore than we want to be judged. The issues I see is (1)providers do not ask (2) providers use the excuse of ignorance of the issue to avoid having to deal with it. Dr. Bernstein I know we disagree on the 2nd one especially, that you have stated the providers you worked with seemed unaware of the issue. While I found this very surprising, I think for many providers they have become desensitized to it and forget, just becasue it isna't and issue for them, it isn't an issue for the patient....alan

At Wednesday, May 25, 2011 10:15:00 AM, Anonymous Anonymous said...


You don't have to worry about a male in this country
performing a mammogram on your wife, there are
none. Let me explain. Before you can seek training as a
mammographer one must attend either a 3 or 5 year
accredited radiography program, undergo a criminal
background check then pass a 250 question comprehends
Then you can only be " cross trained" into mammo
at either a hospital or clinic. That training is generally 3
to 6 months long. There are no schools for mammography.

Mammographers are licensed by the ARRT in the
state of Minnesota and additionally by each state. There are a handful of states, 7 or 8 that don't require a state
license. I spent 6 months looking into this and called
every state x-ray regulatory agency.

For those states that don't require a license I called the
technical agencies that service the mammography x-ray
machine,a state law annually. Each of those agencies
In turn told me that they have never seen a male mammographer at any of the facilities.

Btw, the training to become a mammographer is
somewhat extensive. After all is said and done you are
looking at 4 to 6 years. That is certainly more training,
clinical hours than say a correctional guard or an ma at
a urology office.Certainly more than a registered nurse.

The fact that there are no male mammographers speaks
volumes about the double standards in healthcare and I
consider it the hallmark of all double standards in healthcare.

Consider each year over 300,000 breast augmentation
surgeries are performed each year in the U.S. That the
bra industry is a 20 billion dollar industry. Yes,that's
billions,not millions. Obviously,some serious modesty
issues there.

Next time you visit a urology clinic ask about who
performs urodynamic function tests. It is always some
young female ma. That's someone who spends 5 months
at a institute!

In the state of California ma's, medical assistants are not
allowed to insert urinary catheters,but they do anyway. For
more on this discussion visit allnurses,general dissscussion
duties of a ma,lpn at a urology clinic."you will be inserting
urinary catheters on guys all day long, best job I ever had".

My favorite line to one of these ma's or better yet the
office manager (always female) is when they say

Oh, but she is professional,and you don't have anything
she hasen't seen.

I' m sure male mammographers are professional too
if they existed,but then you wouldn't know about that,
would you?


ps sorry Dr B. I know this was repetitive information but
I wanted to make a point.

At Wednesday, May 25, 2011 2:33:00 PM, Anonymous Anonymous said...

This may have been answered and perhaps I missed it.

Does anyone have statistics on female to male patient ratios in the hospital setting? Regarding just nursing staff: What might be a reasonable split to accommodate patient gender preference....perhaps 70/30?
Assuming hospitals might want to be somewhat prepared should gender preferences (ever) be placed on forms, (and not yet having the data that would create), where might staffing ratios reasonably begin?
It may just be an educated guess for now, but does anyone have an idea on where they think the female/ male nurse ratio might equitably begin ?


At Wednesday, May 25, 2011 3:41:00 PM, Anonymous Anonymous said...


It would have to be split according to patient demand. The ultimate say is with the patient; not the personnel

At Wednesday, May 25, 2011 3:50:00 PM, Anonymous Anonymous said...

swf said

" Does anyone have statistics on female to male ratios in the hospital setting."

Question is just a little ambuigous. Are you referring to female nurse ratio to male patient.
The conclusion can be drawn from
94.5% of all nurses are female,therefore,I have seen many
neuro,med-surg,ccu floors exclusively female nurses. Once in a
while you will see one male nurse
there. There tends to be one maybe
two male nurses in the er.
My experience is that you will
see more male nurses in er than on
nursing floors. If your question
is the ratio of male to female
patients that depends on the type
of nursing floor.
Male patients statistically more
often are trauma patients age 17-25,
and more male than female
patients are the norm on urologic
post op.
There tend to be more male
patients in neuro icu due to the
frequency of trauma,male. The equity
ought to begin with the understanding and appreciation within the medical community that
trust is continully on the decline.
Hipaa is just one clue as well as
an increasing number of bon comlaints,ie boundary violations and
privacy violations. Thirty years ago
state board of nursing regulatories
really had no kind of rules regarding sexual improprieties on the books.
Visit any bon board for any state
and type in sexual impropriety in
the search bar.There you will be
given an exhaustive list of what
constitutes sexual impropriety.
Lack of appropriate draping,
leaving a patient unnecessarily
exposed.Staring at a patient's
genitals. Giving an im injection
in the buttock without appropriate
draping are just a few.
These rules just didn't appear
on the books by themselves,they
were put there for a reason. Every
floor ought to have at least one
male nurse or the availability of
a male nurse if a patient so requests.
Readers should be reminded that
it is considered verbal abuse by
state bon should a nurse argue with
you on how your care is delivered.


At Wednesday, May 25, 2011 5:49:00 PM, Anonymous Anonymous said...

I think the feminization of the medical profession is from numerous levels, Part of the thought is, women control the healthcare of the family so market to them. It still boils down to dollars, men don't protest so address women who do. We (men) have allowed this to happen to ourselves. Now we need to stand up and do something about it or shut up and accept it. It won't change on its own. I have to some degree moved from some sort of universal change to changing my personal experience. If enough men did this it would eventually force a wider change, but until then, I am doing what I can in my little world. Not going to give up, but until then I will take responisbity for my experience and not just go along then get ticked. My daughter recently graduated with a degree in Psych, they graduated health sciences with the school of Psych. the gender ratio was obvious. the do a degree in Physcian Assistant similar to a NP....80% female. doesn't bode well for those not willing to take responsiblity for themselves and are male.....alan

At Wednesday, May 25, 2011 6:28:00 PM, Anonymous Anonymous said...


Thanks for the education. I honestly didn't know that there were no male mammographers. I agree with you that this is the hallmark of all double standards in healthcare.

I visited Florida's bon board and typed in sexual impropriety as well as every related word I could think of in
the search bar. I couldn't find a list of what
constitutes sexual impropriety of medical staff.
Any suggestions?


At Thursday, May 26, 2011 9:53:00 AM, Anonymous colin said...

After years of prostate problems, I have recently had an ultrasound and biopsy. This was prompted by a rapidly increasing PSA level, almost exponential. I was told recently that my biopsy was positive with a T score of T1c and a gleason score of 6. Apparently, I am a perfect candidate for a prostate brachytherapy treatment. I subsequently researched the procedure in detail.

The radioactive seeds are injected via the perineum, while i lay on my back with my legs in stirrups. Probably the most humiliating position a man can find himself in. I immediately asked about the prospects of an all male team. The specialist nurse i asked about it in the fist instance was male, as has been my experience at every turn, a male nurse was FAR less sympathetic about such a request than females are. After some perseverance, I was told that my request would be accommodated.

I have had my fill of the health care system over the last few years, i am so glad i do not have to face a potentially life saving procedure with a will i wont I decision due to female presence.

As has been said by so many in here, articulate your concerns and wished, stand by them and sometimes, you will be happy!

Apologies for burdening you all with this, i have chosen to keen my cancer diagnosis to myself and it helps to put it down in writing.

At Thursday, May 26, 2011 10:12:00 AM, Blogger Maurice Bernstein, M.D. said...

Colin, best wishes from the Bioethics Discussion Blog and I am sure from all the visitors here. ..Maurice.

At Thursday, May 26, 2011 7:08:00 PM, Anonymous Anonymous said...

Colin, good luck with you procedure, hope all goes well. And congrats for standing up for yourself, I know it will bring you comfort knowing you did. I think the taking charge of your comfort will carry through in your treatment. Prayers are with you...alan

At Thursday, May 26, 2011 7:40:00 PM, Anonymous Anonymous said...

Colin,I will pray for your successful surgery.

BTW, there may not be male mammography techs, but as I've shared before, I did have a traumatic experience with a male doing a breast sonogram on me which is just as bad. And if you will read the companion blogs to this blog, you will see many women have had their breasts fully exposed/handled by male techs for tests. So women are not as protected as many may think (not to minimize men's modesty rights and issues)

The US has become desensitized to women's breasts due to all the poor women who have to battle breast cancer. How come breasts are no longer considered the sexual organs they are? When this blog first started, I found a study by an Italian physician saying that American women had been taught to feel that breast exposure in medical settings shouldn't bother them and that Italian women behaved differently.Wish I could find the article again. Anne

At Friday, May 27, 2011 5:24:00 AM, Anonymous Anonymous said...


Best wishes for a happy, healthy outcome. Based on my experience, after all is arranged, sometimes they will try to put an opposite gender person at the last minute and in my experience, I held fast, refused and guess what? They found someone. Keep to your values, let them no there is no "wiggle room" and you'll be fine!
Best of everything and let us know. We care about about fellow bloggers.

At Friday, May 27, 2011 4:34:00 PM, Anonymous Anonymous said...

Here are some articles on gender x-ray tech issues. Notice the feelings of the techs are given more emphasis than those of the patient. Anne

At Friday, May 27, 2011 6:22:00 PM, Blogger Doug Capra said...

That second article -- written by a woman from a woman's point of view. No mention of possible male modesty, just female modesty. It's a valid point of view, but one-sided. Typical of these kinds of articles. Interesting articles, These are great. Keep them coming. They demonstrate attitudes within medicine. I'll comment in more detail later.

At Saturday, May 28, 2011 4:05:00 AM, Anonymous Anonymous said...

It is interesting to note that the first article and study was performed outside the United States. Based on overall opinion with the US ranking higher in modesty concerns than Europeans as a rule, I wonder if these statistics would be similar.

At Saturday, May 28, 2011 5:19:00 AM, Blogger ~Charlotte said...

Interesting surveys, I have a couple of thoughts. First of all, I think that there is a difference between taking a survey and actually having a real medical treatment. In other words, it is easy to be idealistic and think that one will be "just fine" with an opposite gender technician performing a test or procedure than it is to be actually standing there exposed to a strange man or woman. So, in this regard, the survey is flawed. I would certainly test it out and see if the results are different AFTER these same folks have a procedure performed. I think that some people would change their minds as I believe that the reason many of the contributors to this blog have modesty issues is because they have had treatments in the past which were traumatic or at least uncomfortable due to the gender of the person involved.
What I do like about surveys such as these is that it "gets the word out" that gender is something that is of concern in the health care setting and that patients DO have some say in the matter. Up until a year ago, I did not think I had a say in this matter, i.e. I thought I just had to "buck up" with whatever gender was available and for women, up until the last number of years, doctors were predominately male. All that has changed and just knowing that we have a CHOICE is empowering. And women are making that choice. I think that in time, men will have more gender options also, you just have to INSIST and make your voice known.

At Saturday, May 28, 2011 7:04:00 PM, Blogger Doug Capra said...

GaIl -- You're right. I doubt a medical history was taken of those surveyed, i.e. how much experience have they had with intimate exams and procedures? As you say, how one feels having had no experience may change swiftly when one is confronted with the situation. But I'll bet that kind of nuance isn't taken into consideration with these surveys. Also, few of these surveys if any ask about specific kinds of exams and procedures, explaining the details of such exams before the person answers the questions. Even with that, there's a great difference between "considering" how you'd feel, and the real feeling you actually have if it really happened to you.

At Monday, May 30, 2011 9:10:00 AM, Anonymous Anonymous said...

I have been away from this site for a long time so I was just quickly scanning some of the posts. Two things comes to mind when it comes to patient modesty I believe a doctor brought up the issue of draping,designs of the room where a patient can be exposed by a door being open,curtains etc........I agree these are all wonderful and needed things . My problem when it comes to modesty seems to be the staff itself. FOR EXAMPLE. Whats the point of the door if noone knocks on it, Whats the point of a pulling a curtain if 5 interns who want to watch invite themselves in. I had assistants ask me intimate questions literally as I'm standing in the hallway with everyone and their mama walking by. Someone mentioned the receptionist asking the patient why they were here. This has happened to me. The reason for my visit was pretty personal so I gave her a general but good enough answer and she said she needed the SPECIFIC reason so she would know how to schedule me. Of all places in the world you would think a medical facility wouldnt make you go into detail of why your there at the front desk with a line of people behind you . Funny part is they then hand you all the paperwork including guidelines for privacy/hiPPa....uhnm okay after you just announced you need to get your testicles,penis,vagina,breats,rectum checked out.
I have definately learned sometimes it is better to be the difficult patient.

upside down

At Tuesday, May 31, 2011 9:59:00 AM, Anonymous Anonymous said...

Murder,attempted murder,kidnapping,armed
robbery,bank robbery, jail breaking, sexual

What do these crimes have in common? They
are felonies.

Since 1992 state nursing boards have seen on
average an increase of 1400 percent of nursing
students applying for their nursing license who have
previous felony convictions. I'm excluding those who
have DUI convictions and misdemeanor charges.
Generally, a DUI and a misdemeanor are usually
adequate to keep one from receiving a nursing license.

Would it matter to you if the a/c repair specialist, gardener or plumber had a felony conviction. Personally,
It would matter to me.

In the late 1970's a man by the name of James Hamm
and two accomplices executed a man for a drug deal
gone bad in Tucson Arizona. James Hamm was convicted
of murder and was on death row. In the 90's our then
governor rose Mitford commuted his sentence to life.
While in prison James Hamm attended law school and
by the late 90's James Hamm was released from prison,
and by all accounts was rehabilitated,yet the Arizona bar
refused his admittance to the bar.

Why allow him to attend law school in the first place,that's
one less truly deserving student who did not get to attend.

Last time I checked the only time an attorney can save
your life is when you are on death row.

Would it matter to you if the nurse providing your
care had a felony conviction. Don't you think that there
was a better deserving student. When applying for a
nursing license, respiratory therapist license or x-ray
technologist license you are required to admit to any
previous criminal convictions. In fact,employers ask you
that as well when applying for a job.

Recently,several state nursing boards due to legal
terminology have had to provide nursing licenses to
nurses with a felony conviction prior to 2010.

The most trusted "profession" really!


At Wednesday, June 01, 2011 8:02:00 AM, Blogger rev. fred said...

Recently, I received a copy of a report my heart specialist sent to my PCP, with a discussion of my conversation about patient modesty. I welcome the comments of this blog.

"As you know, the reverend is very concerned about modesty. He has given me documents including church documents and a personal declaration as well as links to websites regarding modesty for male patients. He told me that should he need any intervention involving his groin, he does not want any women involved. He told me that he believes that this is his right according to the patient's bill of rights and I do not disagree with him. He did have a bad experience when he had his hernia repair done. He said that women were involved with the care of his surgical site and it caused him embarrassment. I told him that we would try our best to avoid any of that. At least for the time being, we are only planning to do a stress test. He has no problems with our office staff (both male and female)interacting with him as long as they are working 'above the waist'."--REV.FRED

At Thursday, June 02, 2011 5:06:00 AM, Anonymous Anonymous said...

Rev. Fred,

I love the letter except for one thing. "we would try out best to avoid any of that" seems contrary and minimizes the issue(s) for most of us. That is not enough to encourage some patients to move forward.

The only thing that works (in my experience) is to refuse the procedure and to let that be known ahead of time.

At Thursday, June 02, 2011 10:15:00 AM, Anonymous Anonymous said...

Notice the dcotor isn't giving a guarantee only that they would try their best.

At Thursday, June 02, 2011 2:13:00 PM, Anonymous colin said...

Having been told i could have an all male team for Prostate Brachytherapy by some administrative staff, I met with the doctor concerned yesterday.

I found the meeting immensely stressful and humiliating. I was asked repeatedly "why do you want an all male team" my response of "because I do" was challenged several times.

This challenging would NEVER happen to a female, it would just be accepted that she had a reason to ask.

I now feel extremely traumatised by the consultation and totally depressed.

At every step obstacles were presented. The procedure requires 2 oncologists, they have 2 males, 2 medical physisists, they have 4, 2 male 2 female (so no problem one would assume there), an anaethesist, they have several male, and several nurses, again they have some male nurses.

The objection was "it is unlikely that all the males would just happen to be scheduled together".

In other words, they would make ABSOLUTELY NO effort to arrange an all male team, it would need to happen by accident.

Just he way females are treated, OR MAYBE NOT.

I feel so upset by the U turn.

It looks like I will have no treatment for my cancer after all.

At Thursday, June 02, 2011 3:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Colin, of course I can't evaluate your cancer and tell you what the impact of treating it or not treating it will be but I can tell you (and I have written about this here previously) that to make a decision not to treat a cancer should not be based simply on modesty issues. Of course, as you have done, you have the right to avoid treatment for any reason you feel is important. But, to me, if the goal for the management of your cancer is to represent cure or absence of the ongoing pains of bone metastases or other metastatic involvement possible just on the basis of an hour or less lack of genital privacy by exposure to healthcare providers of either gender who are providing your treatment, modesty concerns must be withheld for that goal to be attained.

I have fully agreed with all those writing here that physician understanding of patients' modesty issues and system changes for facilitating complying with patients' requests be worked out. But at this time, when such understanding or system functioning has not yet been achieved, to allow death or the miseries of cancer to occur simply because of moment in ones life when modesty is withheld seems to me just plain wrong.

I know.. "just a doctor talking" but, in life decisions, there has to be times of some logic and rationality. Again, I don't know what your cancer may bring or not bring (and maybe your doctors don't know either) but this is my opinion. ..Maurice.

At Thursday, June 02, 2011 4:36:00 PM, Anonymous colin said...

Dr Bernstein,

I am really pleased for you that you feel the way you do about your own body.

As for my body, I would rather die than endure the humiliation of a prostate Brachytherapy procedure with females present.

Just for clarity, I WOULD RATHER DIE than have that happen to me.


At Thursday, June 02, 2011 5:15:00 PM, Blogger amr said...

Dr. Bernstein,

AMR here - my wife had the mastectomy and reconstruction.

I have been following this blog for many years now and of late only a marginal contributor.

On the day that you say: "I get it." truly will be a milestone in this modesty issue. As you have blogged some time ago, you personally do not have modesty issues and have in fact gone to a female colleague (if I recall). This issue of modesty is holistically a part of the patient. As far as I'm concerned Colin's doctor has not lived up to your precious doctors' credo: Do no harm.

Out of the news pages: Young women are gang raped in Lybia as a part of the war. They did nothing wrong, if they lived, they are in fact survivors. But why is it that many are shunned and/or commit suicide? After all, it was just humiliating for a small part of their lives, "an hour or less." (if they are luckly) Why shouldn't they just suck it up in favor of "living" on the other end?

Point: Humiliation and what causes it is "very personal" and should never be "questioned" by the person who will be subjecting said individual to said "humiliation".

To Colin: There was a contributor not long ago who immediately changed his wife's doctor who was not understanding. Unfortunately money talks, sometimes. And making it very public why you are leaving will also help. I am so sorry that you have to be going through this. For your doc to put you through that is clearly not appropriate. Remember there are stories about doc pressuring women to do pap test. Same thing. They get paid if they successfully pressure the patient.

Dr. Bernstein, if you had finished your comments by asking Colin if there was a possibility of going to another doctor then… then… there would be an "understanding" on your part.

BTW doc, I still am appreciative that you have stuck with this blog. It remains important.

On NPR today I heard a story about a new book out by a US soldier who is trying to expunge his daemons from war. He had to carry around weapons to make sure he was "safe" from the Taliban on US soil. Eventually he found a support group of ex cops and soldiers. He shared with the group his "problem". It turns out that everyone there did the same thing he did.

Unless someone has experienced exposure as humiliation, I find that it is difficult or impossible for that individual to empathize.

Doc, you are concerned with "life" and bodily health. No where in your discourse do you consider the quality of mental health after the humiliation. In fact in your logic, I believe you place it as a low priority.



PS. The more I think about it, the more I think it should be mandatory for ALL health care providers, docs and techs and nurses alike to stand naked in front of their classmates (mixed gender) with the rest of the class fully clothed. Perhaps then, the "medical community", will "get it". This of course should be followed up by a discussion about how each person felt and why. But this discussion should be done again while they are naked.

At Thursday, June 02, 2011 6:17:00 PM, Blogger Doug Capra said...

Part 1

Colin writes: "This challenging would NEVER happen to a female, it would just be accepted that she had a reason to ask."
It might be asked of a woman, but you're right, not on a regular basis. And if a woman insisted, she would most likely get her way. But, there is a "magic" word that men need to use. It's "discrimination." Remind the "team" that "interviewed" you that they're practicing a double standard that could easily be interpreted as discriminatory. Use the word. Ask what would happen in L&D if a woman, who had a female doctor, insisted that there be no male nurses or assistants involved. Would they assemble a "team" to "interview" her as to why? Oh, that's different, they might say. Ask them why it's different?
"I found the meeting immensely stressful and humiliating. I was asked repeatedly "why do you want an all male team" my response of "because I do" was challenged several times."
I'm convinced the meeting was designed to be immensely stressful to you, designed, perhaps not consciously but nevertheless, to intimidate you. Patients like Colin need to learn how to take control of the situation. Don't let the "team" frame the questions. You frame them. Why are we having this meeting? Are you trying to intimidate me into changing my mind? Would you do this to a woman?
If you want to reach the truth, you need to ask the right questions. Don't let them frame all the questions.
Why do you want an all male team?
I feel more comfortable that way. It's stressful enough without adding this extra stress.
But why do you want an all male team?
What if I told you I had been sexually abused in the past?
Have you?
What if I told you that, if I have, I haven't even told my wife about this. Why do I have to tell you? Do I need to be psychoanalyzed as part of this medical procedure?
But why do you want an all male team?
Why do you object to my request?
Get the point? Get your own questions in the forum. You're not the "object" of the meeting. You are a member of the team that's meeting. Make sure that point is made.
Read closely the hospital's core values and/or patients rights documents. What do they say about dignity and respect? Bring that up at the meeting.

At Thursday, June 02, 2011 6:26:00 PM, Anonymous Anonymous said...

Colin my friend,it would seem that they are going to make it one rough road for you.This is a good example of why patients need a personnal avocate to work for them.Someone that can make the phone calls,write letters,send emails or just plain raise hell.The person going thru the cancer treatments has enough on their mind.I hope you have a spouse or someone close that could help you.May I offer a few suggestions.First write a letter to your doctor telling him how upset your meeting with him was.Next,send a letter to his supervisor,clinic manager,hospital administration,and patient relations.Make sure you sign it with contact info and that you are thinking of going elsewhere.Are there any different health care groups near you.Send them a letter telling them why you are dissatisfied with your present provider and would your experience with them be any different.Give all a chance to fix it or tell you no,they cannot.Right now you are playing the game to see who blinks first.No one likes to have a superior question them as to why or why not.But,if it brings a change for the better,do you really care.Change come's in little baby steps,one at a time.The final decision is your's.Your cancer outcome will be the same whether it is done by a all male or a mixed gender team.One leaves you depressed and humiliated,one leaves you glad you spoke up and stood up for yourself.You also help make it a little easier for all that follow you.Take care my friend , and good luck with your journey.GOD BLESS AL

At Thursday, June 02, 2011 6:26:00 PM, Blogger Doug Capra said...

Part 2 to Colin's post

Having written the above, I do agree with Dr. Bernstein in essence. Go with the procedure if only a mixed gender team is available. But let them know that the reason you're going along with them is that it's life and death for you, that you don't feel respected or treated fairly, that you feel discriminated against. But you feel you must have it done to live. Put in writing.
I'm not sure I myself would demand an all male team. I haven't in the past for less personal procedures. But I respect you point of view and understand it. And, I resent these "meetings" you went through that are really designed to gang up on and intimidate patients into changing their minds. It would be more honest to just tell you no, go some place else. It's the we always know what's best for you attitude so just go along with the program. It's the mixed message -- you're a part of the team as a patient, we have patient-center care, etc., but God-help you if you request something that might cause use to change our schedule around.
But, as I said in the first post, patients need to learn how to take command of the forum when meetings like the one Colin described take place. It's not easy. But you're the one going through the procedure, and you have a right to see that your questions get answered, and that your concerns are taken seriously.

At Thursday, June 02, 2011 6:38:00 PM, Anonymous Anonymous said...

Colin, while I agree with Dr Bernstein I would say, do not give up just yet. First off just tell them, if they can not agree to provide an all male team when ever exposure is required you would like a little time to check with other facilities to see if they would be able to accomodate. The key as I see it is not that you have an all male team, just that females not be present when exposure it required. See if you can agree to that, prehaps they can agree to have females step out when it is appropriate. If you don't get a satisfactory answer move up a level and ask the administration if they would consider looking at the schedule to see if they could arranage a schedule to accomodate this. Do not hesitate to bring up the fact that if this was a female the attitude would be completely different, make them think about this. Ultimately, if you can not achieve this, I would urge you to look for a way to to make it tolerable, no exposure until you are out, etc.. What you are doing is a step in a long journey, we can not change things over night. Push as hard as you can, make them think, make them justify, but in the end, if you die becasue of it you will accomplish little and those who care about you will pay the price as well. If you push it as far as you can, succed or not, you will have the ablity to continue the fight for yourself and others. Push them Colin, push them to the very brink, but don't deny yourself and those who care about you years of things to come....alan

At Thursday, June 02, 2011 6:39:00 PM, Blogger ~Charlotte said...

Colin, females are treated the same way, or at least I was. But, rather than tell you the traumatizing experience that i had, I want to give a few suggestions only after stating that I agree with Maurice that, in the final analysis, your health and well-being trump the modesty concerns.
First, I would request another meeting with the radiation/oncologist or the director of the radiation oncology center (the doctor, not the administrator). Then, I would ask for an orientation. Go into the room where you will be staged and look around, ask how many people are necessary for your staging etc etc.Get a full explanation of everything that is involved in your treatment. It may be that it is for the "staging" that they may not have enough male staff since the staging part usually involves more people. I don't know if you have to have a 5 week course of treatment like I did but get ALL the particulars. It may be that once you are staged, you may be able to have a male only team for your treatments as this usually requires fewer people, often only one or two. Then respectfully ask what can be done to make this situation better for you and see if they can come up with some solutions. It may be that there are some suitable compromises. I would definitely have your hospital's patient bill of rights with me and underline sections where it talks about a patient's rights to respectful treatment. I would also ask the director if he is aware of another radiation oncology center near-by that might have a male team. If so, ask to be referred there. But, please do get treatment!

At Thursday, June 02, 2011 7:05:00 PM, Anonymous Anonymous said...


Your comments indicate despite the pleas of so many that you do not really understand the connection between the psyche and the fact that sexually violating a patient (from the patient's perspective) is so damaging to their soul and mental health that the physical aspects of healing don't matter when the soul is damaged.

These are the issues that effect every single person who has been previously sexually abused who needs healthcare. Perhaps there are those on this blog who are uncomfortable disclosing these issues, but your stance putting the medical care before mental health are not only insensitive, they make no sense to those who feel differently than you do.

At Thursday, June 02, 2011 9:41:00 PM, Anonymous Anonymous said...


It is certainly sad is it not
that an individual facing an extreme
uncertainty in their life willing to
withhold treatment for what you call

Is there another more appropriate term to use,say trust
or lack of it. Is that what Colin
is really trying to say? That he does not trust some of those in the
medical community.

What strikes me most is the response he recieved from the oncologist I presume. Many simply
just don't get it. You would think
that at least the oncologist would
get it in that here is a patient willing to play russian roulette with their health.

There are no guarantees with
radiation oncology as you may know
but you must respect the patients wish in the final analysis.

In many respects his story is
quite disturbing. In another aspect
the vast majority of medical physicists are male. Most oncologists are male as are
anesthesiologists. The distributition of radiation therapists are about

Therefore an all male team should not pose a significant
problem. On occasion seed implants
may require an overnight stay in
the hospital.
One would most likely be on
a post-op general nursing floor.I
will remind our readers that many
hospitals are struggling financially
and I mean struggling. Many hospitals are on the verge of closing,holding pay raises,freezing
401 contributitions and the like.
Capital expenditures are frozen
as well. Ask any new nursing grad
how hard it is to get a job. Many
nurses that are working are having a
hard time just getting their 40
hours a week. Many nurses are told
not to come in since there are not
enough patients.
Honestly,I've seen radiation
oncology centers only open half
days due to lack of patients and
truthfully I really don't know what
world this oncologist lives in to
question a patients wishes. He should be grateful he has patients,
especially those with insurance.


At Thursday, June 02, 2011 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

gd, as a physician I cannot accept balancing a brief period of emotional embarrassment regarding modesty against outcomes of death or long periods of terminal suffering such as from cancer. This emotional embarrassment is not rape, the actors are attempting to perform an accepted therapy for the best interest of the patient. Sure, there are professionally unacceptable outliers in healthcare but I doubt that this exception pertains to Colin's situation.

There are many situations in medicine where emotional, psychologic experiences in diagnosis or treatment which may provide discomfort to the patient but, as doctors, yes, we should acknowledge them and try to mitigate them as far as practical and safe for the patient but we have to weigh them, in our estimation, against the realities of the clinical situation and possible outcomes. In the final analysis, it is up to the patient to decide for themselves whether modesty trumps attempts to treat potentially lethal conditions. I just think that Colin's stated decision is not one that I as a physician would recommend. And since the situation is probably not an immediate emergency, I would agree with Doug and others and communicate further with the physicians to solve the issue. ..Maurice.

At Friday, June 03, 2011 3:58:00 AM, Anonymous Anonymous said...


That's where your wrong. It is rape in the essence that the exposure in front of opposite gender care is AGAINST THE PATIENT'S WILL and I don't believe that your analysis is correct.

When the data is completed and the story told, there will be vast ramifications for the medical community and this gender issue when the damage that's been done starts to publicly unfold and that the medical community has tried to keep hidden.

There are legal ways to combat this issue that works because it is not only morally right, ethically right but legally right and sooner or later everyone will have to come on board when people publicly disclose why they are dying.

At Friday, June 03, 2011 5:03:00 AM, Anonymous Anonymous said...

While it does not change my mind that ultimately you should get treatment, I think where we and providers depart is what is reasonable, who is being unreasonable. Is Colin being unreasonable for refusing treatment when it threatens his life, or are providers being unreasonable when they have the ablity to provide this accomodation that could save his life, but simply are not willing to make the effort. In my opinion it is the provider who has failed, being insensitive to the patients over all welfare does not create the trust the patient needs for the best results from this procedure. It has been established time and time again, the physical recovery of a patient is linked to their mental/emotional state. Failing to take the steps needed to provide Colin with a positive mental state could negatively effect his PHYSICAL state. Remember this is a case where they can accomodate, they have the proper staff, they just don't want to make the effort as my guess is they don't see the need from their perspective. That said, they will not be the one who will pay the price. I lost a friend to colon cancer when he put off seeing a Dr. when he knew something was wrong. There was nothing dignified in dying like that, the humiliation he suffered in the last months of his life was far more than the humiliation of seeking help. That said, what does it say about providers who can, but won't accomodate a patient knowing in may kill them....alan

At Friday, June 03, 2011 6:06:00 AM, Anonymous Anonymous said...


I have a background in research on this subject and think that I can help you with these issues to get what you need and what you want.

Dr. Bernstein has agreed to give you an e mail address for me and I will give you some process tips that will ensure a good positive outcome for you that doesn't include forcing you to expose yourself.

At Friday, June 03, 2011 8:37:00 AM, Anonymous colin said...


could you provide me with the email address of "gd" please?

many thanks


At Friday, June 03, 2011 9:07:00 AM, Blogger Maurice Bernstein, M.D. said...

Colin, write me e-mail:
and I will return e-mail gd's address. ..Maurice.

At Friday, June 03, 2011 2:19:00 PM, Anonymous Anonymous said...

I don't agree with how the doctor went about it but the one positive is that he was in honest in that they might not be able to meet your request. That is better than lying to you and saying they will to have you on the table and see otherwise.

I would suggest asking the doctor if you can speak with someone at the hospital who does the actual scheduling. You can aslo ask if he talked to them himself. That will be telling. They will be able to give you an idea on whether this need can be met or not. Please know chances are very slim they will ever guarantee it but ask them for odds of getting an all male team. See if there is a day that would work best.

Another option is to start calling around and seeing if another doctor can better meet your needs. I would make sure they are affiliated with another hospital or you wil run into the same issues once again.

At Friday, June 03, 2011 8:16:00 PM, Blogger Maurice Bernstein, M.D. said...



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