Bioethics Discussion Blog: Patient Modesty: Volume 49





Wednesday, May 30, 2012

Patient Modesty: Volume 49

I think the last two postings on Patient Modesty: Volume 48 set the problem of the current medical system followed by a explanation of why the problem is present.  Both and together I think, are worthy preface to begin Patient Modesty: Volume 49. ..Maurice.

From Anonymous:

As a woman, I've appalled with the way the general medical profession handles (or doesn't handle) patient modesty, and their seeming obsession with having access to the genital area. In the past I have been denied everything from allergy tests to antibiotics for ear infections due to my refusal to submit to a PAP smear. So be it, I now turn to alternative medicine for what I can, and suffer through the rest.
My 60-year-old husband never quite understood my views since he'd only gone for random physicals and never experienced anything untoward. However, he rcently underwent an outpatient surgery to have an ICD device placed in his shoulder, and now he understands. 
He was required to check in to the hospital 2 hours before his scheduled surgery time. A nurse came in and gave him a gown and told him to remove everything including his underwear. She wrote something on a chart and repeated "Now don't forget your underwear." Then she adjusted the bed and a third time said "Remember to take off your underwear." I could tell she was making him very uncomfortable with her repeated focus on his underwear, so I firmly told her to Back Off. I told her he was neither deaf nor mentally impared so I was certain that he understood her directions, and I asked her to leave. She left, but he was visibly shaking as he got changed. And then we sat there in that room for 2 hours, with literally nothing else happening beside a nurse coming in 1 time to take his blood pressure (which was higher than usual). Finally nerves got the better of him, and he slipped his pants back on so he could walk around the room a bit. Like she had radar, a nurse came in shortly after and berated him for not having all his clothes off. So he took off his pants again and laid in the bed for 2 more hours while nothing happened.
Finally a man came in to take him down to the pre-op room. My husband was allowed to go to the bathroom before being wheeled downstairs. And as he asked me, WHY did they insist on him being nude under a butt-revealing short gown for all that time? Could he not have just been told to change when he went to the bathroom? It seemed like nothing more than a tactic to upset him and make him submissive.
Once in the staging area, a nurse cleaned the shoulder area, inserted an antibiotic IV, and jokingly told him not to go anywhere. The she flipped up his sheet a little and joked "Not that you're dressed to make an escape anyway, right?" before she left the room. Wow, what a way to humiliate a frightened man and emphasize his vulnerability. My husband went a little nutters at that point, asking me to remove his IV and bring him his clothes so he could leave. I had to beg him to go ahead with the potentially lifesaving procedure.
Afterwards he was supposed to stay in recovery for an hour (where I wasnt allowed to be)before being returned to his room, but it didn't work out that way. I don't know what happened in recovery, but he came walking up to me in his gown and asked for his clothes. I gave them to him, he changed in a bathroom, and we left.
Now he says that when the battery on the ICD wears out, he won't go back to have it replaced. He says the thing can just "Sit in his chest doing nothing" because it "isn't worth it" to have to go through all that.
Nornally my husband is the apitome of a rational thinker, so obviously their techniques really upset him. I'm sure he wouldn't have made such a rash end decision if they hadn't insisted on making him lay around for 4 hours feeling humiliated with those 2 nurses making an issue of it, when there was no need for it. And they wonder why people don't go in for needed tests and procedures? What's wrong with our medical society?

And from BJTNT:

When you work for the demi-god, you are an angel and patients are mere mortals. This culture has evolved into the PCC syndrome - Power, Control, and Convenience for the medical operations employees. Assume this premise and see how much this describes what you observe in medical operations.
The unfortunate element of the PCC syndrome is that the employees can practive it with impunity. There is no management to crack down on them. The MO administrators are only concerned with implementing the medical committees and ownership policies. The supervisors are promoted employees with the PCC mindset. And MDs only want to "see patients". So, the kids get to run the candy store.
On the other hand, as POGO stated in the Walt Kelley cartoon of the same name "We have found the enemy and he is us." We expect [and I think rightly so] high standards from medical operations{MO} because our health and even our life can be at stake. But, to the MO employees it's just a job. It's just a job with some nice perks {PCC}.

Graphic: From Google Images and modified by me with Artrage and Picasa3.



At Wednesday, May 30, 2012 3:32:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT starts out this Volume today by explaining a ritual. ..Maurice.

Medical operations conflates patient modesty with the ritual of the draping.
When the gurney stops in the operation room the patient is undraped to some extent, i.e. the genitals are exposed [sometimes some personnel may actually need the genitals exposed for a limited time]. When all personnel have had an opportuniy to look and their prep work is complete, they can be an audience. The ritual of the draping begins with the entrance of the high priest/priestess. The high priest begins with the ostentatious washing of his hands and forearms with all other activity stopped so that he has an audience. Sometimes one of the acolytes helps the high priest complete his robing. Then an ironed and folded drap is formally presented to the high priest. He ceremoniously opens and places the drap. [An unironed and clean drape would work just as well and save money, but not quite as ritualistic.] When all the drapes have been placed, the prelude is complete. The operating room staff can resume their activiy.
This ritual is what medical operations mean when they state that we respect patient modesty.

At Wednesday, May 30, 2012 4:04:00 PM, Anonymous Anonymous said...

Planetree, like politicians and government, a lot of big words and empty promises.


At Wednesday, May 30, 2012 5:30:00 PM, Blogger Maurice Bernstein, M.D. said...

To explain Ed's comment, on Volume 48, I wrote the following:

Read all about Planetree since it seems such a patient-centered organization and institutions would be just the appropriate place to participate for those on this blog advocating change in the medical system and attention to patient modesty. Here is "About Us" from the website. ..Maurice.

About Us

Since our founding by a patient in 1978, Planetree has defined what it means to be patient-centered. Planetree’s philosophy is based on a simple premise: care should be organized first and foremost around the needs of patients. To understand those needs Planetree turned to the source. Thousands of focus groups—from bedside to boardroom—with patients, long-term care residents, families and professional caregivers across the globe have borne out their needs and desires for a more personalized, humanized and demystified health care experience.

Bringing these concepts to life requires a shift not merely in operations but fundamentally in culture. Planetree guides providers through a structured process that enables caregivers to transform the health care experience they provide.

Planetree has a 30-year history of partnering with providers across the continuum of care to transform organizational cultures. It’s about creating culture change and delivering health care that is putting the needs of individuals first. By partnering with Planetree, providers across the continuum—from large, urban systems to small, critical access hospitals and long-term care communities–attain the expertise, tools and support needed to transform their health care experiences for patients, residents and caregivers alike. Presently, Planetree’s international membership is comprised of more than 500 organizations from five countries. Additionally, Planetree was selected by The Department of Veterans Affairs (VA) to collaborate with the new VA Office of Patient Centered Care and Cultural Transformation in the development of the VA’s own patient-centered care model for Veterans who receive health care services at VA’s more than 1,000 points of care across the nation.

At Thursday, May 31, 2012 4:57:00 AM, Anonymous Anonymous said...

"Power, Control, and Convenience for the medical operations employees"
That is why I think that lack of concern for modesty is just one piece of the lack of patient-centered care.
In order to have patient-centered care, providers would have to give up Power, Control, and Convenience. Why should they, if they don't have to? Many people like to feel powerful and in control, and it's great when things are convenient. I don't think the culture will change, voluntarily.

At Thursday, May 31, 2012 11:07:00 PM, Anonymous Anonymous said...

Dispensing healthcare is riddled with legal liability,
and imposes a certain level of responsibility both on
the patient and those who deliver healthcare. I'm
suggesting patient-centered care is a myth and
ambiguous in it's promises. If such a kind of care
exists it's fair to say male patients were never
factored into the equation.


At Friday, June 01, 2012 4:39:00 AM, Anonymous Anonymous said...

If you have not done so, you need to go to allnurses and type in what we think in the search. As referenced in this thread it is very disturbing what they write. They appear to be especially amused by male genitals. Not only is the making fun of patients disturbing as it is a look into the minds of people who claim to be "professionals", it shows the us and them mentality as they attack anyone who challenges them. I understand these people do not speak for all nurses, but I don't see to many challenging them. This is why many people don't have the trust and respect for healthcare providers they once did and why many men in paticular don't trust and avoid. Start at the last page and go back to see the contempt they have for us "you" who aren't them. This is on the internet and they feel it is private....disturbing. alan

At Friday, June 01, 2012 10:48:00 AM, Anonymous Anonymous said...

With the need for a new dermatologist and the encouragement of this blog, I took male patient modesty questions to a recommended male dermatologist [MD]. As I was explaining my desire for a new MD and had some questions for the MD, the receptionist opened the envelope [with the questions inside] addressed to the MD while I was talking to her. We know there is no patient privacy within medical offices, but if "it wasn't all about them" there would at least be the pretense of privacy.
I left both mail and e-mail addresses in the questionaire, but didn't except a response. After five days I visited the office. The same receptionist as earlier had the deer-in-the-headlights response, but fortunately a women sitting next to her recognized my name. She said that she was going to call me, but... [not a good first impression]. She gave me the expected answers to the questions, but when she said there was a male aide, I made an appointment.
The visit with the MD was quite satisfactory and I enjoyed that he was training a male aide.

At Friday, June 01, 2012 8:53:00 PM, Anonymous Anonymous said...


It appears that allnurses have pulled another
David Copperfied on us, half the thread is gone and
I'm not suprised. It's pathetic that just because a thread
is called time out, they say what they are really thinking
so now you know.
But, I think a little psychology is in order here. Think
for a moment the kind of person that would enjoy posting belittling comments about male genitals. An insecure person, someone who probably deep inside hates everyone including themselves.
Yet, a person who has such poor self esteem about
their " image-self" they project this anger towards the
opposite gender, for reason of rejection and obesity. But
you were the better person who stood their ground, you
made a fair attempt to show them their behavior was
childish and immature. They continued to protest your
presence as well as others because insecure people
must always be in control.


At Saturday, June 02, 2012 7:41:00 PM, Anonymous Anonymous said...

Thanks PT, while I found the comments they were making disturbing, the fact that they not only saw now harm but were offended that any "outsider" would challenge them was even more disturbing. The justification was this is a nursing blog and the people are not identified was ridiculous and highlighted the us vs them mentality. If we were to use the same justification for racism, sexism, for gender preference, would we find it acceptable, would they? i understand this might be only a few nurse, but where the protests from the rest?
Dr. Bernstein, we had the discussion of context and you questioned why we did not see the diffence context made, this is why. While not many read allnurse, most have heard comments like this from nurses at parties, friends, various places. Comments meant to be amusing, entertaining, harmless. So while the need may be different, many of us know at least some providers have this mentality, whether they show it or not, we know it;s there, and that is why while the need is different, the context doesn;t change how we feel, becasue we know these providers who put on a professional front, are there making these kind of non professional comments....alan

At Saturday, June 02, 2012 8:51:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, by the way, I could never see myself cracking jokes about the patients I have cared for. None of us, doctors, nurses or other providers are immune from becoming patients ourselves with all the anatomy, psychology and weaknesses of patients which could be exploited by those who are attending to our diagnosis and treatment.

Let healthcare providers joke about themselves to their colleagues and others if that is a necessary self-therapeutic action to help relieve the tensions of the profession. To do the same about their patients is, I think, potentially professionally destructive. Once this is started, a patient no longer becomes a subject who needs attention and care but simply an object of a joke. I don't think we in the profession can really look at a patient both ways. ..Maurice.

At Sunday, June 03, 2012 11:29:00 AM, Anonymous Anonymous said...


In regards to the all nurses thread, there are some notable points to be made. One female poster
commented that her post was prompted by the degrading comments she receives because of her obesity, thus transferring her anger towards male patients.

According to article/578089, 55 percent of all nurses are overweight
or obese. Using an elaborate search engine with wild
cards, I imputed the user names of all those posters
on that particular thread of allnurses.

With the exception of the OP and a two others
I was able to find posts associated with the user names
mentioning they are overweight or obese. One nurse
stated her figure resembles the Michelin man. Is this
gender stratification we are seeing or is it something else.
According to the international assoc of eating
disorders,women significantly are more likely than men
to report body checking and avoidance, binge eating,
fasting and vomiting. Is this actually projection and
blame that we are seeing. Sigmund Freud referred to
projection as a psychological defense mechanism.

I'm suggesting that for much of the nursing
industry, it is a blame culture. A way of devaluing others
and the end result is that the blamer feels superior,
furthermore blaming others can lead to Kick-the-dog
effect. Where individuals in a hierarchy blame their
immediate subordinates and this propagates down the
hierarchy to the lowest rung(the dog).

This is essentially why nurses eat their young,
"you are not obese,I am,therefore I will project my blame to you, the new young nurse." Body esteem is
related to depression, social isolation and low self
esteem. For the male patient, you're on the receiving
end of someone else's pent up frustration.

A 2009 experimental study has shown that
blaming others can be contiagous even for uninvolved
onlookers. Patterns of body image distortion is
considerably more prominent in women than in men,
to the point that it is a characteristic female phenomenon (2009).


At Tuesday, June 05, 2012 6:00:00 PM, Blogger alan1973 said...

Dr. Bernstein
I understand human nature and the flaws we have. I appreciate providers like yourself who make the effort to be a professional ALL the time, but I really do understand releasing tension and just plain character flaws. We all have them somewhere. Making an off color comment about a patient to a co-worker while not right, is somewhat understandable. What I did not understand was how these people would post these comments on a forum such as the internet and think it was acceptable. How they could not realize how unprofessional it was to make fun of people, named or not who had trusted them when they were in a very vulnerable position. How they could not see that people reading this crude thread which was largely composed of making fun of men's penis's would erode peoples trust in all providers. Using comments like wiener is so unprofessional it makes one question what providers are thinking when we are most vulnerable. I also could not understand how they could not see what they were doing, and justifying it that it was "their site" and not naming patients made it ok. Would a self proclaimed racist site be acceptable if they didn't name names. The it's our world and the problem is you don't belong, not that we are was disturbing but refreshing to hear your take on it. The problem is, how do we know if we are getting you,,,or them when we need care...alan

At Tuesday, June 05, 2012 9:07:00 PM, Anonymous Anonymous said...

Dr Bernstein, I applaud you for saying you “could never see myself cracking jokes about the patients I have cared for.” but, as Alan pointed out, how do we know if the doctor/nurse/tech we get is like you or like the ones in this NY Times blog (linked below) who call some of their patients “whales” out of earshot of the patients but in front of med students.
There are 246 comments posted, be sure to read comment #99 where “When I asked what she (the mammography tech) was laughing about, she answered, “I know I shouldn’t tell you this, but my co-workers and I describe breasts like yours as raisins on toast.”

and the link to the full article

At Thursday, June 07, 2012 12:19:00 PM, Blogger Joel Sherman MD said...

We have a new post up on teaching medical students about patient confidentiality.
You might be especially interested Dr B.

At Thursday, June 07, 2012 1:03:00 PM, Anonymous Anonymous said...

I posted the following comment to "Dr. Ronald Yap Prostate Pals Blog" where he commented favorably on an article titled "Men’s health is a joke on television" by Dr Joel Sherman.

It's not fair to stereotype the entire female nursing profession based upon the comments of a few. When choosing a physician, the only things I'm certain about is board certification and gender, everything else is a roll of the dice. When agreeing to a particular exam or procedure, I've at least established a professional relationship and comfortable enough with that physician to agree with his (or her) recommendation. My issue with a urological procedure and the physician requiring assistance, is the female nurse/assistant, who've I've never met, arriving in the exam room unannounced, with little if any introduction, and no explanation of why their presence is required. The physicians' failure to ask is presumptuous, unethical, and unprofessional. Instead, the physician effectively ambushes patients expecting submissive compliance; where is the informed consent? Naked, gowned or not, in need of medical care is a difficult time to make a stand. Additionally, I've no idea what their professional qualifications are. Many times they are not nurses' at all but simply medical assistants. Personally, a female high school graduate, with three to 24 months of vocational training, has not earned the professional distinction to witness, much less participate, in any exam or procedure of a personal nature in an outpatient setting. However, if I've established a professional relationship with a female nurse and I'm comfortable with her, I will likely agree to her presence, if a male is unavailable and prior to the exam/procedure, informed consent is obtained. For me personally, the gender of my doctor when I need to be undressed or talk about very personal health problems is important. Being seen undressed by male nurses or assistants isn't much different than changing my clothes in the locker room at the gym. But undressing for women (I'm not married to), regardless of the professional setting, is very uncomfortable.

Numerous posters had posted on Dr Yaps blog commenting on this issue and he had responded favorably indicating he understood the issues and our concerns as patients. Then all the previously posted comments disappeared and he has failed to respond to inquiries as to why or publish additional comments. Anyone care to comment on why a Urologist on a public blog might censor posters comments in this manner.


At Friday, June 08, 2012 7:26:00 AM, Blogger Maurice Bernstein, M.D. said...

Ann, attempting to write to the now long closed "Patient Modesty: Volume 16" presented the following view of physical modesty as seen by a woman. ..Maurice.

For years, all women had were male doctors. No one ever cared about female modesty at all. Mens only choices were female nurses. So both men and women had no choice. Now there are more male nurses and techs and more female doctors. I go to all female doctors and I send my son to all male doctors. My father once kicked a female nurse out of an examining room, when he had to have a rectal exam. My son unfortunately has to put up with female nurses and has ulcerative colitis. The problem seems to be nurses and techs. You can choose a male or female doctor, but you don't often get to choose the rest. I was horrified when in the hospital in my 30's to have male nurses assigned to me, when there were plenty of female nurses and plenty of male patients for the male nurses. Sloane Kettering has a male nurse on their breast cancer surgery floor or they did ten years ago. What are male nurses doing in delivery rooms and in breast cancer wards? Why are female nurses catheterizing men and bathing them? It's the same on both sides. This isn't a male or female issue. It's a problem for both sexes and a lack of being considerate by the medical community in respecting patients. I'm not surprised to read that a male had a female tech when a male was available. Don't assume women get a choice. I was never offered a female nurse... three times when I was in the hospital. They told me there weren't enough. I did not believe that. Male nurses want to be present for baby deliveries as part of their "experience" as a nurse. They are upset that women don't want them there. They feel it is their right as a nurse to experience it all. This is why this is happening. Male nurses get to have their special nursing experience, yet men need them at times when they want modesty. So this is what is going on. Male nurses are demanding to be let into maternity wards, leaving men to suffer too. It all doesn't make sense. -Ann

At Friday, June 08, 2012 8:57:00 AM, Anonymous Anonymous said...

I'm glad that I am not alone in thinking that female medical staff should look after female patients and so naturally male medical staff should look after male patients.

I do not wish to be examined or cared for by a male.

If I was screened for cervical or breast cancer, I can guarantee a female nurse or technician. BUT if I was referred to a hospital for further treatment, the specialists are all male. I do not consent to screening for this reason.

Why can't hospitals provide same sex care for everyone who demands it?


At Friday, June 08, 2012 10:37:00 AM, Anonymous Anonymous said...

Just to add to Ann's comment on male nurses and working in L&D. I agree - I do not understand why a man would choose to work in that environment. I believe a chaperone is offered to a woman if examined by a male doctor. Is a chaperone offered to a woman if examined by a male nurse? Wouldn't you need double the staff to work on L&D? Wouldn't the male nurses be more useful working in male urology where they would be welcomed?

My husband was given an hospital appointment with the local urology department. He did not want any female carers. He rang the hospital to ask for an all male team. This was agreed. When he attended his appointment, the FEMALE nurse asked him to disrobe and put on a gown. My husband then said that he had asked for a male nurse and he was told that there wasn't any male nurses available. The nurse kept telling him to disrobe even though my husband was insisting on a male nurse. He went back to reception to make another appointment only to be told that male nurses where NEVER available as too few were employed.

He has said to me that if I choose same sex care I am seen as assertive but if he tries to do the same he is seen as being awkward, silly or immature.

He still hasn't seen a specialist. He feels let down by the people who are supposed to be caring and by a system that prides itself on being patient led. The reality is that you are not a person, you are the 11 o'clock who won't get into his robe and are messing up my schedule.


At Friday, June 08, 2012 2:23:00 PM, Anonymous Anonymous said...

Men are labeled silly or immature to distract them from the real issue: there are very few male nurses in urology despite 90% of the patients being male. I know this isn’t scientific but go to Google, click Images and search for mammography nurse, just about every image shows female staff, quite understandable. Now do the same for urology nurse, guess what, nearly all the images are female staff again.

At Saturday, June 09, 2012 9:50:00 AM, Anonymous Anonymous said...

There are about 600,000 medical assistants in the US
according to the Bureau of labor and statistics. Of this,
325,000 work in physicians offices. Males comprise about 10 percent of this workforce, yet you never see males employed at any physicians offices.Most clinics actually don't employ nurses unless it is a large practice in which case there may be one nurse while the other employees are ma's.

Why is it that physicians don't hire male employees,are they seen as a liability? That the female patients would be uncomfortable. The truth is everyone
is a liability, state medical boards and nursing boards
reflect this.

Do male physicians enjoy and prefer the company
of female employees at the expense of his male
patients. Is this just a prevailing sexist mentality among
male physicians. Moto gp, motorcycle racing has scantily clad women holding umbrellas over the racers
at the start of the race. As if their Kevlar helmets and
high end leather suits are not enough protection against
the uv rays.

The NFL has cheerleaders and for years some
young woman would kiss the winner of the Indy 500
after a hot race after he drank a quart of milk. Go
figure. We see these examples throughout our society
yet, why should someones privacy be negated all for
the need of a cheerleading squad. Does the oath of
hippo crates apply, I will respect the privacy of my
patients, at whose expense! Do most physicians have such low self esteem that they have the need to be surrounded by women all day.

and that the male cna nursing shortage is a farce.

At Saturday, June 09, 2012 10:24:00 PM, Blogger Maurice Bernstein, M.D. said...

"Munchausen by Internet": I had never heard that diagnostic description before today but as a moderator of a blog that deals with clinical issues, I thought it would be very important to make others aware of it, so I put it up as a new thread titled "Munchausen by Internet: Should We Believe Everything Our Visitors Tell Us Here?" My blog thread is based on a well written Wikipedia article.

For those reading this "Patient Modesty" thread, I am not suggesting that all self-descriptive experiences here are "made-up" for psychological reasons but then who knows since anonymity is rampant throughout the internet on blogs and discussion groups.

By the way, do you think that some of the comments complained about on allnurses web site could be "made-up" experiences to meet some internal perhaps prurient satisfaction by describing or to be going along with a group.

Just a thought. ..Maurice.

At Saturday, June 09, 2012 11:15:00 PM, Anonymous Anonymous said...

I finally became poor enough to receive county health care in California. This is not medi-care, med-cal, or disability etc. It is a program run by the county for the poor. It is called Basic Temporary Health Care. I was APPALLED when I read their Privacy Practices packet. Apparently my health records can be used for researchers conducting studies, teaching, government agencies gathering statistics, as well as any law enforcement, and the list goes on. Nowhere does it say about patient dignity or respect; it's all about records. I am sick and need care so I don't DARE make a fuss but it sure makes me uncomfortable.

At Sunday, June 10, 2012 4:29:00 AM, Anonymous Anonymous said...

It isn't just allnurses, of course. Perhaps more blatant, this nurses's blog - this post particularly struck me, although she is pretty consistant:
If you read down through the comments (even worse than the blog post in places), her contempt for the patient and for anyone who dares speak up for her, is very clear. Her comments about both the overweight female patient, and her discussion of 'micro-penises' are horrifying.
I think people like this might really be like that at work, or might be exaggerating to be seen online as 'clever'. She has a pattern of blogging how smart she is, and how she saved the day against others stupidity. I'm sure she's not the only one with such motivation.

At Sunday, June 10, 2012 10:38:00 PM, Anonymous Anonymous said...

Maurice said

"by the way,do you think that some of the comments
complained about on all nurses website could be
made up experiences to meet some internal perhaps
prurient satisfaction by describing or to be going
along with a group."

Certainly, however, I believe both sides take a
prurient interest on these posts. The made up posts
are done as a test, to gauge responses, gather opinions
and conclusions.


At Monday, June 11, 2012 5:38:00 AM, Anonymous Anonymous said...

Why did the hospital agree to your husband's request for male nursing beforehand if it wasn't going to be possible once he actually checked in? That is quite misleading. I also agree with you that it would make sense to have female nurses care for females (in intimate situations) and male nurses care for males. I do not really understand why nurses themselves would object to this. After all, their job is to care for patients and I do not see why it would matter to them whether they were caring for men or women. I do think, however, that with fewer male nurses this may not always be possilbe for men, unfortunately. Perhaps this is changing with more men getting into nursing which would be a good thing (as long as they are not forced on women). At this point I do agree that hospitals, and to a lesser extent doctor's offices, use personnel not for patient's comfort but more for scheduling and their convenience. As it stands now those of us who will not accept opposite gender care will just have to speak up and if we can't get what we want, go elsewhere or worse, do without.

At Monday, June 11, 2012 3:40:00 PM, Anonymous Anonymous said...

One thing to perhaps remember, not everyone wants same gender care. I for one don't. And my elderly lady friend, before she passed away, was happy with both male and female nurses, and one of her very best nurses who she was very fond of, was a man.
It's about what the patient is comfortable with - I wouldn't personally care for it to be a rule that only women could care for women, only men could care for men. That might make a proportion, or perhaps even a majority, of patients happy - but not all of them. It's about choice.

At Tuesday, June 12, 2012 5:52:00 AM, Anonymous Anonymous said...

Yes, I agree that it is about choice. My previous statement was a little misleading when it said female nurses should care for females and vice versa for males. I do understand that some people are comfortable with either gender and that is fine. But I do think that the same gender option should be available to patients without them having to upset the apple cart too much. It should be offered to them, or at the very least accomodated if requested. My post was sort of a knee jerk reaction to the previous post about the gentleman requesting male nursing only to find it wasn't available once he got into the hospital. They should have informed him ahead of time (when he asked) that all male care would not be possible. Actually I think most people do not object to opposite gender care as long as the care does not involve "sensitive" procedures. Basic, general care is usually not an issue, most certainly not for me. And it seems that when more intimate, perhaps embarrassing, procedures are necessary it would not be all that difficult to find a same gender nurse to perform them if requested. Jean

At Tuesday, June 12, 2012 3:07:00 PM, Anonymous Anonymous said...

Absolutely, people should be informed. No excuse for not doing that in my opinion.
As far as enough male nurses being available - I don't really know, I wonder if they always are. From what I've seen, they're quite a minority. Perhaps it just isn't a profession many men are choosing?
I agree, they should be availble if a man requests them. But is it generally possible? I truly don't know.

At Wednesday, June 13, 2012 7:25:00 AM, Anonymous Anonymous said...

I have been following this thread from the beginning, and the conduct from medical staff I have read here made my blood boil. I personally have felt my modesty was always respected in my treatments, but I know violations routinely happen. Recently I chatted with my mother in law about some of what has been discussed here, she is a 30 year + RN with hospital and Dr office experience. Some of her answers surprised me. She said her whole career she has seen males and females modesty respected, that was just expected. She agreed that male modesty was not formally addressed in school like female was. Believe it or not, she was actually "shocked" when I suggested some males are quite modest and wanted male care, since her experience had suggested quite otherwise. Therefore the "faked shock" response discussed here may actually be more honest than you think. Males really do need to speak up. I related some of the nurse conduct stories from this blog here she was quite appalled, and said she had never witnessed such things. I have no reason to doubt anything she said. She did point out that the "training" the aids and CNAs get today is grossly inadequate. It is in these individuals I think the problem is. I came away from the discussion with a much more positive feeling on the topic. I also posted a story in the GROUP PHYSICALS post about how respectfully our group physicals were always done. Violations DO happen and we DO need to advocate for ourselves, but there is a danger in letting discussion about only negative experiences define our perception of reality. You will always hear from a dissatisfied customer, but rarely from a happy one. Recently my doctor ordered an intramuscular EMG. All the horror stories on the internet had me terrified to the point of cancelling. I went through with it anyway, and it was not that bad at all. Take into consideration what you read, but dont let it completely define your concept of reality.

At Wednesday, June 13, 2012 10:39:00 AM, Blogger Doug Capra said...

Mike: You write: "I related some of the nurse conduct stories from this blog here she was quite appalled, and said she had never witnessed such things."

We see what we want to see, what we've been condition to "see." We filter out what is not relevant to us. The fact that she is completely oblivious to this issue suggests that it's invisible to her. That doesn't mean it isn't happening all around her. It means it doesn't come under her radar. All of us see what we consider relevant and miss what we don't consider relevant.
Having said that, I'm not suggest she's not a kind caring nurse. And I do agree that we don't often read about the good stories and that most people are treated with dignity. But that fact that some nurses say they've never witnessed these events doesn't mean that they're not happening right in front of their eyes.

At Wednesday, June 13, 2012 11:03:00 AM, Anonymous Anonymous said...

Mike said

" She said her whole career she has seen males and females modesty respected,that was just expected. She
agreed that male modesty was not formally addressed
in school like female was."

This sounds like a contradiction to me if I've ever heard one. As I have previously mentioned in past threads nursing manuals do not delineate gender boundaries.
This "faked shock" that you mentioned, everyone needs an ready excuse to discriminate.


At Wednesday, June 13, 2012 11:11:00 AM, Anonymous Anonymous said...

Mike, I am interested in hearing about your procedure because I need one too. If you are willing to speak with me, please ask Dr. Mo for my e mail address as I'm a regular blogger on here. thanks

At Thursday, June 14, 2012 12:41:00 PM, Anonymous Anonymous said...

A friend directed me to a website that vividly demonstrates how clueless many in the medical profession remain concerning male modesty. This office offers a large number of surgical and in-office urological procedures. These procedures, at least for the most part, allow for no preservation of patient modesty, yet when selecting the links that explain the various tests and scrolling down there are two pictures of a young, attractive woman whom one would assume either performs or assists in the exams. Do the practitioners actually believe that men will look at this and think, “Well I have to undergo an embarrassing exam, but at least I can take comfort in the fact that a young woman will be involved in the procedure.” I wonder how many patients this site has cost the practice.
The lesson, of course, as most on this site already know, is to never assume anything. If you are uncomfortable with opposite gender intimate care always request a male technician for any intimate procedure and if you are refused go elsewhere unless your medical condition is so serious that no delay is possible. Only when patients begin refusing such care in significant numbers will physicians make changes to their practices.
The website is listed below

At Friday, June 15, 2012 3:33:00 AM, Anonymous Anonymous said...


I'm in agreement with your comments as you
have well stated the issues. Nursing and other
staff may frequently find themselves as patients and I
believe they are acutely aware of the disparities. They
don't expect to see a male at the mammo clinic, nor
a male nurse on a post-op gyn floor.
I doubt that it's invisible to them,but rather as
you mentioned, just not on their radar. Or is it? There
is a thread on allnurses..Naked where I work- a nurse
with cancer. This nurse mentions that she has a
policy never to be a patient where she works,naked.
Now, the fact that she has cancer is irrelevant
but she sees it as her justification, her suit of armor
to continue with the surgery where she works. That
somehow the diagnosis of cancer makes her
Immune, her being naked diminished.


Regarding the urologic institute of NJ, what
would be interesting if the young woman on their web
went to get her mammogram and was confronted by
a young male displaying the equipment for her
Mammogram, how would she feel.


do you thinks the young woman on their website
would do if a

At Monday, June 18, 2012 10:31:00 PM, Blogger Doug Capra said...

MG -- Re: that website

Here's what I think is happening there. Follow me with this:
1. In the past, doctors and hospitals didn't advertise. It was considered beneath the dignity of the profession.
2. It's only recently, the last few decades, that we begin to see advertising -- and only in the last few years that the advertising has become more sophisticated.
3. Today we see it all over the place -- doctors, clinics, hospitals, FNP's, PA's, etc.
4. Most hospitals hire ad agencies to do their PR and ads. Those agences are using stock methods. They're selling procedures like they sell furniture, cars, motorcycles, boats. How do that they that?
5. They put a pretty girl in front of the picture, in some cases, in various stages of undress.
6. This ad isn't selling patient privacy. It isn't selling modesty. It isn't even selling better health. It's focus is on the equipment behind the girl. The girl is just a pretty foreground. What then is it selling? What does the equipment represent?
7. The equipment represents the most up to date technology. That's where the race in much medical advertising is today -- the machines, the robots, the "new," the "modern." That's what's being sold in this ad.
8. The girl -- what does she represent? Eye-candy, as pretty women do in many ads. The fact that she's wearing the garb of a nurse or med. tech is the advertisers bow to the context of the ad. That's all. She could be standing in a bathing suit in front of new car. Same thing.
I'm not justifying this. It's an obtuse ad. But it shows what the focus is in much medical advertising today -- competition. Competing against the next clinic or doctor or hospital. Making sure the newest technique and technology and methods will be available.
That's this particular ad, and many like it. Look at other medical ads. Look behind the image to see what is actually being sold. You'll see images that sell personal, individual service; friendliness and warmth. The ads all show happy patients and happy providers.
Those who designed the ad we're discussing are completely oblivious to patient privacy and modesty. Those concepts are outside their radar.
It's not even about the endgame. It's about the toys used in the process toward the endgame.

At Tuesday, June 19, 2012 1:02:00 PM, Anonymous Anonymous said...


I can say that having been involved in the
purchase and acquisition of high end medical
equipment, medical manufacturers do not provide
models, period!
Nor do website designers in the case of this
urology clinic. Most likely, they came to take pictures
simply for the website design and whomever was there
that day got their picture done. This clinic has had this
equipment installed for probably some time but needed
to increase their patient load, thus creating their own
Now imagine for a moment a clinic specializing
in mammography. What would be the result of their
patient load if they advertised a young male posing
next to their equipment. Medical facilities are very
careful and selective in producing marketing
ads directed to the public. You virtually never see a
young female nurse caring for a young male, that's
suggestive and so much more if a young male nurse
providing care for women of any age.
The woman in the ad for the urology clinic most
likely works there and is suggestive that this clinic
staffs for their female clientele only. Typical of urology
clinics which explains why Dr Yap pulled the posts on
his blog, keep the patients uninformed and ambushed.


At Tuesday, June 19, 2012 4:01:00 PM, Anonymous StayingFit said...

I think that Doug makes some good points, but there is more to consider. If the ad was produced by a marketing agency, then it definitely is true that the members of that agency are not concerned with patient modesty, at least not that of men.

However, any advertisement produced on behalf of a business would need to be approved by that business. Or, at a minimum, any high-ranking member of that company could raise concerns with the advertisements for that firm.

So, clearly, either explicitly or implicitly, the doctors and staff of the Urologic Institute of NJ approve of this advertisement. Therefore, they are no more sensitive to the modesty of their male patients than those responsible for the production of this web page.

I also think that PT's argument that the site in question was not produced by a marketing company has some merit. The pictures are of rather poor quality, and not very professional. In fact, I would make the same observation of the site design, in general. So, it seems likely that this site was produced by a company with limited resources, and that the woman featured on the web page is an actual employee, as PT contends.

Finally, I agree with Doug's assertion that pretty women appear in advertising to make a product, in this case a medical device or practice, seem more appealing to men. However, women are not immune to this effect, as recent commercials featuring David Beckham attest.

And yet, as PT correctly notes, you never see handsome men used to sell medical services to women, especially if those services are of an intimate nature. Why not?

I can only assume it is because those firms that produce these advertisements, or the healthcare providers that hire them, are very sensitive to the modesty of women. Therefore, they are aware of the issue of modesty in the practice of medicine, but they do not feel that it applies to men. This website being only the most recent proof of this.

At Tuesday, June 19, 2012 4:53:00 PM, Blogger Doug Capra said...


Dr. Yap did post a positive reference to Dr. Joel Sherman's recent article in KevinMD about how men's health is ridiculed in the media:

You write: "Medical facilities are very
careful and selective in producing marketing
ads directed to the public."

They may be careful and selective, but I don't think they're savvy. If that woman works there, she was probably just put in the picture because she was there, and for the reasons I suggested in my last post.

At Wednesday, June 20, 2012 11:40:00 AM, Anonymous Anonymous said...


Yes, he did post a positive reference to
Dr Sherman's recent article about how mens health
is ridiculed in the media. He chose not to accurately
respond as to how men are treated in healthcare. In
particular,his practice. Was this a failed attempt to
draw male patients to his practice. His lack of
communication in this regard alludes to the fact that
he does not staff for his male patients.

Many of the ads directed at the medical
care seeking public use crude but useful subliminal
messages. For example, the urologic institute we
wrote about with the woman in the picture. Notice
she is standing next to a urology table with knee
stirrups. The table is designed for patients to be in the
lithotomy position. That position is used for pelvic
exams in females, rectal exams, some operations,
and sometimes in childbirth.

The subliminal message to prospective
female patients is that," that woman will be there",
cause she is standing next to that gyn exam table
and as a female that is comforting. However, that
same table is used for male patients as well! When
examining males for post-op prostate procedures
and all other urologic procedures, male patients
legs are placed in those knee supports as well,
thus the ad is misleading to prospective male
patients not familiar with urologic procedures.

Coincidence that she was placed next to that
table or the monitoring equipment in the photographs
or just a subliminal message directed to prospective
female patients.


At Wednesday, June 20, 2012 3:51:00 PM, Anonymous Anonymous said...

I have had an embarrassing dermatological condition for several years. After much procrastination, I decided to get help. My GP referred me to a hospital specialist and requested a MALE doctor see me. The first appointment offered was with a female, I refused. Eventually a male saw me but at a much more distant hospital. When I needed a follow up, I was offered another appointment with the same doctor. I rang to confirm it would be the same male doctor. I turned up and he had left the hospital and it was a female doctor. I refused to be seen by her and was eventually seen by a new male doctor. The new doctor said he would need to examine me again from new, I understood this. I then told him I would not want any of the female nurses (who kept popping in and out of the room) to be present while i was examined. He seemed unconcerned, I then said I would be very angry if a female nurse did intrude while I was in a state of undress and he magically found a lock on the door. It seems like sometimes you have to go on and on and on and on in order to get what you want. I have long learned to say what I want and to keep saying it until there is absolutely no room for doubt. Why do they pretend not to understand?

At Thursday, June 21, 2012 7:00:00 AM, Anonymous Anonymous said...

Because they can. I, too, have had similar experiences. They do get it.
Example...I told one of the female specialists that I saw regularly about an experience I had, my feelings about it, and what I need.
This female practitioner always seemed and was annoyed when I spoke of these issues. On one occasion, I asked her a question and she completely ignored me even after the question was clarified and continued to speak about my medical issues ignoring me (that was infuriating). Even though it occurred, when I needed to be rushed to the hospital, she mentioned that I would have an all female staff. I thought to myself...she did get it, but didn't want to admit to me that there is a problem.

It was interesting that they wanted a cardiogram and they sent in a female who was not qualified and got an erroneous reading, and sent her only because she was female. That made no sense and ended up costing the insurance company more money for unwarranted tests due to her bad cardiogram.

So, while the hospital wanted to comply, instead of waiting for a qualified technician who was female, they just sent in some nurse who didn't even know where to put the leads.

At Thursday, June 21, 2012 3:36:00 PM, Blogger Doug Capra said...

"Coincidence that she was placed next to that
table or the monitoring equipment in the photographs
or just a subliminal message directed to prospective
female patients."

Good points, PT -- but I don't think they're that sophisticated with their advertising. I can't see them setting around a table discussing this. But, as you say it could be subconscious on their level, too. It is true that much medical advertising is directed toward women.

At Thursday, June 21, 2012 5:20:00 PM, Anonymous Anonymous said...

I emailed you the details of my EMG experience you asked about.

At Thursday, June 21, 2012 5:43:00 PM, Blogger Maurice Bernstein, M.D. said...

My visitors to this Patient Modesty thread may be interested in a new thread I put up with the title "Coerced Medical Care: Is That Ethical?" Though of a different magnitude than that described in the new thread, I got the sense in the discussions here of degrees of unwanted coercion by doctors, clinics and the medical system with regard to patient modesty and provider gender selection. ..Maurice.

You may want to join Hexanchus who began the commentary portion of the new thread. ..Maurice.

At Tuesday, June 26, 2012 1:32:00 PM, Anonymous Anonymous said...

A Yayoo article out today about Hot Health Careers without a Bachelor's shows not a single male heathcare worker! How is this fair?

At Tuesday, June 26, 2012 2:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Isn't that "par for the course"? ..Maurice.

At Tuesday, June 26, 2012 6:05:00 PM, Blogger Maurice Bernstein, M.D. said...

For those who read and write on this Patient Modesty thread, I offer another view of genital modesty issue as an Essay written to the ethics journal Hastings Center Report in which the authors suggest that public ambiguity in the naming of female genital parts (using words such as "it", "the v" or "down there" leads to illegitimacy of the woman's anatomy. I put up today this topic including a link to the full free article on a new posting "Failure to Use the Anatomic Names for Female Genitals: Ethical Illegitimacy?" I put it up because I wanted to present my view that this was not an essential ethical issue for dialog. However, it looks, nevertheless like I am starting a dialog on my blog. Come join and voice your views of the topic. ..Maurice.

At Wednesday, June 27, 2012 10:30:00 AM, Anonymous Anonymous said...

This was posted over at Allnurses on a thread entitled "What are your thoughts on patients who request no male nurses take care of them".

"If only they knew what went on in the OR though, they would probably get over their modesty issues real fast, lol!"

Says its all.

At Wednesday, June 27, 2012 10:10:00 PM, Blogger Doug Capra said...

Anonymous says: "Says its all."

Actually, it doesn't say it all. I've pretty given up on allnurses. I don't check it out much at all. Most of it is technical nursing stuff, but I don't agree with the unprofessional, unethical "venting" they allow. I have more important things to do in life than read that garbage.

But, after your comment, I did read thread you mention -- the whole thread. Every post. And 99% of the posts defended a patient's right, male and female, to select gender for intimate care. And almost all said they would accommodate if they could and that most of the time they could. There were some exceptions where it wouldn't be convenient for them to accommodate, but if the patient insisted they would find a way.
Now, in fairness to you Anonymous, you picked that one liner about the OR. A few violations in the OR were mentioned on this thread. But you seem to imply that the whole thread came out against accommodation gender requests by patients. It didn't.
I'm getting tired of men whining about this. I still think providers should ask about gender accommodations. But most don't. So, what does that mean? It means we face the reality of the situation. This is the world of medicine, the medical culture we must learn to live deal with. Speak up.
Most will accommodate if you ask. And almost all won't dare not accommodate if you insist and/or walk away and/or state that you'll file a complaint. They know what's ethical and if they won't do it on their own they'll try to accommodate if you challenge them.

At Thursday, June 28, 2012 5:00:00 AM, Anonymous Anonymous said...


You are right. I overreacted. Point taken. Anon.

At Thursday, June 28, 2012 12:36:00 PM, Anonymous Anonymous said...

I hardly ever go to AN anymore. I believe we've seen that the certain groups that are offended by patients rejecting their gender in intimate care will rise against the patient's right to choose. "9 Things Nurses.." not only thumbed their noses at the modesty movement, but attempted to rub it's faces in it. A disturbing mentality that I just can't see wasting my heart and soul with.

We face what we face: If we can't change them then we must find a way around them.

I did, however reluctantly, read the above mentioned post and I was quite surprised. For the most part it was a respectful combination of comments. So I have to wonder...what is different than before?
Is it because it was posted on the male nursing forum and men felt they must show more respect and decorum than their female counterparts? Is it the fact that someone asked a group of mostly women how they feel about people rejecting male care? Is it that the question became personal and everyone had to then realize that choices should be seen both ways? Just what was it that kept them from running off and closing another gender question?

I'm curious if anyone else sees a reason for the drastic difference in responses.


At Thursday, June 28, 2012 3:19:00 PM, Anonymous Anonymous said...

I dont appreciate being treated like a slab of meat by these "professionals" but I REALLY dont appreciate it when they are boldly two faced about it. Recently my wife needed some extensive abdominal repair surgery. It was done a a swank plastic surgery center, not a community hospital. Ornate Spanish architecture, lavish furnishings, VIP treatment. Pre surgery the dr discreetly and most respectfully moves the gown around while marking reference points. He assures me they will take care of her. They administer drugs to prepare to go to surgery. She is drugged but responsive. Up to now absolutely all measures taken to preserve her modesty. They tell me I can go no farther back and assure me again they will take good care of her as the surgical team stands in the adjacent OR nodding in reverent agreement. Surgery goes well and my wife sleeps most of the following day. Slowly details of the experience return to her. She tells me after they ushered me out they stood her on an absorbent mat, removed her gown and scrubbed her naked with the Betadine pads on the spot. I could not imagine her standing naked in a room of 5-6 people being scrubbed like an animal. I was beyond livid. She has disconnected from the experience and does not want me to discuss it take any action. Again, the mistreatment is one thing, only made worse by looking me in the eye and lying to my face. My hate for these "people"runs deep.

At Thursday, June 28, 2012 5:46:00 PM, Blogger Joel Sherman MD said...

I have posted a new article on privacy in prisons. New federal regulations have greatly strengthened prisoners privacy rights and this has implications for us all.
Take a look.

At Friday, June 29, 2012 8:00:00 AM, Anonymous Anonymous said...


The problem is that this behavior is considered "standard of care". The fact that these experiences can be traumatic is the first reason you might want to consider reporting the incident. "To Do No Harm".

If patients at the least, knew what to expect, then they may feel uncomfortable but they won't be traumatized or...can refuse to have this done in such a public way.

At Sunday, July 01, 2012 9:19:00 AM, Anonymous Anonymous said...

Male nurses are collectively segregated on allnurses,
why. They have their little section called the male nurse
threads. Now sometimes,just sometimes they venture out searching for small edibles, and are allowed to mingle with the crowd, but generally they are whupped men.

They are such a small component, about 5 percent
of the population and have no real voice in any
matter. There are many old hens that police that site
to maintain law and order, thus any comments that go
against the grain are quickly removed and the offenders
are quickly punished.

The thread that Doug and Suzy are referring to is
only for female patients, not male patients. We have
seen what happens when the topic regarding male
patients enters the pit, most often closed. Appreciate
the gender of many posting on that thread are
indeterminate, and most of them female.

As Suzy suggested, the comments were predictable
based on it being in the male nurses thread and with
the majority of posters female. Too often we see this
mania that drives optimism in that there must be some
truth,some fairness and some rules. The reality is people cannot accept hard discrimination when it
stares them right in the face, it is too conflicting with
their ideals and conformity.


At Monday, July 02, 2012 9:55:00 AM, Anonymous Anonymous said...

the link to the article on privacy in prisons does not work

At Monday, July 02, 2012 11:06:00 AM, Blogger Joel Sherman MD said...

Thanks for the heads up. The article on prison privacy had to be reposted right after it was put up. I guess the url changed.
Try this link.

At Sunday, July 08, 2012 4:21:00 AM, Anonymous Anonymous said...

I live in the UK. On the BBC radio the other day, a female massage lecturer was being interviewed. She was asked the usual questions about various issues and eventually the interviewer asked her about underwear on or off for a massage. She said her own preference while giving a massage was always underwear on. She did however say that from her extensive conversations with other masseurs, MOST MEN were uncomfortable with the idea of removing their underwear for a massage. She said that in general men were just as embarrassed as women in these circumstances and that men being "brazen" or "unbothered" by nudity were as far as she was concerned, a myth.

At Thursday, July 19, 2012 5:47:00 AM, Anonymous Anonymous said...

Has this discussion lost steam? It has been quite some time since I have seen any news posts. Maybe all has been said that needs to be said (but still not resolved: what happened to the advocacy blog?) Anyways, just wanted to mention something I saw recently on a website providing information on how to choose the right doctor. One of the aspects the authors mentioned a patient may consider in making a choice was that of a doctor's gender. But they went on to say that studies show women are much more likely to pick a doctor based on gender, especially for things like breast, cervical and colon cancer screening and that men don't seem to choose a doctor based on gender. So, I wonder who are they basing these studies on? Obviously not the men represented on this blog. So it still seems at times like this medical modesty issue (for men, anyway) may indeed be just a concern for the small minority.

At Thursday, July 19, 2012 10:01:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous, as I have noted many times on this thread previously, we really don't know to what statistical degree in the entire patient population that physical modesty issues in men play a role in their medical care simply based on what is written to this blog thread.

Here is a new topic which hasn't been discussed at all in all of the 49 Volumes. Do you think that the issue of physical modesty is really just an extension of a general psycho-social expression of modesty and privacy that the individual expresses in many other aspects of his or her daily life including going to the doctor? I realize that all of us express the desire for privacy in our lives to some degree at times (though one would hardly know that by looking at what goes on with Facebook!), nevertheless, may I propose that there are some patients who live a exceptionally private life and which extends to their own "privates". How is that for a psycho-social correlation and a variant for discussion on our quiet Patient Modesty Volume 49? ..Maurice.

At Thursday, July 19, 2012 11:33:00 AM, Anonymous Anonymous said...

I know that I am a very private person in my everyday life and have always been modest even as a child (as far as showing "skin", so to speak). I do not do Facebook. I think medical modesty is, indeed, an extension of my general psycho-social persona. And maybe that is rare in our current social climate (as you mentioned, all the "sharing" on Facebook, etc.). Along with the general modesty and privacy issue I also think that medical modesty involves a compromising of control: the patient feels out of control about what happens and how their body is viewed, examined, etc., especially in a hospital setting where numerous caregivers are involved. That is part of it for me anyways. So maybe I am not only a private person (maybe even, heaven forbid, a loner) but also a control freak. Yikes! Any others feel this way?

At Thursday, July 19, 2012 1:22:00 PM, Blogger Maurice Bernstein, M.D. said...

"Control" has been mentioned on this thread in the past. If the majority of patients need to be "in control" while being examined for an illness why is it that most patients (in my experience virtually all patients) fail to "speak up" before the exam and express their potential modesty concerns? "Speaking up" to the doctor or tech would be part of a method for "control". One could assume that the reason they don't is because of the power difference between the patient and the doctor/tech at the time. Another explanation for not "speaking up" is that most patients voluntarily decide to lessen "control" when they pair it with the value of a proper and needed examination. Unfortunately, there are some patients (who have written here) who insist on "control" at all live's cost and will refuse exam or procedure despite doing so might or will risk their life.

It might appear wonderful if every patient could get "what they wanted" within the current medical system but realistically, they can't or in some special cases, they shouldn't. So each patient when they decide autonomously (consent)to an examination or procedure has to consider also the factor of temporary "loss of control" whether it be provider gender selection or the total loss of control with general anesthesia, as an example. One has to weigh temporary loss of "control" against potential "benefit" and then come to a decision. I think most patients despite what is written here will decide temporary loss of "control" is worth the outcome. ..Maurice.

At Friday, July 20, 2012 7:57:00 AM, Anonymous Anonymous said...

Loss of control is the central theme of psychological trauma. It's great when you can express your concerns, but what happens when you don't realize you have concerns? That's when it's too late and the damage is done.

It's up to the medical community to explain what's going to happen when it concerns someone's dignity. They may be uncomfortable but they won't be traumatized.

I believe the reason that they don't share, is that if more people understood the degree of exposure in a mixed gender room, they may object and the medical profession would be forced to find better ways to protect patient dignity.

At Friday, July 20, 2012 8:50:00 AM, Blogger Hexanchus said...

Dr. B,

Giving up control to general anesthesia isn't as necessary as it used to be. Case in point, in India there is a cardiac surgery group that has done over 1000 open heart procedures, including bypass & valve replacement, on awake non-intubated patients using high epidural anesthesia.

While there are some patients that undoubtedly would not want to be awake for surgery, I believe many would choose that option if it were given to them. The problem is that most surgeons/anesthesiologists don't even bring it up - IMHO they prefer working with unconscious patients.

I personally have had three surgeries where I was awake and completely unsedated. A combination of local/regional anesthesia was used - no narcotics or benzodiazapines. Didn't even have an IV for two of the three, and the one I did was for preop antibiotics.

Oddly enough, the option wasn't even discussed until I brought it up. There was some initial resistance, but when I explained my reasons (and told them there would be no surgery otherwise) they agreed to go along with my request. In all three cases, they remarked to me during the surgery that it was really different from waht they were used to, and kind of nice to be able to talk with the patient during the procedure.

For me, it's the way to go. None of that silly NPO crap, and for the last two I even drove myself to & from.

At Friday, July 20, 2012 8:57:00 AM, Anonymous Anonymous said...

Belinda. It's the old saying "To divide and conquer".I believe most people feel they have no choice or say so.The medical field try's to make you feel like your the only one that feels that way.The internet say's otherwise.They think you should get naked for them at the drop of a hat.It shouldn't matter to you who it is or how many.Their prpfessionals,remember.But it does matter to some.Does the percent really matter?I think most people just assume that their modesty will be protected.That would be a wrong assumption.They must hate the internet for connecting the people around the world to what's going on. AL

At Friday, July 20, 2012 12:49:00 PM, Anonymous Anonymous said...


While being awake during surgery is an option, it doesn't give you control over your body when it is paralyzed and normally, restraints are used for arms when awake patients experience surgery with spinal anesthesia.

It might be even more traumatic if you didn't know what to expect, and then you are carelessly treated, or treated in manner that one would absolutely consider to be cruel and degrading.

So, it is an individual preference for some to be awake, and for others to decline.

I know this...after suffering at the hands of medical personnel, I will never explicitly trust anybody to do anything unless I call the shots with who does what to me and who is in the room, advocate included.

At Saturday, July 21, 2012 4:25:00 PM, Blogger Joel Sherman MD said...

Readers make a difference. Please see our latest post how a reader of hours was able to get a nurse's abusive blog deleted.

At Sunday, July 22, 2012 6:23:00 PM, Blogger Elisa Hampton said...

This may be of interest to some of your followers. I just posted at regarding why there appeared to be many jokes/snide and belittling remarks about male genitalia on their site. I stated that as an female Australian RN with 20 years experience, presently in ED (ER-USA useage), I had never encounted this sort of behaviour. I apparently had the insufferable hide to dare to suggest that this may be a reflection of a cultural difference between Australia and USA,with Australia being a more liberated and generally less conservative society than that of the USA and I have visited the USA many times. My post initially appeared but within minutes was deleted. I received a notice that my post was divisive and therefore was deleted. What it really means is that it was not supporting their backslapping, high fiveing status quo. Regards Elisa Hampton RN Australia.

At Sunday, July 22, 2012 6:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Elisa, thank you very much for reporting your experience with to our thread here. I think what you experienced provides a sort of "empirical evidence" of what has been suspected here about that website. If what you had written to the site was considered "divisive" shows that the site has an agenda to disseminate and one that is not open to free discussion. Again, thanks. ..Maurice.

At Monday, July 23, 2012 11:08:00 AM, Anonymous Anonymous said...

I thought the USA was the land of free speech.

Everywhere it seems excpet allnurses!

At Monday, July 23, 2012 6:07:00 PM, Anonymous Anonymous said...

Today I went to the hospital for a routine test. The technician couldn't contain herself (and said so) and wanted to know why I wasn't wearing a hospital gown that is routine for this test.

I just let it all hang out and I said, " because I was sexually abused in a hospital and that's what I was wearing at the time and I have no intention of ever wearing a gown again."

She was a lovely woman and replied that in my circumstance, she didn't blame me one bit.

What I thought was interesting is that she was flustered by me in appearing for my test in a bright aqua linen blouse, but wasn't flustered by my response and even shared a story about her daughter.

I also told her that if I needed an ultra sound as a follow up that the tech and the doctor had to be same gender and I would have to make an appointment if that couldn't be arranged.

The conversation was pleasant but I wanted to let her know that my decisions are mine, they had no say and her degree of pleasantness was a surprise.

It was all due because she treated me like a person; not a patient. Is it because I didn't wear the uniform??? Interesting thought.

At Monday, July 23, 2012 7:39:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, you bring up an important thought. I was thinking, as a doctor, I see and very likely communicate to a person differently if that person is a patient in a clinical environment, particularly one for which I have responsibility compared with any person or even that patient person but whom I meet on the street, in a market or sitting at the next table in a restaurant. I have a feeling that most doctors may sense a difference between a patient sitting across the desk in the medical office compared with the patient sitting on the examination table in a gown.
I think a patient wearing a gown and the doctor covered with a white coat does change the communication and interaction and reaction environment as you suggest. ..Maurice.

At Monday, July 23, 2012 9:28:00 PM, Anonymous Anonymous said...

Anonymous said

" I thought the USA was the land of free speech
everywhere it seems except all nurses."

How true,yet it's worth mentioning that you never
know who deleted the thread. It seems that many
comments are deleted on that site that actually
don't violate the TOS agreements. I believe I
once met Brian, if it is the same man, this nurse
I met a number of years ago had an artificial arm.
He actually started the site.I am not sure how to
contact him or if it would be worthwhile to actually
speak with him, and it would be interesting to know
what the legal scenario would be for deleting


At Tuesday, July 24, 2012 5:50:00 AM, Anonymous Anonymous said...

Belinda and Dr. Bernstein:
I was thinking after reading Belinda's story about not wearing a gown for her test: why does anyone have to wear a gown if it is possible to do these tests/exams with the patient wearing their own clothes? Obviously the test was done without Belinda putting on the gown (am I right?), so why is it required for anyone? Are there some exams and tests that indeed can be done without donning the hated gown and, if so, why is that not the norm? Most people probably would not think to question the whole practice so why is an option not offered (gown or own clothing?). I can bet that if a choice was given most people would pass on the gown. I think it is just another case of "standard procedures" and to me that is just one more instance of patients having to give up control of any sort. We are just to obey standard procedures whether they make sense to us or not. I may not mind doing things if I know the reason behind it and if I feel like it is a valid one. But many times patients are just told to do things without an explanation. To some of us many of those things don't make sense and seem excess. There is still a big issue of noncommunication, maybe because of a lack of time or because a lot of assumptions are made. Jean

At Tuesday, July 24, 2012 6:24:00 AM, Anonymous Anonymous said...

Jean, another personal story.

Previous to this location, I had the same test done at another location. They handed me a gown and when I came into the testing room without it, the technician argued with me.

It caused me to blurt out the reason and made me feel violated that I was forced to disclose something just to get what I needed. She was very understanding after I told her, giving me "permission" not to don the "uniform".

After meeting with the owner of the testing site (who was quite patronizing - and I complained about him as well), it was explained to me that the gown is standard and that the technicians don't want to be responsible for buttons or other things on street clothes that could damage test results, so the demand is generic.

After speaking to the owner, they actually changed procedure and now give the option to wear street clothes and have trained their techs on what to look for.

Thank you for your comment. Given your support of my observation, I would ask why anyone would want to wear the gown? I also think, for the medical staff, it makes it easier to treat patients removing the person from the patient and look at medical needs in a neutral environment. There are two flaws to this, first we are both body and mind, and secondly, it makes a patient easier to be objectified when the person is removed. I think this is actually a problem and one that should be addressed.

Finally, it is very liberated and enables me to get treatment when I present logical arguments, gain agreement and establish a plan. It give the patient comfort and control.

At Tuesday, July 24, 2012 8:57:00 AM, Blogger Hexanchus said...

Getting the patient into a gown is also a psychological tool that is deliberately used to establish control. It puts the patient off balance and in a perceived position of subservience, making them much more likely to "do what they're told". It's no different than parading terrorist prisoners at GITMO naked in front of female guards - same principle.

This is a deliberate tactic that is taught in nursing school, or at least it was when both my wife & sister were getting their nursing degrees.

This is why one of the ways I strongly encourage patients to stand up for themselves is to simply ignore the instruction to disrobe and put on a gown before they even see the physician. The initial discussion between physician and patient should be on an equal basis - not one of patient subservience. By not playing the game, the patient puts the provider slightly off balance, allowing the patient to take back a semblance of control over the interaction.

At Tuesday, July 24, 2012 9:04:00 AM, Blogger Hexanchus said...


Kudos to you for standing up for yourself!

While it wasn't sexual in nature, I was physically abused (assaulted?) leaving scratches and bruises, in a hospital, at the age of nine, by a nursing instructor that tried to physically force me after I refused to cooperate with being used as a teaching tool for a bunch of nursing students. So while it's not quite the same, I do sort of understand where you're coming from.

At Tuesday, July 24, 2012 9:31:00 AM, Anonymous Anonymous said...


It's exactly the same. Psychological trauma comes in all shapes and sizes. I, too, was what I call, medically sexually abused in a hospital. While I will recognize there are differences in each person's experience, what you experienced was horrific and what I experienced was also horrific although the experience was different! Congrats for handling everything since.

I must say, I never found out what happened with your relative but hope that it all worked out for her.

At Tuesday, July 24, 2012 9:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Wearing a paper or cloth gown is to make access to the patient's skin for proper and effective inspection,auscultation,palpation and percussion possible and is also more convenient for the examination process than serially removing or attempting to move clothing around from the anatomy being examined. Attempting to examine through layers of clothing is virtually not examining at all.

I certainly would discourage x-ray taken through clothing containing radio-opaque objects that could obscure the underlying anatomy or a lesion.

As I have said, though, I am sure that physicians may have a different view of, attention to or communication with the patient wearing a gown from one in street clothes to one wearing a gown. ..Maurice.

At Tuesday, July 24, 2012 10:14:00 AM, Anonymous Anonymous said...

There's a difference between being prepared for an exam (having removed underclothing, etc. ahead of time) and coming to an exam as if one just walked off the street.

I suspect removing clothing piece by piece would be uncomfortable for patient and physician.

I have all MRI's, Xrays etc in street clothes that are cotton, no metal, no hooks, no zippers and no problems.

I will say, that the goal of going gown free is much easier for women (sorry PT) because they wear skirts!

At Tuesday, July 24, 2012 8:30:00 PM, Blogger Hexanchus said...

Most common fabrics, natural and synthetic, have very low radiopacity values, so they would not impede x-ray imaging.

As Belinda said, as long as the garments have no radiopaque elements such as hooks or zippers in the area being x-rayed, it's not an issue.

MRI imaging is a little different. The strong magnetic fields used preclude the use of most metals.

A simple cotton or cotton/polyester sweat suit with no metal grommets, etc. works just fine in almost all situations.

At Tuesday, July 24, 2012 8:41:00 PM, Blogger Hexanchus said...


The situation with my niece worked out about as well as we could realistically expect.

My niece is just fine and as feisty as ever.

The facility sent her a letter of apology in which they also promised to update training of their personnel to avoid the potential of a repeat situation.

The two personnel directly involved negotiated a plea which involved writing letters of apology and community service, with an option of having their record expunged if they keep their noses clean for 2 years. They also got a written reprimand from the BON.

At Tuesday, July 24, 2012 9:32:00 PM, Anonymous Anonymous said...

Sometimes I think the comments and the mentality on this blog approach the level of ridiculous. If you are
scheduled for an MRI, you don't want to be wearing
street clothes that contain any kind of ferrous metal.

The magnet is so powerful that ferrous metal in or
on your body can become a serious danger to you. If
you were ever a metal worker, screening x-ray of your
face will be done to insure no tiny fragments exist in
your eyes, those small fragments can become bullets.

Several years ago a small boy was killed in an MRI
scanner when someone left a metal(steel) oxygen tank
in the room. When the magnet was energized, the tank
became a projectile and killed the little boy. The tanks
and everything in the room are aluminum,a non- ferrous

Same scenario with a cat scan, if you have metal
on your body the metal will ruin the quality of the scan,
requiring you to possibly have parts of the scan repeated, a higher radiation dose to you.

The same problems will be encountered in x-rays
as well as thermal imaging and a pet scan( positron
emission tomography) and NM( Nuclear Medicine).

Use common sense, make your concerns known to
the technologist performing the scans. Gowns are
always offered for these exams and an adjacent dressing room. Most simply double gown, one on front
and one on the back.


At Tuesday, July 24, 2012 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks PT. Based on what you have told about your work history, I already knew you would return and post the reality of what was being discussed. Again, thanks. ..Maurice.

At Tuesday, July 24, 2012 10:44:00 PM, Blogger Hexanchus said...


Agree with you on the issues with MRI. That said, you can wear street clothes that do not contain metal such as a simple cotton sweat suit - I have done so without any effect on the quality of the image. I did have the waters x-ray before hand.

With x-rays or CT, it only matters if the metal is in the area being imaged.

I have to disagree with you on thermography though. Unlike the other imaging technologyies you mentioned, thermography is a passive imaging process. With thermography you're looking at a thermal image of the skin surface and immediate underlying structures that is the result of infrared photons emitted/radiated from the skin surface. Even with the most sophisticted and sensitive cooled detector scientific IR imagers, you can't get effective resolution through clothing - even a thin gown. Thus the skin area being imaged must be exposed. You're looking at differences of 50-100 mk or even less, so surface emissivity becomes a major factor. The emissivity of human skin is a relatively uniform 0.97. A gown or other covering is going to have a different emissivity that will need to be measured and corrected for.

The good news is that the patient is typically alone in a small room or test chamber that is kept at a cooler than normal temperature to enhance thermal sensitivity and contrast. The thermographer and anyone else are outside and only see the thermal image, not the patient. As an ASNT level III thermographer and court certified expert witness, I know wherefore I speak. Of course there are exceptions - I know a thermographer that did imaging of the human brain in an OR during a craniotomy looking at blood flow patterns.

At Wednesday, July 25, 2012 7:55:00 AM, Blogger Maurice Bernstein, M.D. said...

I am thinking that the contributors to Patient Modesty thread would be interested, particularly with regard to the discussion about the behavior of those within the medical care system would be interested in reading the following commentary from Anonymous which was published today on the "I Hate Doctors: Chapter 3" thread. ..Maurice.

I quit reading all of these comments after a while. I actually ended up here because I googled "I hate working for physician's"....and some of the time, that is true. Some of them are so high up on themselves that in their 10 years of education, they didn't even grasp the basics of common courtesy or respect.
Regardless, I work in an office with about 15 doctors. I would say of the 15, probably 12 of them leave me alone to do my job. The other 3 make me want to quit.

I am overworked, underpaid, and no human on this planet can possibly keep up with the amount of work we have to do. After reading these comments though and thinking about a typical day at work, I realize it is the patients I hate the most.

If I am working in the walk-in clinic, I check in at least 10 patients in an 8 hour period that want to see the doctor because "their throat is sore". Nevermind that there are 20 other people in the waiting room with actual problems, yet Mr. Sore Throat is going to be the one coming up to me every 5 minutes asking me how much longer he has to wait, complaining how unfair the healthcare system is, blah blah blah. You still have to wait over an hour, just like you did five minutes ago. Yes, I agree it is rediculous to wait 2 hours to see a doctor for a sore throat, I also think it's rediculous to even go to your doctors because you have a sore throat. You don't need antibiotics, even if you have strep. You need to gurgle some aspirin for a few days until it goes away. If you're going to wait for 2 hours to see the doctor, I think you need a life, and yes I am rude to you because I have piles and piles of work to do, and you keep interrupting me with your complaints! I used to think the doctor couldn't possibly be as stressed as I am, because I have so much work to do and all he does is get his little clipboard and talk to the patient for 5 minutes, but I figure he probably is pretty close to as stressed as I am, because his JOB is to listen to people COMPLAIN. Complain about their illness, complain about their injury, complain about their healthcare system. I am allowed to tell the patient to save it for the doctor, and by the time the patient gets in to see him/her, they have that much more to complain about - I was rude to them, they had to wait too long, wah wah wah.

Nevermind that I live in ONTARIO, where healthcare is paid for out of our taxes. Now patients complain incessantly how the government plans to cut billions of dollars out of our healthcare. Well I don't blame them. I bill OHIP after every patient visit, and every time you come to the clinic for your "sore throat" it costs the government at least $50.00 for your 5 minute visit. If an 8 hour period, if I check in 10 people with sore throats, you just cost the government $500.00 PER DAY.

Worst of all is answering the phones and listening to you bitch about how you called three times before someone picked up. That's because I'm busy listening to the person in front of me bitching about how they have been waiting for 2 hours and their throat hurts and no one cares wah wah wah. Then to complain about how we are rude to you or incompetent. Doctors are not miracle workers, they are people with a very expensive education. And just like any education, some of them probably barely made it through, and some of them probably worked really hard. Regardless, they are JUST people. Patients need to acknowledge that, and so do some of the doctors. I could careless about their credentials, and I would trust Google just as much as I would trust any regular old GP.

At Wednesday, July 25, 2012 8:02:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is the link to the "I Hate Doctors: Chapter 3" thread which I forgot to include in the above posting. ..Maurice.

At Wednesday, July 25, 2012 10:11:00 PM, Anonymous Anonymous said...


I certainly agree with you and yes thermal
imaging is demonstrating that it can detect breast
cancer years before the same cancer is found by
mammography. I referenced thermal imaging only
in regards to clothing issues,actually no clothes
can be worn over the area imaged.

I want to reiterate the importance to our
readers about wearing proper gowns for imaging
studies. Metal artifacts is not the only issue that
can negatively affect your study. It's about how
the beams are attenuated through body parts and
particularly certain clothing. Denim jeans and certain
kinds of clothing can conceal phantom fractures and
soft tissue abnormalities on radiographs.

Even skin folds and medial scapular border
misinterpretations have resulted in unnecessary
chest tube insertions in many patients. I do believe
reasonable balance exists between receiving quality
healthcare while maintaining privacy.


At Thursday, July 26, 2012 6:06:00 AM, Anonymous Anonymous said...

Wearing attire that will promote the proper test results are important to me. So, one would have to do a little research into material used in traditional hospital apparel or paper gowns. It doesn't take rocket science to figure it out. I've been doing this for years and have never had a negative or poor result.

Wearing a hospital gown for someone who has a negative traumatic memory attached to one, serves no purpose to the patient. Actually, it can have negative consequences to the patient, raising blood pressure, heart rate and create anxiety that may all be prevented. It may seem odd to some, but I'd rather go without a covering rather than wear a gown.

Gowns/clothing are removed for mammography, radiation treatments.
Sensible cotton clothing without zippers, buttons, etc. serves the exact same purpose, while not objectifying the patient, or making one who was mistreated while wearing one, to have a negative experience while wearing a gown.

Isn't the objective to create an environment for yourself that allows you to get the treatment you need? Isn't the objective to get patients to come back to a hospital when they need one? A little intelligence, homework and the will to take care of yourself and be recognized for such, is a small price to pay.

Just for the record, I would love to hear examples of clothing that does not contain the proper fibers for testing. We all know that metals shouldn't be worn during tests that involve radiation and MRI.

At Monday, July 30, 2012 9:10:00 PM, Blogger Maurice Bernstein, M.D. said...

I have a question that has to do with the etiology of the physical modesty as expressed on this thread by the patients or potential patients. Do you think that a patient's modesty is specifically related to a patient's concern that either he or she or the healthcare provider will become sexually aroused on exposure of the body parts and is not primarily related to patient's need to have a sense of general "control" over the patient-provider interaction. From a provider's point of view prevention of distraction and attention to professional behavior sexual arousal is an important issue in general. However, specifically for the patient's sense of control, the interaction with the physician or other provider, sexual arousal by either party must be prevented. Therefore, physical modesty must be maintained.

How is that for a theory and explanation of patient modesty? ..Maurice.

At Tuesday, July 31, 2012 1:08:00 AM, Anonymous Anonymous said...

I would say the answer to that question is "No". It seems funny to me that I would say that after being victimized in a sexual way in the hospital. I realize that it's the rare exception.

It seems that it's about humiliation, and degradation that bodily exposure can cause if not handled properly (as in Art Stump's example) (or in mine).

He was supported by staff and hospital. I was not. He developed relationships with the staff. I don't think I'm capable of that kind of trust now. There's always someone who is ignorant and too many that don't care and worst of all, those that do it for power and control on purpose. This happens more often then you would want to know. Sad but true.

At Tuesday, July 31, 2012 5:47:00 AM, Anonymous Anonymous said...

I'm not sure I totally follow your line of thought but I can say that my modesty concerns have never been associated with a sexual component. Quite frankly I do not even like to be disrobed in front of another woman but it is not as upsetting as being that way in front of a male. If there is a sexual basis to it, then it is so buried that I am not even aware of it. For me it may be more of the embarrassment factor: maybe I have a fear of judgment of my body even though it is probably in better shape than the large majority of those my age. For me it is also the loss of control and feeling of vulnerability. It never has been sexual. Jean

At Tuesday, July 31, 2012 7:52:00 AM, Blogger Maurice Bernstein, M.D. said... about all you men? Is it all about concern regarding developing an erection during the exam? ..Maurice.

At Tuesday, July 31, 2012 8:39:00 AM, Anonymous Anonymous said...

Dr. Bernstein:

Sometimes I don't understand why this issue becomes more complicated than it really is.
Is there really no scenerio where you as a man would be uncomfortably humiliated by nudity and/or genital touching by a group of females? Or even one female? Why isn't the idea of wanting to keep your nude body covered in front of the opposite gender enough of a reason for modesty....medical or otherwise?

For you, would all modesty about being nude in front of strangers simply be based on the fear of an erection? I have to believe there would be times where simply being naked would bother you, with or without an erection.

For me: I like to choose who touches me, or for whom I show my naked body. I see no puzzle in that.


At Tuesday, July 31, 2012 8:57:00 AM, Anonymous Anonymous said...

It's not about an erection. I'm too pissed off at the power and control being exercised over me to get aroused.

At Wednesday, August 01, 2012 9:46:00 AM, Blogger Maurice Bernstein, M.D. said...

BJTNT, from where does the "power and control" arise? From the medical system and healthcare providers? Yes, one might, at first, look at the "power" as being unequal in the sense that the patient is the one who is sick and may have less knowledge regarding diagnosis and treatment of his or her illness than the doctor. But, what can more than equalize the "power" is the "informed consent" potential of all patients. Without informed consent by the patient all acts within the provider-patient relationship cannot occur. If, at any time, consent is requested but the patient is not fully informed about the details of the action the patient can refuse. Patients should be made aware of this consent "power" they hold and, of course, all physicians and other healthcare providers should be reminded. Remember: paternalistic medical care now is or should be virtually gone with patient autonomy as the guiding direction regarding the doctor-patient relationship, medical diagnosis and treatment. ..Maurice.

At Wednesday, August 01, 2012 11:03:00 AM, Anonymous Anonymous said...

Maurice, I think (because I have seen a repeat pattern) that medical pesonnel do not understand and it's time to put on their "patient hat".

Patient do not know enough to refuse a treatment based on expected bodily exposure, or exposure in front of whomever because they are not properly told enough to decide whether they consent.

It's only AFTER the fact (when the damage is done) that the bells go off. Things happen so quickly that it's almost always too late.

At the current time modesty and privacy issues are not discussed in informed consent.

As per the "Naked" article of some years back, there should be standarised care with regard to those psycho social expectations on what to wear, how undressed one is, who is in the room, so that patients can prepare themselves for a necessary emotionally uncomfortable experience.

They will also know when someone is not acting in their interests and may have alternative reasons for various states of undress that are simply unnecessary.

Should the medical profession decide to keep everything either a big secret or worse, invalidating patient feelings, then trauma will and does surface. The medical community has the burden of fixing the problem if they want to do no harm.

At Wednesday, August 01, 2012 12:30:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, could you provide us all with some examples of what words a healthcare provider should use for informing the patient about a female breast exam or a male or female genitalia exam? How should the communication be phrased to be fully informative and open to consent or dissent? This will be very useful for me since the words which are taught to medical students are definitely not directly derived from patients. In practice, for example, I would simply tell a female patient "I am now going to examine your breasts for lumps and tenderness, is that OK?" After she gave consent, often, I would ask the patient to help in exposing her breasts. If she did "help", this would indicate to me a confirmation of her consent. I am sure most considerate doctors would take the same approach.

By the way, my other visitors, besides Belinda, can also respond to my request for examples on this subject. ..Maurice.

At Thursday, August 02, 2012 5:29:00 AM, Anonymous Anonymous said...

I don't think Belinda is referring so much to a one-on-one exam with doctor and patient, when the expectations and consent are pretty obvious. It is more a problem when elective surgeries, procedures, tests, etc. occur: when there are numerous other medical nurses and/or assistants present other than the doctor. That is when patients are often "surprised" by the number and gender of those attending to assist and that is also when the patient has not been told what to expect as far as exposure and who will be there, what they will be doing, what they will see, etc. The patient may give consent to the procedure ahead of time without knowing what to ask and without being told in greater detail what will happen. The scenario is much more damaging in those situations than it would be in a simple doctor's visit exam.

At Thursday, August 02, 2012 8:30:00 AM, Anonymous Anonymous said...

In response to Dr. B., it's the attitude of entitlement within a long enduring culture, most clearly exhibited by the techs, receptionists, aides, et al [support staff].
Why should the staff ask permission when they have the power? They don't even deign to tell the patients anything, they just issue orders. Why should they extend the common courtesy of "asking" as a polite way of informing? It's not a consensus interface because they can practice control with impunity. It's human nature, when you have the power, use it.
I have never felt dissed by an MD, but I totally blame them for the culture because they are the only ones that could affect a change. Yes, I had one incompetent anesthesiologist and my urologist/surgeon described the disadvantages of ultrasound when I
stated to him that I should have opted for lithotripsy instead of surgery. I liked him, so I didn't correct him. It does add to the saying that
"once a surgeon, only a surgeon".
Isn't timeliness part of informed consent? When a patient is asked to sign consent agreements on the way to surgery, I consider this duress in the legal sense and am surprised that ambulance chasers haven't sued MDs many times on this charge. Why shouldn't the surgeon provide all appropriate forms at the first consultation? The lame excuse of paper repro cost diminishes the integrity of the medical profession.

At Thursday, August 02, 2012 9:04:00 PM, Anonymous Anonymous said...

I am surprised no one has called attention to the NY Med show on ABC. The show feature real docs, nurse and patients, not actors, and not staged recreations. The patients are in the hospital for scheduled surgery as well as ER visits. The full episodes can be watched on the website for free at the links below. First episode, first patient, guess what he’s in the ER for? Surprise, of course, it’s a priapism! One of the nurses jokes “It’s alive!”

Be sure to click the Videos tab and watch this one:

You hear a man screaming, yes screaming, a bunch of people dash into a curtained off area and the nurse chuckles “Men really don’t like foley catheters being inserted.”


At Thursday, August 02, 2012 9:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Sandy, thanks for the links. This should stir up a bit of a conversation on this modesty thread. ..Maurice.

At Friday, August 03, 2012 11:05:00 AM, Anonymous Anonymous said...

I have just watched the video women v men in pain.

I can't get over just how many random people just stopped and gawked at the poor screaming guy. They were not involved in his care - just staring for their own amusement?

As for the female patient - again, I was horrified at just how many people are milling around as she was having her clothes cut off. Privacy and modesty anyone? I'm glad she couldn't see what was going on.

I hope I am never in an accident and have to go the ER.


At Saturday, August 04, 2012 9:41:00 AM, Anonymous Anonymous said...

For those who haven't heard a urologist with Mt. Sinai
hospital was arrested on the subway for secretly taking
photos under the skirts of women. Here is the link.


At Saturday, August 04, 2012 6:59:00 PM, Anonymous Anonymous said...

It is very difficult to believe that nobody in the employ of that hospital never saw this doctor do anything that was inappropriate.

Deviance cannot be turned on and off.

So, where are all those hospital employees that knew something wasn't right? Should the same thing that happened to Joe Paterno happen to them if they witnessed sexually deviant behavior and didn't take responsibility for reporting it and getting results?

At Saturday, August 04, 2012 7:17:00 PM, Blogger Maurice Bernstein, M.D. said...

I have a general question that deals with the underlying theme, the underlying concern of this Patient Modesty thread and volumes. Is the concern primarily related to sexual deviation of outliers in the medical profession? Is this issue the basis behind everything that is written here about personal physical modesty?

I would say, and I'm sure you all agree, that sexual deviation in professional behavior should never be tolerated but I can't believe that this is the underlying basis for the comments written here all these years. Am I wrong? ..Maurice.

At Saturday, August 04, 2012 9:02:00 PM, Anonymous Anonymous said...

My comments will be published in two parts due to space limitations. Part one follows:
"OK how about all you men? Is it all about concern regarding developing an erection during the exam?"
I'm confident this is a real fear for most teenage boys (it was for me) but certainly not the vast majority of adult males. And for those that are concerned, wouldn't you agree that the real issue is how the medical community should minimize and mitigate those concerns?
"Is the concern primarily related to sexual deviation of outliers in the medical profession? Is this issue the basis behind everything that is written here about personal physical modesty?"
Frankly, Dr Bernstein, after 49 volumes, I'm amazed and disappointed that you continue to ask these questions. Why people feel the way they do simply isn't relevant, IMO. We don't need to justify or explain our feelings to anyone, especially when we're paying for a service that claims we'll be treated with privacy and dignity. The fact is there are lots of folks who are simply pissed off about this to varying degrees and the medical community needs to accept it and change accordingly. What other service industry treats their customers this way? Only the U.S. military or law enforcement has a similar culture expecting such compliance.
Being treated with dignity and respect isn't rocket science. The fundamental issue is who defines privacy and dignity and how it's implemented equitably for all patients regardless of gender. My opinion is the patient defines it and I shouldn't have to ask, insist, or demand to be treated with respect. Yet my real world experience with healthcare providers has been exactly the opposite.


At Saturday, August 04, 2012 9:03:00 PM, Anonymous Anonymous said...

Part two continued:
I prefer male physicians for male health issues for the same reasons many women prefer female physicians for female health issues. When seeing a physician for the first time, I can be sure of exactly three things; gender, board certification, and the true professional status they've earned that permits me to discuss extremely personal health issues with a stranger and drop my pants for the resulting exam or recommended procedure. My consent isn't a blanket authorization for the female nurse/assistant, who've I've never met, arriving in the exam room unannounced, with little if any introduction, and no explanation of why their presence is required.
Or the male PA for a full body dermatology exam, who walked into the exam room with a female (nurse, medical assistant, tech, chaperon, or receptionist, for all I know), without my consent. There is a professional distinction and their failure to identify themselves correctly, is at a minimum, ethically questionable if not illegal.
Or the female charge nurse, after being prepped privately for a cardiac catheterization procedure by a female tech, completely exposing me from the chest down in the OR, and shaving from the waistline down to include my inner thigh and genitals, while numerous "observers" watched.
Or the female nurse who stated that she would catheterize me if I couldn't urinate (my first attempt immobilized flat on my back) in the next 10 minutes even though I didn't need to urinate.
Or the three female nurses who just walked in and observed while two other female nurses obtained x-rays requiring complete nudity from the waist down. Whatever happened to patient advocacy, welfare, privacy, dignity, and simple consent prior the event? If the genders were reversed, these same female providers would likely raise hell, and well they should. In contrast we're labeled as difficult patients!
"Patients should be made aware of this consent "power" they hold and, of course, all physicians and other healthcare providers should be reminded. Remember: paternalistic medical care now is or should be virtually gone with patient autonomy as the guiding direction regarding the doctor-patient relationship, medical diagnosis and treatment."
You're joking right? Informed Consent is an academic concept which isn't practiced in the real world because of expediency and profit. After 49 volumes of patients complaining about this issue, you haven't figured this out yet?
DonMD, a physician who does work in the real world ( modesty issues pg 7) summed it up perfectly from a male patient perspective.
"The bottom line is that a man without pants is as exposed, in any position, as a woman in stirrups for a pelvic exam, and should be given as much privacy as we accord a woman in that situation. All patients need to be treated as if they are the most modest person on the planet. You won't cause emotional harm if you treat the less modest person with the utmost regard for privacy. But you'll harm a lot if you treat every guy patient based on the myth that "guys don't mind" being seen naked, or "it's no big deal". And speaking of big, the elephant in the room is the issue of penis size in our society. Women do look, and do compare and do talk. As a doc, I can't tell you how often I've heard nursing staff making comments. So it's hypocritical to pretend it shouldn't be a concern for the male patient.

At Saturday, August 04, 2012 10:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed, I am fully aware patient physical modesty exists and took that into consideration as I practiced medicine though I never, never had a patient express any concern about their modesty. So, as I have repeatedly noted here, I was surprised after starting this thread about the potential extent of the issue.

However, just as doctors attempt to understand the pathophysiology of symptoms or a disease, I have become interested in understanding the underlying mechanism or basis for what is disturbing patients and why they are not communicating these concerns directly to the healthcare providers.

The possibilities I had suggested are not to diminish the importance of the modesty topic but to offer them for discussion.

If the problem is that the medical community is unaware of a defect in their behavior by being ignorant or uncaring about a basic psychodynamic property in every patient (or indeed every human) then first the medical community has to be told about such a defect, understand that underlying property and understand the importance paying attention to that property.

Therefore, I ask about that property: is it simply about a "power" differential or specifically all about sexual arousal, is it about concern regarding potential sexual deviation by the healthcare provider or is it as you appear to suggest patients' concern of a general disregard or misunderstanding by the medical profession of the general concept of patient physical modesty?


At Sunday, August 05, 2012 7:09:00 AM, Anonymous Anonymous said...


While I understand Ed's position of "it's nobody's business". Actually, to fix the problem, it's everyone's business.

I have been sexually abused in a hospital and although my feelings about bodily exposure have changed because of that experience, it's not that experience I worry about. I only worry about one thing. It's how I felt then, and because my experience was so outrageous, involved deviance, the public, etc., I vowed that I would never be put into that kind of position again and I won't. The experience changed the way that I feel about medical care and my right not to give up control.

So, is it about power and control? Absolutely, when the effects of behavior have you stripped naked in mixed company without your consent. It's a violation of the soul. It is the first thing done in a torture situation. It strips you of your personhood, making you less, complete violation and humiliation.
Who has the right to do that to another person without their consent?

Isn't it the job of the medical community to keep such examinations private with as few people as possible. Would it kill them to do the cutting and draping in private?

The mental mindset of the medical community is in the dark ages and has been a right of entitlement, to look, to gawk, to invite the salesman in the room and the patient has no say? The objectification of the patient has gone too far. What kind of experience would anyone have after being violated even if there has nothing inappropriately done.

The saddest thing about all of this is the hospital employee lack of empathy, or worse, enjoyment at patient expense with this issue.

I personally had an experience that was completely inappropriate, unnecessary and the male tech actually yelled at me for not following his instructions to take everything off. I yelled right back at him telling him that if I felt there was a reason to remove clothing above the waist for ulra sound on a 10 week fetus, I'd think about it! He was very angry.

Clearly, there was no reason to remove my blouse and underclothing for this procedure, yet he felt totally justified in asking me to take of EVERYTHING (gown open in the front). He still argued with me about getting gel on my clothing afterwards and again I let him have it.

This is just one experience that I write about in my book. It happened after I was abused and knew what to looks for. many people dont know. They just do what they are told.

There is a sense of perversion in the medical community that simply is not dealt with. Until people are sanctioned for bad behavior and lose their jobs and licensing nothing will change.

PT, I'm sure both genders are guilty of this behavior (as in my experience) and that's why, in the article "Naked" they talk about absolute protocols for test procedures so that everyone knows what to expect!

At Sunday, August 05, 2012 9:51:00 AM, Anonymous Anonymous said...


To answer your question,yes and I believe that
is what we have been saying all along. However,
the term outliers suggests that only a few within the
medical community are deviants. I am saying there
are many deviants within the medical community and
that has been our concern, yes sexual deviation in
unprofessional behavior is the underlying concern,
basis for these threads, at least that has been my
You may have read the two recent physicians, the
urologist and the well noted plastic surgeon who were
filming patients. But Maurice, it's not just physicians
doing this, it's the entire medical community from
nurses to registration personnel and it ranges from
voyeurism to sexual assault, although I believe for
the majority it's voyeurism.
For many will certainly agree that voyeurism Ieads
to sexual assault. There are many types of voyeurism
and the problem is that few realize it's a serious
problem in most healthcare settings. When it does
reach the news as did the urologist in new York, many
suggest it's an isolated incident, for which it is not.


At Sunday, August 05, 2012 10:05:00 AM, Anonymous Anonymous said...

Ed.Thankyou for sharing your feelings and experience with us.You sound like a caring and compassionate Doctor,although i wonder what your speciality is.I agree with you on everything right up to the part of the female nurses.Why didn't you refuse?Being a doctor didn't you know what was going to happen?Have you voiced your concerns with the medical community?I totally agree it's not about them , it's about the patient.Period.One thing i noticed on this blog is that the term patient modesty is very carefully used.The problem is opposite gender care.The issue isn't about just modesty, it's about opposite gender intimate care.We all know there will be some exposure for some procedures.It's the gender of the people giving that care.Just ask,don't ambush us.My healthcare is not a spectator sport.Is asking really to much? AL

At Sunday, August 05, 2012 10:13:00 AM, Anonymous Anonymous said...


Why on earth would the male tech need you to remove all your clothing for a simple ultrasound?

Only a small amount of your body needs to be exposed. If you get gel on your clothes - so what - it will wash out!

Good for you for standing up for yourself and exercising control over the situation.

The technician sounds like a man who is used to women doing as they are told. Hence the raised voice when you didn't obey him.

I hope you made a complaint. There is no excuse for that sort of behaviour.


At Sunday, August 05, 2012 1:40:00 PM, Anonymous Anonymous said...

Dr. Bernstein:

I am a bit confused at this point as to how to answer you questions. In my above post I asked you if there "is really no scenerio where you as a man would be uncomfortably humiliated by nudity and/or genital touching by a group of females? Or even one female? Why isn't the idea of wanting to keep your nude body covered in front of the opposite gender enough of a reason for modesty....medical or otherwise"'

I don't think I can give you a reference point until you give a clear reference point, and that is : how you view the comfort or discomfort of nudity.
Until then, we have to just keep assuming that you find modesty in general a useless emotional response that needs to be analized from our mentality.

If I could just understand your belief about modesty and nudity in front of, well........anyone at all(?)


At Sunday, August 05, 2012 3:54:00 PM, Anonymous Anonymous said...

"Until people are sanctioned for bad behavior and lose their jobs and licensing nothing will change."
That says it all belinda.
What is the mechanism for sanctioning non-MDs in medical operations? I quit attending the CA med board []
hearings on MDs because only formalities were discussed. I was requested to leave for the voting and who knows what else. Why hold public meetings? Where is the transparency? I say "I" because no one else ever left except me and there were many attendees
in the room.
Only once did I ever hear any details because the MD who wanted to be reinstated had an incompetent lawyer [just formalities in legal terms].
The MD took over the presentation, which I'm sure violated protocol, but in fairness, the med board did cooperate with him. Like all hearings, I was kicked out before any decision and...

At Sunday, August 05, 2012 4:33:00 PM, Anonymous Anonymous said...

I never said "it's nobody's business" and that's certainly not my position at least with respect to these blogs.

When actually receiving medical care, I do believe that patients' modesty, dignity, and privacy, regardless of gender, should be afforded the same degree of respect. That doesn't mean I expect same gender care any time the exam or procedure is embarrassing. Providers should, at a minimum, explain why the exam or procedure is necessary and ask my permission first. Unfortunately, that's not been my experience!

In my read of Dr Bernstein's comments throughout this blog, I get the impression he thinks those of us that complain are a distinct minority and therefore his primary focus is on the patient role in this issue as if it's some disease to be diagnosed and treated. Dr Bernstein, my comments are simply a frank observation and in no way should be construed as disrespectful or critical.


At Sunday, August 05, 2012 5:07:00 PM, Blogger Maurice Bernstein, M.D. said...

To Suzy and others: Of course, I have the same physical modesty as I think most people have with regard to public viewing. I am not a naturist. A few years ago, I did join as some of the visitors will remember to attempt to get naturists to talk about their medical experiences here. As some will recall, I did get one naturist to participate. But I have the same modesty as apparently the rest of you who write here--however, apparently with one exception. I truly believe that physical modesty must be suppressed when it becomes part of medical diagnosis and treatment. And for me personally it is suppressed. I would never avoid a clinically significant experience because of any modesty I have in other situations. It has been written here that some would avoid consent for life saving procedure if the patient's modesty issues could not be managed. I personally would never consider such a decision.

I would, however, speak up to the doctors or staff or hospital or clinic if I suspected or discovered that I might be used for some other purpose than strictly for my own medical benefit. That would include having detail men or women in the OR or having students or others observing without my permission or to have "helpers" not strictly trained and monitored in attention to patient physical modesty.

I refuse to believe that medical diagnosis and treatment should be practiced also as a "side-show". If it is, that attitude has got to changes. If I am satisfied that it isn't, then I am willing to drop my own modesty feelings to get appropriate diagnosis and treatment. ..Maurice

At Sunday, August 05, 2012 6:23:00 PM, Anonymous Anonymous said...

And so Dr. Bernstein:

I imagine your modesty toward 'public viewing' has little to do with the fear of an erection (Question 1) and not much to do with 'sexual deviation' (Question 2) either. Maybe it is simply are modest.

I would ask: why is it that people have to 'supress' their modesty instead of just addressing the modesty issue? Seems much more humane to me.


At Sunday, August 05, 2012 6:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Speaking about naturism and medical practice and what was written on this thread in the past, I searched back to Volume 9 in 2009 for a couple comments posing other views than what has generally been written here. The first is from CSM and the second will follow in the next posting. ..Maurice.

At Saturday, February 14, 2009 10:17:00 AM, Anonymous said...
Also arriving from the ClothesFree website and having read only a few posts here, I thought I would just add a few personal observations on medical staff and modesty. Growing up in and having parented a naturist family, I find that gender issues are for us much less concerned with physical traits than with personality. We tend to see gravitate toward doctors oriented to the "whole person" as opposed to being "body mechanics" so over the years our family doctors have often been women. However, as we are comfortable in mixed-gender situations from childhood, the gender of the doctor or staff is really of little default importance. We are also used to treating sexuality as a distinct private activity separate from nudity, but this makes us perhaps not only more comfortable with our bodies than the norm, but also more alert and aware when medical staff behavior is not impeccably normal and respectful. Our family has lived for extended periods in both the US and France, so we are aware of cultural and legal differences. With our current US family doctor, we made a point of telling her right away that we were naturists so that American-style modesty issues were clear. She and her staff seem to appreciate being able to dispense with the usual clothing gymnastics. We just disrobe as needed for consultations and, if unclothed, only put on the strange paper-open-back gowns for trips down hallways. While we don't have "typical" physical modesty issues that doctors must be so sensitive to in the US, we also realize that not all medical staff have thought through the human respect issues that naturists take for granted, so we know we need to be alert if family members are in a situation, for instance, of being sedated. In general, though, American medical folks have been very friendly and adaptable, and often seem almost to breathe a collective sigh of relief when they find out we're comfortable about having a body. A footnote: our family doctor in France is also naturist, so we're already on the same page. (posted by CSM)

At Sunday, August 05, 2012 6:51:00 PM, Blogger Maurice Bernstein, M.D. said...

Another comment by a "comfortable" patient. What do these postings tell us? ..Maurice.

At Saturday, February 14, 2009 12:01:00 PM, Anonymous said...
Maurice --

Thank you for visiting the clothesfree website and asking for input on this issue from nudists/naturists. While I confine most of my nudity to the privacy of my own home, I have, on occasion, had the opportunity to be nude with others at a nudist park or nudist home, and I find that I resonate with much of nudist ideals and values.

I find your invitation to be very timely, as I was, just this morning, thinking that I should probably consider talking with my doctor about a colonoscopy, as it has been about 6 years since my last one. But I find myself hesitating because, more than anything else, I dread those horendous gowns.

And I expect I'm not alone. Just a few days ago I saw a local hospital ad on TV that featured a man dressed in a hospital gown, doing various things that a person might do throughout the day. The message of the ad was that men need to be tested from time to time for various things, and the tagline said, "Real men wear gowns." Apparently this hospital felt that enough men hesitated going through testing because of the gown that such an encouragement was necessary. And I wondered, how many guys fail receive the health care they need because of those gowns.

I find hospital gowns to be tremendously degrading. They send a message to me that my body is so shameful that I need to cover it up with the most ill-fitting, uncomplimentary garb ever designed. I know this may sound strange, but I really find them to be insulting.

Believe me, I would much rather be allowed to remove my clothing and remain nude. In doing so, my healthcare providers would be telling me that they respect my body as it is, and that I don't need to cover it up. It would tell me that I can trust them to care for my body while I am semi- or unconscious, because they don't consider it shameful.

Contrary to some of what I read above, I don't find being nude in front of others who are comfortable with my nakedness to be a loss of personal power, but rather an increase of it. Because, by allowing me to be nude and accepting me that way, they are telling me that their acceptance of me is not based on my clothing, or my physique, or any other outward thing, but rather only on my being myself. And that gives me power, and builds trust into the relationship.

My only question that remains is this: The next time I'm told to get undressed and put on a hospital gown, how do I tell them that I'd rather just get undressed and leave it at that?


At Sunday, August 05, 2012 9:49:00 PM, Anonymous Anonymous said...

I get the naturist approach and wish I was as liberated; I'm not. I've been blessed with excellent health and only recently felt compelled to seek medical care for some issues most males experience as we age.

Specifically, in answer to your questions Dr Bernstein, I don't fear an erection in a medical setting. This is a real fear of younger males but an unwarranted one, IMO. I do think though most have no choice in the selection of provider gender and an already embarrassing exam could be potentially humiliating in the presence of a female provider, magnified by the requisite female nurse or chaperone. Something females likely never have to endure. That's a huge ethical failing the medical community continues to perpetuate and likely will negatively affect their perceptions of medical care as they mature.

Unlike many other service providers, we don't visit physicians out of choice. Its either we're ill or feel it's prudent to be screened for health issues, neither one is appealing. Therefore, when visiting a physician, I've already done my homework and I'm comfortable with their professional status. Specifically, I've never been concerned about sexual deviation on the part of the provider. Do they exist? Sure, but the chances of running into one are so insignificant it's not even on my radar.

Al, not sure where you got the idea that I'm a doctor; I'm actually an airline pilot and that's one reason I feel as strongly as I do. I am scrutinized much more closely than any physician or nurse in a much more regulated industry. I receive two FAA Class I physicals a year and two to four days of recurrent training twice a year where I actually have to prove my ability to fly the jet in some highly unlikely scenarios. Both (physical & recurrent), by the way, administered by objective third parties. If I fail either, I lose my license and therefore my ability to make a living; that's as it should be. However, the medical profession is not subject to the same scrutiny and if they are, it's normally by other physicians or nurses.
Therefore, when the female provider (nurse, assistant, chaperone, student, whatever) feels it's her right to be present for an embarrassing exam or procedure, I'm personally offended. I've no idea what their professional qualifications are. Many times they are not nurses' at all but simply medical assistants. Personally, a female high school graduate, with three to 24 months of vocational training, has not earned the professional distinction to witness, much less participate, in any exam or procedure of a personal nature without my consent.


At Monday, August 06, 2012 6:02:00 AM, Anonymous Anonymous said...

Nudity is a secondary issues on this blog. The problem is nudity in context.

The underlying themes on this blog is a loss of dignity, control, feeling degraded, medical right of entitlement.

Nudity is only the vehicle used to bring these feelings to the surface.

Objectification of the patient is the issue. I'm sure we can all think of a situation where we felt belittled, or degraded in a medical situation by the attitude of the providers.

Hop on the power differential train and take a ride on that one.
It's only patients who go in with explained expectations with what they want and don't want that are treated properly. Everyone else is railroaded like cattle.

It is the power differential that creates these situations to begin with. It's up to the patients who can take back the power. That doesn't mean being difficult, nasty, bossy, or angry. It means cooperating with the medical community explaining what you need and why you need it.

It's my bet that the people on this blog have had negative experiences with the issues and that's why they object to opposite gender care.

At Monday, August 06, 2012 6:08:00 AM, Anonymous Anonymous said...

Ed says it all very well and, as a female, I understand his feelings. I feel the same way about medical care: it is not pleasant and once I do have the occasion to go (infrequently)I also am not concerned about the doctor's credentials nor about the possibility of sexual deviation. I do, however, have the same concern about additional personnel being present for exams without so much as an explanation and/or introduction, nor choice in gender if their presence is necessary. Suzy also says it right as far as I'm concerned. It's my body and I should have the say so who sees it naked. I've already made the coice of doctor, so that person basically has "consent" but when other, unexpected "assistants" come on board that's when a question of informed consent arises. It's that simple. Jean

At Monday, August 06, 2012 7:14:00 AM, Anonymous Anonymous said...

Here are two statements from a near by hospitals patient rights.
The hospital will reasonably respond to requests and needs for treatment or services within it's capacity,stated mission,and applicable laws and regulations.
Patients have the right to designate their visitors,and people involved in their care.
I would think your choice of gender is covered.But,if you don't speak up you'll get whoever they want to assign.I'm not naive enough to think you won't have problems.And for those who say they don't have male techs.We called the imagining and gastro departments and asked if we could have all male/female team.They said yes,but you may have to wait a bit.Do your homework.If they don't have male/female they can't assign them.Ask nicely but make your request known.Good luck. AL

At Monday, August 06, 2012 8:28:00 AM, Anonymous StayingFit said...

I think that Ed's situation brings up an additional dimension to this discussion: coercion. Is the violation of a person's modesty likely to be worsened, if that person feels coerced into accepting the conditions of their examination, because they fear that they will face consequences if they object?

I recently had my yearly physical, which I schedule of my own volition. So, I am free to choose my own provider, and to object if I am not happy with the way that I am treated. Since I am healthy, and the examination is voluntary, I face few repercussions if I upset my health care providers. In fact, they have every incentive to keep me happy, since I can easily find another PCP.

In Ed's case, his bi-annual physical is mandatory. I am not clear if he has any choice in who performs those physicals. If he doesn't, and is scheduled to be seen by a female doctor, is the situation worsened because he may fear the consequences of requesting a change in provider? Or, under such conditions, would he really feel comfortable in asking a chaperone to leave, if his examination is to continue?

Similar conditions exist with pre-employment, life insurance, DOT, and other physicals where the doctors do not work for the patients, and where there are real consequences if the patients do not accept the manner in which they are treated.

I also wonder if a feeling that we have been treated unfairly, or that a double standard exists, could exacerbate the modesty violation. For instance, if Ed observed that female pilots were always assigned to female doctors, and male pilots were often assigned to female doctors, would this combination of coercion, as well as unfairness, exacerbate his sense of violation? I think so.

In all of this, there is definitely an aspect of control, or loss thereof, as others have noted previously. Coercion, consequences, and fear of objecting to unfair treatment merely being different means by which we lose control of our bodies, and who has access to them.

At Monday, August 06, 2012 11:04:00 AM, Blogger Maurice Bernstein, M.D. said...

Use of the term coercion when speaking about patients has a broad meaning which is based on broad usage. As I have previously mentioned, since the waning of physician paternalism and the encouragement of patient autonomy, therapeutic coercion has also waned with ethical and legal insistence for patient informed consent based on the patient's desires and not any form of coercion. However, other forms of coercion, perhaps less obvious, still exists in medicine. "Threat" but in a subtle form is often a tool for coercion which is frequently used in a physician's conversation with his or her patient. To attempt to reverse unhealthy lifestyles, the physician may tell the patient to stop smoking or improve eating habits with the personal threat of lung cancer or diabetes/cardiovascular disease.

I question to what extent the term coercion should or can be applied to patient gender selection for their provider or provider assistants. What is the threat made to the patient when it appears, under the immediate or current circumstances, no alternate gender is available? Yes, to have "visitors" during a clinically essential exam or procedure without the patients informed consent for them to be present and then with the hospital or clinic telling the patient essentially "to take it or leave it", this to me would clearly represent coercion.

Any form of unethical coercion upon the patient should be forbidden by an institutional policy which is not simply devised by the executives but by true consensus though participation by members of the patient community.

By the way, in my experience with what is taught to first and second year medical students, coercion is discussed only in terms of avoiding this behavior and maintaining general informed consent for undertaking exams and procedures.

By the way, anyone want to talk about patient psychological coercion of healthcare providers which does occur in various ways such as seductive behavior, threats (yes, threats) or fictionalized stories demanding sympathy and provider actions which may be clinically inappropriate? ..Maurice.

At Monday, August 06, 2012 3:33:00 PM, Anonymous StayingFit said...

Dr. Bernstein, the situation that I describe, and that I have seen in my life, is the very real fear on the part of the patient that, should they raise any complaint about their treatment, or request any change to the circumstances of the treatment, that negative consequences will result. If you are troubled by the term “coercion”, perhaps you could suggest a better one?

The term used to describe this situation is of far less importance to me than the question that I posed. Which is, does the fear of negative consequences, resulting from an objection on the part of the patient to the way that he or she is being treated, increase the likelihood, or severity, of a perceived modesty violation?

I believe that is does, and that it is a related aspect to the loss of control discussed earlier. I am very curious how you, and others, feel about this.

By the way, you seem to have assumed that I was referring to coercion on the part of the health care providers. While that is a possibility, the likely consequences are economic, and come from the employer, insurance company, etc. If, for example, the patient does not allow a pre-employment examination to be completed, will the employer regard this as a sign of a troublemaker, and withdraw a job offer? That concern is very real, at least in the mind of the patient.

As to the topic of coercion of health care providers, by patients, I find that to be of great interest. I, for one, would very much like to read any story that you care to share. I'm especially curious if that would relate to patient modesty in any way, or if that would be the topic of a different thread on your blog?

At Monday, August 06, 2012 4:04:00 PM, Anonymous Anonymous said...

Maybe someone could help me here but why are people being required to have intimate exams for employment? Vision, hearing, weight bearing, etc. makes sense. Gender issues of provider would not even matter for these types of tests. What do breast and genital exams have to do with flying planes and driving buses. How is this even legal. Talk about coercion! I hear they are even doing this for desk jobs. This is frightening. LKT

At Wednesday, August 08, 2012 8:47:00 AM, Anonymous Anonymous said...

LKT, While I wouldn't be pleased with this situation, I think we need to look at it from the employer's perspective.

They are hiring an employee and while they can't discriminate on health alone, they want to know how healthy their perspective employees are because cancer or some other catastrophic disease might determine who they want to hire causing a major expense on health insurance. So, if they can hire employee A who is healthy and just as qualified as employee B (where they find breast cancer for example), who would they hire?

If these exams happen after hiring, then I would agree, they serve no purpose.\

At Wednesday, August 08, 2012 10:46:00 AM, Anonymous Anonymous said...

Thank you Belinda for your response. I have very much appreciated your posts on this blog. However, from my research, it seems that "legally" speaking these employment physicals can only be used to determine the fitness of a candidate for specific job functions. Quotes such as "medical testing must be relevant to essential job functions" and "examinations must test for essential job related abilities only" are prevalent on websites related to these tests. Apparently results cannot be used simply for keeping the "unhealthy" off of the health insurance roles. I believe we all know that in the real world economics matter and many probably use these exams as a "filter", legal or not. That being said, unless I am being hired as a prostitute in Vegas, the health of my breasts and genitals would have nothing to do with "essential job functions." LKT

At Thursday, August 09, 2012 8:00:00 AM, Anonymous Anonymous said...

In response to StayingFit, I choose from a list of qualified FAA Aviation Medical Examiners (AME) and therefore I'm able to select the AMEs gender. In all the flight physicals I've taken, including those in the USAF, all were conducted privately with the physician and didn't have to ask for the same. Unlike USAF flight physicals, all very thorough, those I've taken for the FAA vary in completeness. Interestingly, a genital exam is required for males but a pelvic exam for women is at the option of the examinee. Another double standard similar to boys sport physicals requiring a complete genital exam but not for girls. I've had buddies complain that their AME insisted upon a DRE even though that's supposed to be at the discretion of the examinee. In that case, a coercive aspect certainly exists because if you object, you risk alienating the AME. Not surprisingly, they all complied! Finally, I've had only one flight physical where the physician was female (USAF Flight Surgeon); she knew I was uncomfortable and respected my limits thereby gaining my trust and respect.
My negative experiences have been with civilian providers while seeking medical care due to illness or screening; services I paid for both directly (copay) and indirectly (employer health insurance).

At Thursday, August 09, 2012 10:11:00 AM, Anonymous Anonymous said...

Wow, the last two comments by LKT and Ed should
certainly convince the medical community to stand up
and take notice. Comments like these just don't get
any better.


At Sunday, August 12, 2012 4:25:00 PM, Anonymous Anonymous said...

If you think that men are treated equally, watch this video.

At Monday, August 13, 2012 7:00:00 AM, Anonymous Anonymous said...

While this video is outrageous, you would equally find outrageous video of male officers actually stripping females taken into custody.

There was a viral video happening here in the US. The victim's first name was Steffie and she sued.

This issue over and over again, is NOT gender specific and it is just disrespectful not to acknowledge that these things happen to everyone for all those who suffer the ramifications of such degrading situations.

At Monday, August 13, 2012 1:06:00 PM, Anonymous Anonymous said...

I could only stand to watch a minute or so of this video because it is so disturbing. However, compared to what male patients are experiencing in hospitals and physicians' offices every day, maybe its not so bad? As a medical patient, this guy could also have had his genitals shaved (by a girl from the local high school), a foley cath inserted, a full body skin exam, hernia exam, a DRE, and testicular exam all carried out with multiple females "assisting". (maybe with photos taken as well) I am disgusted by the behavior of my own gender. Now that females seem to have the upper hand in our estrogen dominant culture, have they not become the very thing they once opposed? LKT

At Monday, August 13, 2012 9:38:00 PM, Anonymous Anonymous said...


Look at procedures for female prison inmate
searches and you will read that male guards don't strip
search female inmates. Furthermore, I am not at all
surprised by this video considering that female prison
guards are charged more often with raping male inmates than male guards raping female inmates according to statistics from the Dept. of justice.
Leering non-medical female clerks at countless
military induction physicals and we can conclude that
males in general don't fare well in hospitals and other
medical facilities in regards to privacy.


At Tuesday, August 14, 2012 4:48:00 AM, Anonymous Anonymous said...

PT, First, you have no study statistics to back up what you say. Let's see them.

Secondly, this is a blog about patient modesty violations and while abuses occur in every type of institutional environment, our focus should be obtaining medical care in a safe environment.

I don't think it's fair to go there but if you must, 94% of sexual predators and assaults are perpetrated by men. So, if you want to go there you will lose and nobody should lose with stastistics.

On the other hand, I've said again and again, this isn't a war about who is abused more or who is treated in a more degrading way, it's about what's humane to us all.

We should all be on the same team to achieve healthcare in a way that is not degrading or abusive to anyone regardless of their gender, sexual preference, race or religion.

Let's hear from those that support this position!

At Tuesday, August 14, 2012 10:27:00 AM, Blogger Doug Capra said...

I agree with your position, belinda. But recent Justice Department reports do back up some of what PT is saying. Read the recent article published on our blog by Dr. Sherman. The stats show that women guards are more likely to abuse male prisoners than male guards female prisoners. The same goes for male youth in detention centers. Dr. Sherman provides the sources for this in his article.
And I do disagree about the big picture. Medical modesty is one piece of a bigger picture, and various aspects of the big picture should be open to discussion on this and other blogs. There is a cultural context for what s happening in medicine regarding gender and modesty.
Doug Capra

At Tuesday, August 14, 2012 10:43:00 AM, Anonymous Anonymous said...


There is an initiative within the joint commission stop lateral violence among nurses. This lateral violence as many have found negatively affects patient care on many fronts. lateral violence
Remember 95 percent of all nurses are female. I
know of no other industry where a government
body has to step in and control so much hate.

The incidence of professional boundary violations
reported to nursing regulatory bodies is high.

Justice department report on sexual assault in
juvenile detention facilities.

For youth reporting staff on youth incidence of
sexual violence, 95 percent reported that the
perpetrator involved a female staff.


Female prison guards often behind sexual

2007 U.S Dept. of Justice study analyzing the
prevalence of sexual assault in state and federal
prisons found that 58 percent of staff perpetrators
of sexual misconduct were female prison guards
and female prison nurses!


At Tuesday, August 14, 2012 4:27:00 PM, Anonymous Anonymous said...

PT, Doug,

We are all a product of our experience. Because my experience involved abuse from both male and female hospital employees, the gender of the abuser doesn't make much difference to me.

The bottom line that we can all agree is that this kind of behavior regardless of gender of the perpetrator, needs to be stopped. That can only happen with responsibility and accountability of the institutions involved in abuse. That also means supporting patients (to do no harm) who have been previous victims to get the care they need and to accommodate when they can with kindness and understanding instead of being annoyed of such requests that is sometimes (though in my experience not the norm) the case.

At Tuesday, August 14, 2012 9:32:00 PM, Anonymous Anonymous said...

Here is my take on women who want to work as
a nurse or a prison guard in a mens prison.

They want to be a Dominatrix. Think about it for a
moment. For female guards who just acquired a GED,
uniform is required. They essentially punish men all
day, watching them shower and toilet, chaining and
cuffing them all day. Must be exhausting!

And, they can choose who they can have sex with. All
that role playing must be tiring but it's all part of the
job. Not like these people did well in differential
calculus if you catch my drift. They just decided one
day, I want to work in a mens prison.

Why would a female nurse want to work in a mens
prison or DOC( department of corrections) which may
be a prison,jail etc. Many reasons, no families of
patients to deal with, no patient satisfaction concerns
and no hipaa concerns. Fact is, if a DOC prisoner is
taken to a hospital for treatment, these prisoners are
not allowed to participate in patient surveys about
their care.
Nurses know this and discussed frequently on
their allnurses dept of corrections threads. Quality of
care is bad,doc patients can't complain about poor
care. Fact is, many female nurses have sex with their
inmate patients which is considered institutional
sexual assault. It is estimated that this occurs
hundreds of times a year. Here are four of the most
recent. prison nurse arrested
Laurie Blum. Wisconsin prison nurse arrested
nurses name not listed,only as female nurse prison nurse arrested
Nicole Kerschenstein Prison nurse arrested
Lori sue Helmick


At Wednesday, August 15, 2012 4:51:00 AM, Anonymous Anonymous said...

It has always been the norm to have the mindset that the medical profession has been up and above board and that there might be a "bad egg" in the mix.

Researchers do know, however, that someone who is deviant will gravitate to healthcare and other environments where people are vulernable. Look at the convenience, opportunity, nudity. It's almost too good to be true.

Given as Doug suggests that the "climate" is what it is, do you feel that there is more abusive behaviors in hospitals than one would have originally thought?

I have always felt that there is based on my experiences. I always thought if this stuff is happening to me, it's happening to everyone.

I know that you think perception is skewed on this blog about how the patients feel (I do not), however, I was wondering how you feel and how to get those "bad eggs" out of the system...permanently.

Just for the record, my mother was an RN.

At Wednesday, August 15, 2012 8:04:00 AM, Anonymous Anonymous said...

Speaking of deviants and "bad eggs", there was a New York Post story yesterday by Don Kaplan entitled "XXX-ray vision in Mt. Sinai O.R" about an OR tech who routinely watched porn on his smartphone during surgeries. A quote from the article stated that his porn habit "was so commonplace in the operating room that other perfusionists routinely joked about his behavior". LKT

At Wednesday, August 15, 2012 9:59:00 AM, Blogger Maurice Bernstein, M.D. said...



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