Patient Modesty: Volume 55
As we move on to Volume 55 of this thread on Patient Modesty there appears to be more discussion about ways to educate physicians, nurses and other healthcare providers regarding the personal feelings and concerns and particularly related to physical modesty. Scripting responses for the medical staff to communicate to the patients or families is being currently discussed. It may well be that appropriate scripting by administrators in humanistic terms and attention to see that the staff apply this technique properly and consistently may well help in preventing some of the conflicts described on these threads. Today, I posted on Volume 54 the following in this regard: Here is a wonderful example of "scripting" for the employees if this wasn't (as I suspect)only a public advertisement for the Cleveland Clinic. Maybe more videos of this kind (demonstrating to the staff what is going through the minds of patients) would help toward diminishing the conflicts and emotional trauma as described on our blog thread.
As I have written previously, this thread has had virtually 8 years of descriptions, some quite detailed, of the visitors' experiences and concerns. What is needed are descriptions of approaches to provide change in the medical system along with changes in the approaches by the patients which will provide an interaction between healthcare providers and patients which is comfortable and valuable to all. ..Maurice.
Graphic: From Google Images and modified by me with Picasa 3.
NOTICE: AS OF
TODAY JULY 6,2013 "PATIENT MODESTY: VOLUME 55" WILL BE CLOSED
FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 56.
posted by Maurice Bernstein, M.D. @ 8:33:00 PM
156 comments
156 Comments:
Maurice
I don't see that as an example of scripting at all. It is a good example of the need to develop empathy. If employees were given specific lines to say in response to those perceived situation, that would be scripting. But the key is "perceived" situations. Specific lines don't work in all situations.Caregivers must have mature social intelligence to identify the specific context and respond appropriately. And even then they may not get it right because we can't be perfect in how we read each other. It is a good film, though, a good way to get across what might be going on in people's minds.
Doug, I would look at "scripting" in a bit broader sense. I would also consider the action as instilling not only a textual series of words to be repeated to the patient or family but as entering a series of specific considerations related to humanistic attention and expression. For example, by rewriting the original "script" that simply viewing the patient and family as objects to be attended to using the standard tools of the healthcare provider to a script of viewing each patient and family unique, each with their own specific and unique medical issues in their minds should provide professional reconsideration and a change of behavior. As it is, the script dictating professional homogeneous and uniform interaction with the patient based on disease or procedure rather than based on person and what is going on in that person's brain is what needs rewriting. I agree that YouTube film is good and can be used as part of that new script. ..Maurice.
Belinda - why do you feel a pelvic or mammogram is needed every year? What medical evidence do you have that supports this statement? JT
I see your point, Maurice, but the complaints we read, esp. from nurses, about scripting don't seem to be about your definition of scripting. They are about being forced to use "scripts," i.e. very specific sentences at very specific times regardless of any individual context. To me, that's the issue. The word script denotes a piece of paper with lines on it that must be followed. Trained actors can take those scripts and, after some study and rehearsal, internalize those lines so they become believable to an audience. Untrained (in acting) medical professionals are more likely repeat those scripted lines. Bloom writes about the process of internalizing values in his affective domain. It's not an easy process. The caregiver may have internalized the particular value the scripting represents, but for various reasons is unable or unwilling to carry them out. Memorizing lines won't necessarily change that.
Thanks Maurice. JT, this is what I said,
If the answer is yes, would it make sense for women who are in the "safe category" to have an annual pelvic exam, just as we do mammography?
Here's what I think. If someone is sexually active and doesn't use protection, they should be checked annually for HPV. Should this turn into cancer, it would be caught early.
Same for mammography. If someone has a family history, or abnormality, they, too, should be checked. Everyone has choices. Just to put one's mind at ease would be reason enough for some.
I did not research this topic, I have no desire to do so, and do what I think is best for myself. Everyone must do what they think is best for themselves as long as they do their homework and recognize responsibility for the outcome if they decide not to have recommended testing. Recommended testing is not always in our best interest but which test or exam to leave out is a personal decision and hopefully well informed choice.
belinda
Doug, I agree that scripting in any sense that gives the healthcare provider the "proper" words to say to the patient and even if the provider had "acting" experience, the uttered words may represent simply words of an insincere "bedside manner".
On July 2 2005, I began the thread "'Bed-Side Manner' is Just Acting" in which I reproduced a comment I had posted on KevinMD Medical Weblog. Here is what I wrote:
"Bed-side manner" is currently considered in medical school definitions as a dramatic acting behavior and which is scripted and learned. We don't teach bed-side manner. True empathy is NOT scripted. Attempts at understanding the bio-psycho-social aspects of the patient and the illness is NOT scripted. Attempting to simply care for the patient, rather than acting like the physician cares is NOT scripted. And there is no script of acting regarding how to make that all important intellectual and spiritual connection with the patient. Students learn that the goal is to become a trusted, understanding and caring physician. They attempt to reach that goal by trial and error with patients under mentoring by role model teachers through expressing the student's own personal qualities, behavior and technical skills. The technical skills are all part of the goal to provide care to the patient. Each physician will appeal to the patient in different ways regarding trust, understanding and care and it is up to the patient to select, if possible, that physician whose behavior is most comfortable to the patient.
I am sure we agree on what I wrote. But my use of "scripting" is used in the sense of Mirriam-Webster's 3rd definition of script: "plan of action". The plan of professional action is to first understand the uniqueness of each patient/family and then the plan describes the use that concept as a guide to further communication and action. ..Maurice.
One of the visitors to that old thread, described above, wrote the following which I think should begin to solve the issues described on this "Patient Modesty" thread.
"The skill of listening to what the patient's concerns are rather than treating what we think they should be will go far toward establishing a working relationship." ..Maurice.
Reply to Anonymous who stated on Sunday, May 05, 2013 9:55:00 PM "makes me wonder what brought him to this blog, or he's an exhibitionist who came here to brag."
You obviously missed my earlier comments that I posted on Sunday, May 05, 2013 9:55:00 PM. In short, I have an intense dislike for most female assistants/office staff. I cringe when I have to see my urologist with an all female staff.
Gerald
Many women are under the false assurance that a
pelvic exam and pap smear are an absolute assurance
for cancer screening, those exams are only good for
right then, there at that moment. They say nothing about the next day, next week, next month or next year. I have seen many women who recieve their annual pelvic exam on any given day in January, given a clean bill of health yet by May are in stage 3 ovarian cancer.
With that type of diagnosis you are looking at surgery,debulking, many chemo rounds of taxol and cisplatinum with weekly lab panels, cat scans, pet and
mri. In one year your medical bills could easily top
1 million dollars. It remains to be seen how obamacare
will affect people needing this kind of care.
There seems to be a desire to give pelvic,pap smears to every young woman on this planet, yet
for older patients the necessity declines, why? For
women in their late 30's who smoke, have a history
of ovarian cancer in their family and or tests positive
for a mutative gene, they should be offered a Ca-125
at least 3 times a year. This simple blood test could
save tens of thousands annually. Of particular
importance moreso for women who have had a partial
hysterectomy.
There are a number of false positives with pap
smears,pelvic exams are degrading yet don't always
give a full picture of any pelvic disease process.
In conclusion, I believe scripting is a useful tool
in healthcare. It tends to remind many of the mindless
robots in nursing that we are the customer,the patient
and our opinion matters. It was invented primarily as
a tool for hospitals to improve the "perceived" level
of quality care so as to increase the flow of dollars
at the Medicare,Medicaid level to medical facilities.
This process has only a trickle down effect for
those of us who have regular insurance. It is a
gimmick to simply impress welfare mothers and their
countless children of this new idea of fake customer
service only as an attempt to improve hcap scores.
PT
I think the thing with scripting is it is not aimed at those who provide it in a geniune spontaneous manner. It is aimed at those who do not see the "customer focus/service" model as normal. The comments allnurses were as much a rejection of the concept as the scripting itself. Comments like this is a hospital not a hotel are very telling. I think the industry is having a hard time transitioning from a mentality from dictating to patients from a I know best position to recognizing patients have the absolute right to make decisions. The mentality I am here for physical healing and that is not only primary but in some cases the only priority. There was another interesting read on allnurses regarding finding the balance between what a nurse needs to do to achieve physcial goals and what the patient wants. Examples the patient who resists getting up and walking after surgery, the diabetic that demands food not on their diet, etc. Where this comes to this thread is those mentalities of not questioning, and we are here to heal your body not make you comfortable....have a huge impact on how modesty is viewed. If someone feels the end result of healing justifies the means, if accomodation for modesty is seen as an intrusion on their job and a nusiance, it is easy to see why it is ignored. Can anyone really justify why a patient would have to be nude wearing only a gown for a cataract surgery? And yet it is common becasue it has always been that way and don't question...scripting may seem over the top, but you are assuming providers understand and agree with patient service and I do not think one can assume that...so you go over the top to plant that seed with the hope it will grow...don
Don -- You make some very good points. Yes, there is a significan group within mediciine who go with the "this isn't a hotel" line. And they're right. A hospital isn't a hotel. But that doesn't mean that certain aspects of caregiving can't accommodate a customer service model. What bothers me, and I think the good nurses, is that the "system" thrusts these scripting lines upon the good the bad and the ugly, i.e. everyone is supposed to use the specific lines at specific times. When this happens, the good people, those that have good bedside manners and practice good empathy are forced to use lines that don't fit with their style. But, you do make some good points regarding those who just don't get it. Maybe forcing a script on them will help. But it some cases, where it might make things worse, mangement needs to oversee how the practice is going. Having someone with a bad attitude forced to use a script that they don't like -- well, the tone behind their delivery could be very harmful. Managment had better make sure they're overseeing that kind of forced scripting.
What does everyone here think about "non-scripted", non-directed ( no check off boxes) but routinely requested feedback regarding the hospitalization by every patient or even or as necessary family members prior to patient discharge directed to the administration? The feedback could be anonymous and hopefully used by administration to make changes in institutional behavior either generally or in specific cases. Has anyone here been given any opportunity and encouragement for feedback at the end of their hospital stays? And if so, have you or would you take advantage of that opportunity? ..Maurice.
It's a good idea except if it's a general form without a list of categories someone might have "buried" something that bothered them or think that certain subjects are taboo or not what the form was meant for.
So, I would recommend not specific boxes but categories for comments.
belinda
I have never been asked but I think it would be great. I have however made it practice to send unsolicited
Comments good and bad for most of my visits....don
I think it would be a good idea to ask patients and their family to give feedback. I think the feedback form should include a section asking the patient if she/he felt that her/his modesty was protected and if there were any problems with modesty. I wish that all medical facilities would have a section on all forms that ask a question like this: Do you prefer male or female doctors / nurses for intimate procedures? I think that gender preferences for intimate procedures is as important as allergies.
We recently received a case from a lady who was discharged from a family medicine group because she expressed wishes that she did not want any males or medical students to be involved in her medical care. I thought it was very unprofessional and unethical of the medical director to drop her as a patient from the group. You can see more information about this case at http://patientmodesty.org/rights.aspx. Look at the case under Kay from New York.
Misty
Misty, her dismissal from the facility may not have been related to her needs as much as much as the way of they were communicated.
It's important to have someone on the team who is empathetic and you can engage to help implement those needs.
Coming off as entitled (and she was due to privacy law and the legal right to reject students if they are not part of your medical care), may have been a turn off to the medical community.
Once that happened though, if you threaten suit based on your legal rights, they might have changed their mind.
It is so important to get your doctors, an empathetic nurse on the team, and explain that while everyone is well qualified, you have needs that may affect whether you can tolerate a procedure. I think you will find a different approach might achieve goals when you take the time to explain what you need and why you need it in a manner that dictates "please help me", instead of, "I'm the consumer, give me what I asked for". What do you think?
belinda
belinda
So we need to keep fighting for every consultation, surgery and/or procedure, because they're not respectful enough to accommodate or plainly refuse to do so? Sounds extremely tiring. No thanks. I'd much rather go without.
Maria, "go without" what? Diagnosis and treatment? There are still doctors around who listen to their patients, I still do. Find one, a primary care physician, that you are comfortable with and that doctor will help you with your problems with other consultants or hospitals. Referring physicians still have clout with consultants and their hospital administrators. Remember, they are the ones who do the referring. Don't sacrifice your health because of your physical modesty issues and that you are awaiting a change in the medical system. ..Maurice.
Maria, it does seem tiring but to me, it's inspiring. It's like anything else. While I would gladly refuse if my accommodations would not be met, they will be most of the time.
I have used myself as my own guinea pig with research and consider every interaction, even if it doesn't go well, as an education to learn what I can do better next time. What ends up happening is that you get what you want, it's not so tiring (other than from hearing yourself speak over and over on the subject) but you are also educating the medical community. If nothing else, you will make them think. Make it personal, ask them how they would feel or what may be important to them.
belinda
It is rather interesting that a number of recent new threads I started on this blog actually have a connection with this thread on Patient Modesty. And I thank those who went over to the new posts and presented a view.
My latest new thread has a title which could possibly apply to the concerns long described on this Patient Modesty thread. The title is "Good People Doing Bad Things for Good Reasons".
The thread starts out as follows:
What is ethical or not is often in the eye of the beholder. That is why often the ethics of decisions or acts that we deal with in medicine is established through the process of consensus. And I don’t necessarily mean consensus by only scholars, lawyers or ethicists or even physicians. I think in ethical consensus the many voices of society should be included. I think that an understanding of reason for the divergent views that may occur in ethical analysis can be expressed by what Marcia Angell, former editor-in-chief of the New England Journal of Medicine has said in the past. Perhaps you have already have heard it.“Ethical violations are usually not a case of bad people doing bad things for no good reason, it is usually the case of good people doing bad things for good reasons.” If it were bad people, bad things and bad reasons, there would be no ethical conflicts. The question is whether the acts of those good people carried out for those good reasons best meet the principles of ethics for that particular issue.
Rather than going to that thread to write, I hope some visitors here would comment here on the proposition as applied to the concerns written here. ..Maurice.
One would have to agree with this premise. While it may be valid to some extent, there are countless complaints over unethical violations that were done purposefully either to humiliate or punish the patient for non cooperation or for the medical community to exert the power differential.
Standards of practice are in and of themselves abusive and until that is recognized, you can't even get to the premise that you are evaluating.
belinda
As many of you know, I wrote an article about urinary catheters and lack of informed consent I recently found a law student who is willing to volunteer her time to write an article about legal options that patients have when they have an urinary catheter inserted without their consent. The good news is she was a nurse for a number of years. She agrees that too many unnecessary urinary catheters are done.
I am working on specifications and questions I want her to address. I would love to hear your feedback about what you want to be addressed in the legal article. I think all patients should be able to sue medical facilities for non-consensual urinary catheters. Also, some nursing students practice urinary catheterizations on patients under anesthesia.
Misty
A female family member who was living in a continuous care facility was awakened about 5:00 a.m. Two nurses came into her room and without waking her inserted a cath. She was so upset, didn't understand what was happening to her.
We brought this issue to the administrator and the response was, "We always do that. It's uncomfortable and before they know what happened it's over'. This is "standard practice"
We made sure that this never happened again but I thought this was abusive and cruel and reported the issue. She didn't have the opportunity to consent or not to consent; exactly what they wanted.
Maurice, this stuff happens all the time. What do you think about it? More, importantly are you aware of this mindset and...if you aren't, what else are you not aware of. This is not your fault if you are unaware, you are just living in a bubble, protective, secure but surely sometimes out of touch.
I stand firm that these situations are not outlier issues, common practice at some places. Thank goodness for people like you, Maurice, to allow this issue that encompass' everything from modesty to autonomy and consent.
belinda
Belinda, I have never heard of what you described as any standard of nursing practice and neither has my wife, a nurse. Insertion of a urethral catheter is a bodily invasive procedure which even if a necessary routine for the patient requires the patient with capacity for decision-making to provide consent and cooperation for the procedure. Cooperation will be impossible, at first, by a patient awakened by that procedure in progress. Note that even the drawing of blood from an arm vein is invasive and needs the prior acceptance and cooperation of such a patient. In a non-competent patient, prior general understanding and acceptance by the patient's medical surrogate is necessary but still the patient should first be awakened and explained unless the patient is comatose. Obviously, the medically necessary insertion of a catheter into a patient who is already sedated with an analgesic drug is another matter but again it requires some prior understanding and inferred consent.
The act, to set upon a sleeping patient, which you describe appears to me to be one of nursing self-interest only and in no way logically of beneficence to the patient and from an ethical and humanistic view represents the nursing staff turning the patient from a subject to an object. Shame. ..Maurice.
Maurice, I agree with you 100%. This being said, and it was a nursing facility, not a hospital, there are lots of examples of this kind of behavior and the problem is an individual institution or an individual person. How can the medical community set standards that this kind of behavior doesn't happen?
All the nurses were female so gender wasn't an issue, but from the patient perspective, this could have been considered a sexual assault.
I'm overwhelmed with all the problems and right now just concentrate on getting my needs met.
belinda
Maurice
I know of many intensive care units that require
the patient to have a urinary catheter despite the fact
they don't need it. These patients are NOT incontinent,
are not requiring checks for urine output. It's only for
nursing convenience and that is wrong. Uti's as well as
kidney infections,a perforated urethra and death are
just some of the complications of a urinary catheter.
Not to mention many nurses seem to enjoy
inserting these instruments into people. There is
certainly enough medical literature documented that
warrants nationwide education on this subject.
PT
PT, the insertion of a urethral catheter requires a physician's order who has made a decision for catheterization based on a complexity of considerations NONE of which should be primarily for the nursing benefit. In fact, I think that many doctors are cautious about ordering caths because they are the ones and not the nursing staff, who will be responsible but not the nurses for the infection complication and its management.
From the viewpoint of this patient modesty thread, catheterization does do one "good" in that regard. If modesty is really the issue, nurses don't have to frequently expose the patients perineum and genitalia for the essential need to keep the area dry to prevent the skin breaking down in the bedridden patient. But is that worth the potential complications to catheterization which you described?? ..Maurice.
Maurice
All physicians are aware of what is called a
"standing order". I have seen Icu's that have a foley
catheter ( urinary catheter) as standard procedure
upon arrival into the Icu. Is it me or do I really see
more males than females have foley catheters as
patients?
catheter out.org/?q=early-removal
On this particular website I might add that
1) Physician recognizes that a urinary catheter is
present.
2) Physician recognizes that the urinary catheter
is unnecessary.
3) Physician writes the order for the removal of
the catheter.
4) Nurse removes the urinary catheter.
I don't believe this issue is really about modesty,
although it might appear that way. Truth of the fact
is it is more of a patient safety issue. I would be more
than glad to provide many case examples of patient
demise from unnecessary catheter insertions.
The end of a urinary catheter has a balloon tip
that is inflated once inserted. Many patients have
had these catheters pulled out accidentally either
while being transported, or other equipment snagging
the foley bag, almost always requiring extensive
surgical repair due to urethral trauma. Many of these
urinary catheters were unnecessary. A physician
writes an order for folate. A nurse mistakes the order
due to poor physician penmanship , assumes the
order is for a foley. I cannot tell you how many times
this mistake is played out. Then you have the case
of the hipaa violation that occurred at Mayo hospital
with a urinary catheter and you have a recipe that is
played out countless times at hospitals every day.
Are you listening Misty, we could have a field day
on this subject with your blog on Dr Shermans site!
PT
Belinda:
I am so sorry to hear about your female relative’s experience. I wish that the nursing home could have been sued. It seems like elderly patients are constantly catheterized. I believe that many nurses catheterize patients for staff convenience so they won’t have to change diapers or clothes and sheets.
“We brought this issue to the administrator and the response was, "We always do that. It's uncomfortable and before they know what happened it's over'. This is "standard practice" My response to their statement is: This is not a good excuse. I wish that they could have been sued. Many medical and nursing facilities get away with unnecessary urinary catheterizations because they are not sued. If there were many lawsuits regarding urinary catheterizations without consent, I believe we would see a big decrease in urinary catheterizations.
Patient modesty is not the only concern with urinary catheterizations. There are so many complications that can happen as a result of urinary catheterizations. Look at the third paragraph in this article about elderly patients. Elderly patients are at high risk of getting C difficile, bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.
PT: I am also very concerned about how it is standard practice for patients in many Intensive Care Units to have urinary catheter inserted. I agree with you that urinary catheter is often unnecessary for ICU patients. I was very disturbed about what happened to my 80 year old grandfather after he had a seizure and aspiration pneumonia 3 years ago. He was taken to ICU. The nurses inserted an urinary catheter in him. He was very upset about the catheter. He tried to pull it out. They put a diaper on him to try to keep him from removing it. I do not know why they could not have offered him an urinal. I think that the nurses did this because they were afraid that he would urinate on the bed. This is not a good excuse to insert catheter. If I had known all of the information I know about urinary catheters today, I would have spoken up 3 years ago.
Misty
Misty,
While there may be merit in what you say about catheterization, the issue with my relative was that her rights were taken away, she was objectified, traumatized and this facility felt justified.
They probably could have been sued but, it wasn't my job to do so.
If her children wanted to proceed, I would have supported that.
belinda
Worldwide alone each year there are over 1000 male
patients who require surgical intervention from urethral
trauma simply from nursing staff using the wrong type
of catheter.
Nursing staff attempt to use a urinary catheter
designed for a female on male patients. The catheters
designed for females are not long enough and the
balloon becomes inflated in the urethra of the male
patient. In some countries attempts have been made
to color code these catheters.
Mrsa is a superbug that seems to be continually
evolving. Inserting a urinary catheter into a patient with
mrsa when the patient dosen't need the catheter in the
first place will only exacerbate the problem.
Often catheters are place for very short surgeries
when the patient is at an outpatient facility and will be
discharged after the surgery. Catheters are placed
on able and ambulatory patients for urine output when
patients are fully able to void in a urinal.
PT
Here's my latest attempt at same-gender care. A year ago, I made an apt. after finding out that the dermatologist [MD] had a male aide who took notes during my body scan. A year later, the aide [female] who took me to the exam room said that the MD could only treat half the lesions today and the other half at a different apt. I said that my apt. was for a body scan and that I never had any lesions. After several rounds of her repeating this and
we couldn't get beyond it, I realized that I was probably being harassed because I had confirmed that the MD still had a male aide.
I left which was dumb because that meant she got to control me. I should have waited for the MD and got my body scan.
How should I have handled this?
BJTNT
What you encountered was a power struggle between low level employees and you. You lost.
Remember....you are the one in control. Just say no. If you dismiss this person, you do two things. First, you take away their power and you give it to yourself.
She would have been beside herself if you had told her you were leaving. Then, she would have been on the "hot seat" when trying to explain why.
What happens to us all, is that this respect for authority is so engrained, that it seems unnatural to question it. If you go into every appointment with the mindset that you are in charge, you are in control, you may leave without your exam, but you'll feel great about the way it was handled. Few things are such an emergency that it can't be reschedued.
Good luck next time!
belinda
In the current, June 12 2013 issue of the Journal of the American Medical Association (JAMA)there is a Viewpoint article title "Encouraging Patients to Ask Questions: How to Overcome 'White Coat Silence'". (This current issue is not yet on the JAMA website so I don't know yet if it is a "free" article. If it becomes "free", I will provide a link.)
Just to let you all know here that both the Joint Commission and the Agency for Healthcare Research and Quality have encouraged through independent programs to encourage patients to "speak up" to their physicians and for the physicians to listen and respond.
It could have been that all these years, patients have been contemplating the modesty issues described in these threads but not communicating to me because of "white-coat silence" to my white coat, that might explain my ignorance prior to reading this Patient Modesty thread! ..Maurice.
Dr. Bernstein,
Is there any way you could copy and paste that article here with the source? It sounds like a very interesting article? It is very important for patients to communicate their wishes about modesty. Many patients feel powerless.
Misty
Misty, nope..can't do that. It is copyrighted. But.. if I find that it is "free" to access (as an occasional JAMA article is), I will put up a link to that article. Otherwise.. well..there is the library. ..Maurice.
I have always thought patients do not speak up about the modesty thing to doctors because of the very reason you stated: they are intimidated, embarrassed or feel ridiculous bringing the subject up. They just stay silent and "suck it up". I never would have thought to say anything about it to a doctor before I read this blog. So, yes, I think many (not all, certainly) do not bring this up because of white coat intimidation. Sort of like white coat hypertension. Jean
Call it white coat intimidation, but it's part of a larger issue of how uniforms contribute to authority and how most people tend to obey authority figures. Paul Fussell wrote a book called Uniforms: Why We Wear What We Wear. Also Phillip Zambardo’s book that I mentioned on an earlier post, The Lucifer Effect: Understanding How Good People Turn Evil, goes deeply into the role that uniforms play in intimidating people so that they will obey even if something inside them tells them it may be wrong. That’s what some of them are designed to do -- intimidate people. Healers, medicine men and women, sachems, doctors -- have always been authority figures throughout history. The white uniform is relative new, historically, but it serves the same purpose a costume or uniform served hundreds or thousands of years ago.
I actually covered, in part, the issue of how a doctor should be dressed in a thread 5 years ago ("How Would You Want Your Doctor Dressed or "Undressed") which you may want to go and read including my visitors comments. As an example of a comment pertinent to our discussion here is a response by "Mary":
I don't think I would mind my doctor wearing casual clothes during an office visit or discussion of my health. But during the physical exam procedures I would prefer the traditional attire. Picturing my doctor in street clothes giving me a breast or pelvic exam would make me very uncomfortable. Somehow the white coat advertises the doctor's credentials, and that it's OK to be naked in front of him. For me, the environment at such times should be 100% clinical in appearance.
..Maurice.
Dr. Bernstein,
Many women disagree with Mary. Many women do not want a male doctor to do intimate examinations on them under any circumstances. A male doctor wearing a white lab coat or scrubs does not change the fact that he is a man. Many men who do not want intimate medical care by female doctors or nurses would agree that the way female doctors and nurses dress makes no difference in how they feel about their modesty in medical settings.
Misty
Maurice
I'm not saying that wearing any uniform for any reason is necessarily bad, even if it's used to demonstrate authority. Sometimes that's needed as with police and military. Nothing wrong with doctors wearing white. It's the misuse of authority that matters. And we've talked much about that on this blog, in many contexts. And, as you've suggested, people have different responses to uniforms, depending upon their backgrounds and experiences.
To All:
Continuing on with the discussion of "white coat" and "authority":
How does the patient see "authority" misused? Do you want to see the healthcare provider appear "anti-authoritarian" or lack any suggestion of authority?
What would be most acceptable to patients in general for their healthcare provider?: "scrub suit or even T-shirt and shorts" and "leniency, toleration, forbearance, moderation, indulgence, sufferance.
laxity, slackness, weakness, appeasement" or any of the above? or more simply "white coat" but "a humanistic rendering of authority."
On first entering some relationship with the doctor, nurse or tech, what is it that the patient expects to see and hear from the healthcare provider that would provide the feeling of comfort,safety and confidence for a successful interaction? And if those expectation is fully met, will that remove all the noxious reactions related to the patient's physical modesty? ..Maurice.
Maurice,
This last post just drives the message to us on the blog that you don't get it. Defining our feelings as noxious reactions seems to mean that there is no cause for these feelings or that they are exagerrated in some way.
There is authority and there is abuse of authority. Nobody minds a strong doctor with strong opinions telling you what they think. Nobody minds a nurse who knows his/her stuff and wants to get a competent job done.
What we're objecting to is abuse of that authority when it encroaches on our personal freedom, autonomy, dignity and being treated as objectified non human patients. We are unhappy when we are not listened to, we are unhappy when an employee is doing something that the patient knows is wrong and when questioned or the patient stops a procedure, the attitude we get. We are unhappy when we are not treated in a respectful way, yelled at like children.
Persanlly, I like the white coat. It creates a roll for that person and makes total sense for someone to be uncomfortable being intimately examined without it. Take of the coat and that doctor becomes a man or a woman, but the coat is almost costuming presented for social comfort of both parties.
It is when the coat is worn and there is or was some kind of infraction when a doctor was wearing the coat may very well be the culprit of the "white coat syndrome".
The reactions are noxious because the violations of privacy are; nothing more, nothing less.
belinda
A couple more comments....standard of care practices need to be modified to protect the dignity of each patient.
Education to medical professionals that teaches them not to be adversarial when patients have requests, treat them like human beings and ask them why.
Stop lying to patients about what's in the IV, etc by omission.
Ask permission before you bring medical students into the room.
When there are infractions, a program set up to keep track, discliplin and removal of employee if necessary.
Psychological exams to evaluate the mindset of people who want to work with patients on an intimate level prior to employment, complete background checks.
Finally, when a patient needs same gender care, make sure it happens for them. Usually the reason has some relationship to trauma (whether from previous experiences or social norm training). The mental health of the patient must be as important as the physical health of that patient.
Modify protocols in the ER and OR, keeping it as private as possible when prepping and draping are taking place. The gawkers must be removed every time.
belinda
Here's a very interesting article called "Ask patients if they feel comfortable asking questions" by Kevin R. Campbell, M.D. It focuses on the difficult patients have with asking questions about sexuality, but the same principles apply to modesty. It's worth reading, and I'd like to hear what others think of what he's saying.
http://www.kevinmd.com/blog/2013/06/patients-feel-comfortable-questions.html
Here's another interesting article called "How to stop medical students from becoming jaded" by Robert Centor, M.D. We've discussed this here in terms of the underground or hidden curriculum. Maurice -- you will be particularly interested in this. And, though the article doesn't mention modesty, it does tie in to the old "You've got nothing I've never seen before" line patients sometimes get regarding their modesty.
http://www.kevinmd.com/blog/2013/06/stop-medical-students-jaded.html
Belinda, it appears from what you just wrote that you would be comfortable with a doctor in a white coat and my description "a humanistic rendering of authority." I think also that this is the best combination. After all, the physician should have some degree of "authority" in matters medical otherwise why would a symptomatic patient be visiting that doctor? ..Maurice.
Maurice,
I agree with what you just said. My feelings are that I'm paying someone to advise me. It's my job to listen, ask if there are other options and then, if it's something serious, it's fine to get a 2nd opinion. Then I discuss the 2nd opinion with the first doctor and listen to the pros and cons.
Sometimes I don't agree with a recommendation but then tell the doctor why and 100% of the time I've given them pause for the concern and we come up with a plan together.
A question for you. Do doctors like patients gowned for the same reason that I like the white coat?
My problem with the gowning is that it has become a symbol for dehumanization and emphasizes the power differential. However, doctors may see this differently.
I want a doctor who tells it like it is, doesn't skirt around a serious condition. My job is to be as compliant as possible, discuss apprehension on a recommendation and keeping the dialogue open between me and my docs.
The best education I received is when my specialist recommended I see another specialist. When I got there, the 2nd specialist wanted me to see someone she regularly works with who is the same kind of specialist that my own doctor who recommended her was.
World War III broke out and I ended up dropping both of them and was extremely angry that they tried to use me as a pawn. Clearly, the specialist who was recommended to me by my established doctor was wrong and my doctor couldn't hide her anger. It was terrible and I was sick.
belinda
Belinda, you questioned me: " Do doctors like patients gowned for the same reason that I like the white coat?" If you mean "to identify the patient as the patient", I would vigorously state "absolutely not!" I have never ever had that thought in mind and I never ever heard another doctor or nurse give that explanation for a gown. I can only respond beyond that more about my consideration of the gown and what I and I know the other instructors have taught the medical students. The gown is to allow more rapid and uncomplicated access to the bare skin where all physical examinations should begin, to prevent chilling and the possible associated shivering and other muscular contractions and finally and just as important to preserve a degree of physical modesty for the patient and to avoid unnecessary distraction to the physician, nurse or tech by working upon a patient with unneeded nudity. Those are the reasons for gowning and not to identify or diminish the personhood of that individual who at the time happens to be a patient.
Yes, in medical education, you will find that dressing does play an identifying role: short white coat for a medical student, long white coat for a doctor (intern, resident and beyond). ..Maurice.
I want to clarify what I wrote with the words "If you mean 'to identify the patient as the patient'. What I meant was the use of the gown was NOT to degrade the humanity (looking at the patient as an object rather than a human subject) of the patient nor the healthcare provider's respect for the patient. ..Maurice.
"Do doctors like patients gowned for the same reason that I like the white coat?" If you mean "to identify the patient as the patient", I would vigorously state "absolutely not!...Yes, in medical education, you will find that dressing does play an identifying role: short white coat for a medical student, long white coat for a doctor (intern, resident and beyond). ..Maurice.
Maurice -- You contradict yourself. If "uniforms" do play an identity role then, yes, a gown identifies patient as patient different from staff. It is an identifying piece of clothing, not always necessary for whatever procedure is being done. One time, before surgery, I had an EKG. They asked me only to take off my shirt. I had my pants and my boots on. then they handed me a gown. I was curious. Why do you want me to wear a gown? The techs really couldn't answer except that was just what they were supposed to do. I pushed. Why do I need to wear a gown. Because you're the patient, one said.
Of course it this is mostly done unconsciously, unthinkingly, out of habit. If it's really necessary to wear a gown the fine. But it's not always really necessary. A few years back, in a Reader's Digest article about things you doctor won't tell you, one doctor said that he was taught in medical school that in dealing with a "difficult patient," get the patient naked and put them in a gown. That will control them. I'm not saying that's the standard and what most caregivers do. But that doesn't mean it's never done.
If white coats and long white coats are symbols for doctors, then certainly gowns are symbols for patients. In past posts I've talked about the work of Erving Goffman, about the dramaturgy involved in medical situations, role playing. Costumes play a part in this.
Also, the two URL's I posted a few comments back relate directly to what we're talking about. Check them out.
Doug, it is technically appropriate to have even the male patient having an EKG performed to be covered with a cape or gown. It has nothing to do with labeling the individual as a "patient" but for the simple physiologic reason to prevent the patient to be chilled and develop shivering which would affect the recording of the EKG waves. It would be poor practice to avoid using a covering. (Check with our visitor PT on that or Dr. Sherman!)
And as far as using nudity or gown to respond to attempt to settle an "uncooperative patient", I can't imagine this was taught in medical school. If this doctor learned such a "trick", it must have been offered by some idiot superior as part of the "hidden curriculum" in later training.
I think there is too much "sinister" explanations for what could very well and truly be a deficiency in attention to patient modesty issues as recorded on this blog. I would look more toward issues of time limitations, healthcare provider gender availability and selection, inadequate awareness of providers toward modesty issues of patients and patients remaining quiet and hesitant to speak up. But sexual crimes and sinister behavior (including gowning patients) on the part of healthcare providers I think is far overstated here. But that's my opinion as a physician (and even as a patient, myself).
..Maurice.
Oh, of course you're right, Maurice. I'm not attributing "sinister" motives for all uses of the gown. But, tell me, why can't patients just be told, when they ask why in my situation, "the simple physiologic reason to prevent the patient to be chilled and develop shivering which would affect the recording of the EKG waves." See how poor communication leads to non medically trained patients to perhaps assume other things? Techs need to just answer the question and explain why? Is that too much to ask?
[Dr. B. - If this is inappropriate for the patient modesty blog, just discard it. Bernie]
Our patient modesty campaign needs to emphasize the need for grassroots advocacy by each of us.
That's the reason for my question at the end [below] even though it's not modesty.
Several years ago, I was amused even though I was the pawn in the "it's all about them" culture. One of the receptionists in my MD's office sent me to an X-ray technician in a different medical office. When I arrived [three floors away], the X-ray tech said that she needed authorization. I returned to the receptionist. She said that I should return to the X-ray tech. When I arrived, the X-ray tech said that oral authorization was insufficient, but she would do it anyway [from her agitation I suspect that the receptionist did some yelling].
After the chest X-rays, I returned and after a long wait I was admitted to the exam room. I assumed that the wait was for the X-rays. The MD completed the appointment without any mention of an X-ray. When I asked the receptionist, she told me to collect the X-rays from the tech and bring them along at my next appointment.
Six months later I presented the X-rays to the MD. I can still mentally picture the blank look on the MD's face. He laid them on his desk and returned them to me at end of the visit. I still have my chest X-rays with only me and the X-ray tech having seen them.
It was such a blatant "power and control" gambit by the receptionist that I can only imagine many worse consequences suffered by other patients - not that I appreciate the roentgen accumulation.
How should I have handled this and don't suggest talking to the MD since he missed an opportunity to quiz me? Besides, I'll spare you the details, one time I did call the MD regarding the office functions. He became upset and
defensive. In fairness, at the next visit he was effusive in his greeting, not that we don't have friendly relations and hold non-medical discussions at every appointment.
BJTNT
Dr. B,
You wrote:
"And as far as using nudity or gown to respond to attempt to settle an "uncooperative patient", I can't imagine this was taught in medical school. If this doctor learned such a "trick", it must have been offered by some idiot superior as part of the "hidden curriculum" in later training."
Not to disagree with you, but as I have previously mentioned, both my wife and sister are RN's and they were taught this same tactic in nursing school. Given that, I can't help but believe that the odds are overwhelming that it is very wide spread in the medical education system.
Hexanchus, I have no knowledge or control of what is taught in nursing school but I know I and my colleagues in medical school would never teach such behavior to medical students.
Healthcare providers dealing with a "difficult" or "uncooperative" patient requires that the provider understand the basis of their interpretation of the patient's behavior. Once the basis is understood, it is communication with the patient which is needed to resolve the issue but not humiliation, the latter being exactly what your family's nursing school was teaching their students.
Humiliation of the patient tells more about the ignorance and insecurity of the provider than a mechanism for patient cooperation.
..Maurice.
Oh yes..by the way.. do you notice anything similar to the humiliation which we have been writing about referring to actions against "uncooperative" patients with a rather similar approach (forced nudity) used by our governmental agencies both in Iraq and elsewhere for middle East "prisoners of war" who were found to be "uncooperative" in terms of providing what was felt to be essential information? I hope the nursing schools involved with nurse education are not stealing techniques from the CIA. ..Maurice.
You know, Maurice, sometimes I wonder...
What Hexanchus writes is true. The military and police strategies you descirbe above are part of our cultural attitudes toward nudity. These attitudes just don't fall out of the sky and land in war zones and prisons. They're part of our worldview.. I'm not saying it's widespread wittin the medical community, but are you saying that the medical community is somehow outside of our culture, immune to its influences and attitudes and blindspots? You joke about medical professionals "stealing" such behaviors from the CIA, as if those CIA behaviors are somehow outside of who we are as a culture. They're part of who we are. Not a good part but a part nevertheless. I've posted before about the danger of not recognizing how institutions like hospitals can, if they're not careful, begin to develop characteristics we see in total institutions. Certainly some nursing homes can move in that directions, treating the elderly like they're children or objects. This potential behavior we're describing may certainly be rare in the medical community, but you can't convince me that it doesn't exiist within the hidden curriculum. I can see why you're so upset about this, though. I would be too if I were as fine and ethical a person, teacher and doctor as you are.
Doug,
I agree with you and it was at least a part in what happened to me.
What was misconstrued as being uncooperative was a patient completely overwhelmed by what was happening and the inability to respond quickly. After a few seconds, they took matters into their own hands, explained nothing,subjecting me to extremely cruel and degrading treatment with the help of gawkers who had no business being there. It involved the public and medical staff that was not required to be there at the time.
belinda
How does the patient see "authority" misused?
What bothers me the most about how caregivers are dressed is that they all walk into the examination room wearing the same thing, scrubs. Everyone from an MD to an uneducated MA is dressed the same way. Whether the purpose of that is to fool the patients into thinking a CNA actually is an authority figure or that an NP or a PA is actually an MD, any way you slice it, it's fraud. Many, but not all of them wear a nametag with their credentials but many inexperienced patients have no idea what the initials stand for or their actual job description.
I've experienced this problem many times and didn't know who I was really dealing with.
Belinda, it depends on what you mean by "gawkers" unless you defined the term by those "who had no business being there." My experience with my first year medical students is that they entered the operating room one or two students at a time and their business was to see what went on within the operating room during an operation for their education in preparation to their work there as a 3rd and 4th year student on the surgery clerkships. There was no nudity on the part of the patient for them to observe or even "gawk" at (if that is the correct term).
Doug, delivering humiliation toward others, usually others who are the weak and at the time defenseless, is unprofessional in medicine regardless of how common it is in the culture of the ambient society. And those healthcare providers who humiliate patients should be ejected from the profession. ..Maurice.
The gawkers were family members of other laboring women and the only one acting unprofessionally in the room was a medical person hired to take care of the new baby.
Thank you for stating that providers who humiliate patients should be ejected from the profession. They are not, others will support them and it's a very sad situation.
belinda
Healthcare providers who are thinking about humiliating their patients should also think of the words of Maya Angelou “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”..Maurice.
Dr.B,
"I hope the nursing schools involved with nurse education are not stealing techniques from the CIA"
My wife & sister graduated from their BSN program 30 years ago, so maybe the CIA picked it up from the medical profession :-)
FYI, this was no small school - it's a large state run health sciences university located about 950 miles north of you - there's a medical school at the same campus, so you can probably figure out which facility.
I asked, and she said it came from clinical instructors at the school and was pretty commonly known - it wasn't just one or two.
Many of my recent published threads seems to have relevance to what has been written here on the Patient Modesty thread. I just put up another one titled "'Nudging' Informed Consent Toward One Direction" which I must say is a practice that, in one way or another, is common to virtually all physicians. You may want to visit the above linked thread and write there your opinions. ..Maurice.
BJTNT
Not sure I understand your concerns but I will try
to address them. Did the physician order the chest x-ray and if so were they read by a radiologist within a reasonably time frame. If the physician did order them
and did not have them read by a radiologist within a
few days then that is not the standard of care.
What if the chest x-ray showed a neoplasm or
metastasis, after sitting for 6 months.Only a physician, licensed physician assistant or licensed nurse practitioner can order a chest x-ray and no,technically a secretary CANNOT take a verbal order!
If I were you I would write the physician a letter,
have it notarized and ask for an explanation about
the x-ray and who ordered it and was it read in a
reasonable timeframe by a radiologist. This is a
case whereby the medical board would investigate
as well as the x-ray regulatory board.
Fines of up to $10,000 can be levied against a
physician and his staff for ordering radiological exams
without the physician knowledge or an order by a physician. I would be happy to show you the regulations
on this state by state.
PT
PT,
Thanks for your reply. My point was that the receptionist did it all on her own just to "prove to herself" that she could do it with impunity [and she did]. The culture in medical operations attracts the insecure because they can exercise power and control with little chance of punishment. We patients are not the paying customers of the medical bosses, so why should they be concerned with how patients are treated?
BJTNT
Patients are paying customers via deferred compensation and copays!
Ed
The patients' small copays and the indirect payments by patients don't get the attention of the administrators. The government and insurance companies are the direct paying customers that the administrators care about.
BJTNT
I just had a family member tell me about observing several surgeries that would by their nature require expoure. they had just completed their MCATS and haven't even recieved the results. They were not in medical school let. That is a gawker, not for cheap thrills, but for now real value to the patient. Regardless of why, if they are not there for the benefit of the paitient, they are gawkers. Permission of the patient makes it better, but patients are not there for others benefit, they are ther for their needs......name withheld for protection of identity of the student.
BJTNT, my W-2 for 2012 shows $17388.72 for employer provided health coverage; that's deferred compensation.
Additionally, I pay nearly $200.00, debited from my pay every month, for a family of four plus the "small" copays for every visit. It's our healthcare and I'm paying for it so it's going to be administered by who we chose in a manner that's acceptable to my family and I!
Ed
Ed,
I don't disagree with you. In our modesty campaign, we should cooperate with the administrators
to lobby the government and insurance companies for patient modesty. For example, why not propose female and male modesty compliance officers in the larger medical operations. The administrators would actively
pursue this since they run a cost-plus-profit business. It's unlikely to success, but it would
increase awareness of modesty issues. Our campaign has to be one of small and constant
steps forward.
BJTNT
BJNT, I agree with you that the insurance companies, and other "aggregators" of health care dollars, control a lot of cash and, thereby, yield a lot of power.
At the same time, the insurance company pays the health care provider, on the patient's behalf. If a patient leaves a provider, that provider loses the ability to charge for the services related to that patient. In this sense, the patient truly is a paying customer.
I admit that the services related to one patient are small, in the grand scheme. But, most companies, at least those outside of health care, usually take the complaints of a few customers very seriously. The reason being they assume that, for every person who complains, hundreds did not. They simply took their business elsewhere. So, they will value a person who tells them what they are doing wrong, in the belief that addressing these issues will save them many customers, not just the few who complained.
I guess that's my long-winded way of saying that folks on this board should not feel powerless. Their opinions, and dollars, really do count.
Here's the latest Father's Day message from Trisha Torrey on why men should receive medical care without any consideration by providers to their modesty concerns.
http://patients.about.com/b/2013/06/14/real-men-dads-included-are-smart-patients.htm#comment-304055
Ed
It's been apparent for some time that Trisha Torrey
is not and never will be a patient advocate. She gives
readers a false sense of empowerment,particularly
men. Using fathers day as an excuse no less is
rude and insulting and I for one would be further
incensed knowing she gets paid for posting useless
trash.
PT
The woman doesn't have a clue.
belinda
An article about a 'Digni-bra" for women who want to be covered during surgery.
I'm sure some of you will be interested.
Dr. Sherman,
I was glad to learn about the Digni-bra. I think it is awesome that nurses helped to invent this bra. I am afraid that this bra would not work for a heart bypass surgery because the surgeon must have access to heart which is between the breasts. Am I correct about that?
I do think we need to come up with something that would cover at least parts of women's breasts for heart bypass surgery. This is a concern because most heart surgeons are male.
One lady who had gallbladder removal surgery told me that she was able to wear her underpants, but that she was required to be topless because one of the incisions for the surgery were covered by the bra.
Misty
I liked the idea of the "digni-bra also but one thing that puzzled me: why in Great Britain are surgical patients (male and female) given these paper underwear but here in the US it's never offered; most often "standard procedures" require patients to be totally nude under the gown (which will most likely come off)? If they can do surgeries in the UK with a patient wearing these underwear (and/or paper bras) why can't they do the same here? I'm sure at times it does depend on the type of surgery (i.e. a hysterectomy, hemorrhoid surgery, prostate surgery, etc. may not allow underwear to be worn) but if the genitals are not involved in the procedure why can't patients here wear the paper underwear? I also note the large percentage of women given the option of wearing the digni-bra would be glad to have it. I am sure women here in the US would be the same, as would men (and women) if given the choice of paper underwear. Actually, I think it would be a great idea for a savvy business person to try and market them to hospitals, surgical centers, etc. It may prove to be a big money maker and a big comfort to many patients. Jean
Interesting to note the comments from readers regarding
the digni-bra. Nurses proposed this idea, yet other
nurses commented that " no one is looking at your bits".
That's what I call talking out of both sides of your mouth
at the same time. I could only imagine the comments if
a male nurse proposed something like this for male
patients. Folks, we have a long long road ahead of us
and quite honestly the stupidity is so thick you could cut
it with a knife.
PT
I am so thankful that compassionate nurses in the UK invented the digni-bra. It’s very important because many bras have metals in them. This is also a wonderful bra for women undergoing shoulder surgery. I do understand why you cannot wear any clothes with metal such as jeans with zippers because metal can heat up and cause a burn during surgery. But the good news is patients can wear clothing, underwear, and bra that do not have metal.
I was very disappointed in some callous comments by some people on that article. I was especially disappointed in the way Betty, a nurse responded from Dallas, TX. I did not appreciate the following comments she made: I can tell you as a nurse, we could care less what your " bits " look like. Any medical professional worth their salt will tell you the same thing. It's all the same to us, whether you're our neighbor or not. I would not want to have her as a nurse.
Jean: I agree with you that it is ridiculous that it is standard for patients to be required to take their underwear off for many surgeries that have nothing to do with their genitals. I found a great article that exposes the truth about the myth that removing underwear for surgery helps to maintain a sterile environment. Look at All patients should be allowed to wear 100% cotton underwear and even cotton shorts unless they are having surgeries that involve their genitals or buttock area. It would be difficult for a hip surgery patient to wear underwear though. But I think that they should come with a type of underwear that does not cover one hip that is being operated on.
One man who had a colonoscopy was unaware that there were colonoscopy shorts available or that he could have worn a boxer short backwards because he was never made aware of those options. This is why Medical Patient Modesty exists to educate patients about issues that medical professionals will rarely address. So many patients are taught to trust the medical profession without questioning.
Look at an article that I found: A patient’s underwear removal does not ensure a sterile environment for surgery at all. I have pasted the most important parts of the below article:
3.1.1 Patient personal clothing
A recent editorial from Canada11noted no increase in infection rates in patients undergoing day-case cataract removal when the patients remained fully dressed to enter the theatre, including their ordinary shoes.
Brown12 describes the ritual of making patients coming to the operating theatre remove their underwear as the “most illogical of rituals”. It is still practised in many surgical units and should be stopped for the good reason that it causes embarrassment to the patient and serves no useful purpose.
Misty
For some reason, the article link I posted earlier did not work. Here is the correct link: Behavior and Rituals in the Operating Theatre. Look under Patients personal clothing.
Misty
If you want to talk about infection, let's talk about the nurses, doctors and other personnel who go out to lunch in their scrubs, go to the bathroom in their scrubs and then think because they washed their hands they're sterile. Talk about stupidity.
Sometimes they are wearing their shower caps too.
I don't believe hospital gowns or scrubs are sterile; just clean.
You'd be surprised if you just tell them what you will and won't do how the tune will change because there is no medical reason for so many things.
Uniformity in medicine is easy to teach and implement. Everyone wears a gown so nobody has a faulty test. The workers are not educated enough sometimes to override a decision.
belinda
Belinda,
I really appreciate your excellent points below:
If you want to talk about infection, let's talk about the nurses, doctors and other personnel who go out to lunch in their scrubs, go to the bathroom in their scrubs and then think because they washed their hands they're sterile. Talk about stupidity. I don't believe hospital gowns or scrubs are sterile; just clean.
When my grandmother had heart bypass surgery more than 3 years ago, I saw many doctors and nurses with scrubs in cafeteria eating. They did not change their scrubs. They went right back to surgery. If they really wanted to maintain a 100% sterile environment, they would need to take a shower and change scrubs every time they went to the bathroom or another room. Think about all germs that are in the bathroom and cafeteria. Underwear removal for patients does not help to maintain a sterile environment. In fact, I believe there are more germs when a patient is naked because of bodily discharges.
I can understand a policy prohibiting any clothing with metal. Most patients would be happy to comply with that rule by not wearing anything that contained metal including zippers.
Another question to consider is: are the medical gowns really sterile? They could be picked up by a person who has not washed his/her hands from the dryer.
Misty
Based on the concerns written repeatedly on this Patient Modesty thread, I submitted an original article to bioethics.net which was published today and which I reproduced on my blog with the publisher's permission. The article's title is "The Ethics of 'Gawking' in Medicine".
You may want to go to the above link and post your comments and views on the specific subject of "gawking" directed to those visitors who have come directly to that thread. ..Maurice.
I put up the comment copied below on my new thread "The Ethics of 'Gawking' in Medicine". I hope to promote conversation on that thread's topic by encouraging the visitors here to go there and write their views strictly and specifically to the issue of "gawking" in medicine. Please respond to my comment there only. Thanks. ..Maurice.
A recent CBS Los Angeles news item: "A 43-year-old man faces misdemeanor charges after allegedly taking inappropriate pictures of unsuspecting women at two shopping malls in Glendale" And there are many more "Peeping Tom" stories, often associated with picture taking, if you want to Google the topic. In what ways does observing nudity or partial nudity strictly for self-interest within an operating or procedure room differ from the alleged criminal behavior of those arrested "Toms"? Is it because simply the attribution of "self-interest" in general is not the criteria but it is really proven prurient self-interest that defines criminality. And then perhaps those who have been allowed by the healthcare system to stand and watch in the clinical situation can argue their self-interest is for self-education and for later care of patients in the case of students and in the case of others, some other societal, safety or humanistic value but not for personal sexual interest. In any event should those who stand and watch still have been made aware to the patient and accepted as part of the patient's informed consent? ..Maurice.
Maurice
What's your default position here? Based upon your last sentence, it seems to be that we need to defend the position that the patient should be asked. I challenge that. I say that the default position is that the patient should be asked and those who say no to that need to defend their position.
Doug, I wanted this conversation to continue on the new thread on "gawking" and so I put your current posting there followed by my response. Let's keep the discussion regarding the behavior of "gawking in medicine" going on that thread. ..Maurice.
I am a long time follower and occasional poster on medical blogs. A year ago I had a urological surgery at a local city hospital. I was absolutely stunned by the attention and emphasis that was focused upon my modesty because this is never the case. Even though I never made mention of exposure concerns they treated me like the most modest person in the world, which was good. Later I noticed my "exit scorecard" had lots of questions about them respecting modesty. It was a job measureable, not just somthing these people were doing for my own good. As a long time athlete I have become used to the undressing, showering, etc in the open, so I dont feel like I am an overly modest person. For me, the problem I have with medical personnel is the disrespect. Disrespect plays heavily in the modesty issue as well because of the way patients are treated in regard to their nudity. My time spent in athletics has also shown me this absurd stereotype of "guys are not modest" is a 125% self serving load of crap. It is an excuse for them not to have to make any effort. I know for a fact that many men are indeed quite modest. I have known a lot of guys without a stitch of modesty, and many that were very much bothered by just having to strip down to their underwear momentarily in front of other guys. Claiming modesty in men is just not somthing they need to be concerned about is another example of the disrespect. Anyway, I began experiencing big time testicular pain so my urologist orders up an ultrasound. Swell. I get sent to a "sono tech in a box" imaging center. Volumes of blog entries swam in my head as I wondered how this experience would go. In my hour plus wait I notice there are four male techs taking people back today. That made me feel a bit better knowing I had a male. Well guess who takes the opportunity to show up at my slot, the first woman I had seen since I got there.On the way back I mention, "I waited for an hour, are you the only sono tech today?" No, she says, we are fully staffed. Then confirms the nature of my visit. I take the opportunity to ask, "for personal procedures like this dont you try to match the gender of the patient and tech?" The answer will no doubt shock all of you. "Well, for women we do but you know how guys are". Actually yes I do know how guys are, they have feelings like everybody else. She takes that moment to bolt out for somthing important, obviously seeing where it was going. Like I said, its not her being a woman, or having to be exposed, its the disrespect that sets me off. As instructed I strip waist down and cover with the narrow sheet that covered just enough, but exposed the scrotum. She knocks and waits for me to acknowledge her in, closes the door and brings no assistant. All was going well. She says she will get me a towel to cover the penis, pulls off the paper sheet, throws it away, walks over to the cabinet, gets a towel, folds it at the tableside, and covers me with it. I was wondering, "what the hell is the point of covering me back up now?" Near the end, she wanted me to find the painful lump. Lying flat I couldnt, so she says try standing up. I stand up holding the towel on me to keep my penis out of the way and also to keep the gel from getting all over me while I locate the testicle lump with the other hand. She is sitting there beside me on her stool intently watching, then says "let me take that towel", and pulls it out of my hand. She then resumes her position sitting there two feet away watching me grope around for the lump. Even with a lower than average modesty level, it didnt feel right. When we were done she says clean up and get dressed, and I will take you back up front. Then stands there waiting, obviously not going to leave the room for me to do it. I absolutely felt like a slab of meat. Being treated like an unfeeling, uncaring object that possessed no human feeling what so ever. This seems to be the "standard of care" foe male health care.
Mike
I'm curious, Mike. When you found out the clinic was fully staffed, and when you got a remark like the one you did: "Well, for women we do but you know how guys are" -- why didn't you just say you wanted a male tech? It seems to me that these are the moments when the rubber meets the road, when patients make their preferences known and either get them or walk out.
Mike, I was part of the problem until I started reading this and Dr. Sherman's post and started not only asking but giving feedback. The first experience I had was very similar. Scrotal ultrasound, female tech when males were available, rolled up the towel, etc but she appeared a bit more professional. She asked the next patient a female if gender mattered. I sucked it up and took it. It bothered me for months, I finally wrote the facility not expecting a response and was surprised to be contacted by 2 staff members. I was shocked, we discussed they got suggestions and sometime later one called back to tell me of the changes they made. Everytime we expereince something like this and do not challenge we put our stamp of appoval on it. Whether it be a call, an email, or a letter. If you do not express your concerns you have validated their right to continue it. I think it is paticularly important to point out the sexism in treating patients modesty different by gender. Terms like sexist, discrimination, and so on garner a lot of attention in our society where PC is at an all time high. I would urge you to write or call them and make your thoughts and concerns known. Even if significant time has passed challenge them. Change doesn't happen it is caused. Give them a call and let us know what they say....don
Doug and Don
Thanks for the feedback. The years of following this, and Dr Shermans blogs have definately made me feel more empowered.I completely agree with you both that we have to make our preferences known. If it were that important to me to have a male tech, I knew they were available and would have demanded one. Though I am guilty of forcing myself to "suck it up" in the past, this was really not one of those moments. I dont plan to ever again allow somthing to happen to me that I am not OK with, nobody ever should. This was really a more comical "just my luck" moment to get the one and only female. I feel like my modesty levels are probably lower than the norm because of my past, and having a female do the procedure honestly was not an issue to me. My recent and sudden onslaught of urology procedures have for sure numbed me down to the embarrassment. I still feel I should have been given the courtesy of a choice though. As I was saying, I think the disrespect is as much a part of it as the nudity, especially when they are so closely entertwined in a medical type encounter. I have been treated with the same levels of disrespect from both genders, so I did not feel like a male tech was necessarily a ticket to a good experience. You are right though, demanding the male tech at her initial comment and first signs of stereotyping would have proved a point, even if actually getting a male was not a priority of mine at the time. My appointment was just this week, and I still have plenty of time to lodge a complaint. Even though it was not a big deal to me at the time to have a female imposed on me, I know for some it would be. I probably need to go ahead and express my concerns for the benefit of the many, and as you say challenge what is becoming too much the norm. Looking back, other than the farsical draping part, there was not a whole lot of easily definable parts of the process to suggest specefic improvements to. That is they will want, and that is the problem with trying to file a complaint suggesting the process is broken. Technically she followed PROCEDURE and did not do anything flagarantly unprofessional. It was really more the whole underlying and obvious philosophy that men have no concerns, feelings or emotions to consider. She was nice, she was cordial and she was professional. She also did not give an ounce of a damn about how I might have felt about any of it.
Mike
Mike,
I am sorry to hear about your bad experience. Don has excellent suggestions.
Misty
I wanted to invite anyone who may live a few hours within of the Charlotte, NC area to a parenting, baby, and kid expo (http://www.parentingbabykidexpo.com/charlotte) at Monroe Crossing Mall in Monroe, NC from 11 AM – 5 PM tomorrow.
There will be a silent auction to benefit Medical Patient Modesty. Many attractions including Disney World and hotels in Southeast US donated tickets and gift certificates to MPM. I will be at the silent auction table handing out brochures about MPM. Please pass this to any friends or family members who live in the area. We all are from different states. It’s always nice meeting people who are passionate about patient modesty.
Misty
Let's go under the radar and talk about what we should be talking about here. The young female tech said: "Well, for women we do but you know how guys are."
Let's do an exercise. Fill in the blanks below.
"Well, for _________ we do but you know how _____ are."
Play with the combinations below, put them in and reverse them.
men/women
blacks/asians/Hispanics/whites
Catholics/Protestants/Jews/Muslums
Gays/Straights
Rich/Poor
Get what I'm saying? At the very best, what that woman said was stereotyping. At it's worst it was sexist. If she had used some of the terms above,it would have been racist or antisemetic, or gay bashing, etc. But in our current culture, it's politically correct to make such comments about men.
Now, I can already hear my critics. Oh, don't take it so seriously. She didn't really mean anything. You're too sensitive. Even if it's in jest, just try making such a comment with the above terms inserted, and then using the excuse that it was in jest. Give that a try. My point is that we need to confront these comments when they arise. We don't have to be angry or insulting.
In that situaitons, I might have asked. "No, tell me, what are guys like?" Let her answer. See what she says. Then respond, "Are all guys like that, everyone, they're all the same?"
And I agree with Mike. For me at least it's 99 percent a respect issue, and 1 percent a modesty issue. The buck needs to stop with each individiual patient.
Mike we had strikenly similar experiences. My female tech was very cordial, professional, nice, and I would likely have never challenged had I not over heard her asking the next female patient if she had a preference when I was not afforded the same consideration. While she may not have technically done anything wrong, as medicine become more patient centered and patient experience based chasing patient dollars just expressing your concerns and making suggestions like when it involves exposure and both genders are available ask... etc. I applaud you for your statement that while gender was not the issue for you, you recognized it was for other males and were willing to challenge for them, bravo for your concern for others. I hope you will contact them and let us know what they say....thank again for your concern for others...don
"For me at least it's 99 percent a respect issue, and 1 percent a modesty issue. The buck needs to stop witheach individual patient."
I couldn't agree more. This is just another way of saying "it's all about them". That culture is deep and wide. We all need to be aware and respond whenever the situation arises, not just on modesty issues.
BJTNT
In the last week, I have seen two newspaper articles and one television news segment about the fact that June is "Men's Health Month". Each of these reports follows the same format' beginning by lamenting the fact that men seek medical attention far less than women and then going on to explain the various preventative medical exams and screenings that we men should subject ourselves to.
Nowhere in any of these reports is the question asked as to why men might be reluctant to seek medical attention. In virtually any other business, management would ask why they were failing to reach a specific demographic and what they could do to change things. However, the medical field on the whole takes the attitude that male avoidance of their services is entirely due to some defect on the part of men and has no relation to anything the medical profession might be doing to discourage more male involvement. Readers of this blog know full well that the increasing feminization of the medical field along with a general disregard for male modesty is a major reason for the current situation. And if the medical-industrial complex would admit to this there are steps that could be taken to ameliorate this situation such as:
• Hiring more male nurses, particularly in primary care and urology offices. Can anyone imagine a female urologist using a male nurse to assist or chaperone during an intimate exam? Yet male urologists routinely expect their patients to accept the presence of female nurses during intimate exams and procedures.
• Commit some funds to an ad campaign encouraging young men to consider entering the nursing field.
• End so-called medical "ambushes" by being certain that females will not be present for any intimate exams unless the patient has been fully informed and given consent beforehand.
• End the ridiculous practice of pressuring patients to be fully nude under a flimsy hospital gown for knee, hand, and even cataract surgeries, etc., where there is no medical necessity for nudity at all. Also, provide modesty shorts for colonoscopies.
• Open some men's health centers, staffed exclusively or primarily by men. I think such practices would attract large numbers of men who would then be assured that their modesty would not be violated by some female PA, nurse, or CNA.
The medical profession is unlikely to make any of these or similar changes unless enough of us males demand them. But it will only be then that I will recognize June as truly being Men's Health Month.
MG
MG, ..and wouldn't it be humanistic and understanding and more likely to lead to success for all women to advocate for men all the steps you suggested? How about it, Women, are you all in agreement? ..Maurice.
Absolutely in agreement. I have said on this blog over and over, this isn't a gender war, it's about men and women having their needs met.
Every time I think whether I should say something I realize what's happens if I don't speak up. It's just enough to push me over the edge to speak my mind.
Every man or woman who doesn't like the way an office is run should stop going to that office. Even if you go to three offices by voicing your position (and get others to do the same). It works and changes will come. it's everyone's obligation to do their part. Things will change when enough adversity to the status quo is in the mind of public opinion.
belinda
MG writes: "Readers of this blog know full well that the increasing feminization of the medical field along with a general disregard for male modesty is a major reason for the current situation."
We don't "know" this to be a "major reason." It could be. It needs more research. It certainly is a reason for some men, and these men's needs should be respected. My point is that more research should be done in this area to learn about all the reasons involved. Some men prefer female caregivers for their own reasons -- and these men's needs should be respected as well.
Otherwise, I agree with all your suggestions, MG. As far as mens' clinics go, as you say, there needs to be enough male staff so men who prefer men can easily have their needs met. But, as I said above, some men do prefer female caregivers. The important goal of these mens' clinics is to get more men into the healthcare system who otherwise might not feel comfortable doing so -- for whatever reasons.
Golly Doug, what you just wrote would be an interesting thread to create discussing why, if true, men currently are disinclined to enter into patient-care work in the healthcare system of the U.S. Do you think that men might feel more of an emotional challenge to "nurse" female patients than female employees attending to male patients? After all many females in the role of "mothers" have been "nursing" in one way or another males for years since their birth, whereas males as "fathers" have only had, perhaps until recently, a less of a role in "nursing" their female children. Or am I way off on that?? ..Maurice.
What you are into, Maurice, is dangerous ground, i.e. gender issues. I agree with you that these are interesting topics and should be discussed. You're delving into gender role issues. To what extent are these roles embedded and to what extent are they learned? Is gender entirely a cultural construction, as some claim? Are women "natural" healers and caregivers? Is it not a "natural" inclination for most men? Interesting, yet in our current politically correct culture, potentially dangers topics. There's a lot written about this. I don't know how much solid, scientific data exists, though. Certainly, there a lot of opinions out there. I'd want to make sure all sides are represented in this debate -- and it might be a challenge to keep the discussion on topic and civil.
Doug, "danger" is created by those discussing the phenomenon of "gender roles" and not by the issue itself. And yes, all discussions to become productive need to stay on topic and civil. ..Maurice.
Interesting discussion, Maurice. The danger isn't created totally by the "individuals." It's also created by the "culture." It's a paradox, I believe. Even though the culture is made up of the individuals, the culture itself can take on "a life of it's own." Parts of the culture can be manipulated by powerful people and groups, to some degree. The culture can move us along, and unless we're very aware and savvy, we don't even notice it sometimes. But you're right. People can choose not to be manipulated by the culture, and people can certainly choose to discuss taboo subjects with civility.
There are so many issues in the past couple days posts. But I think there is some common threads . Why would a nurse feel comfortable making a comment that would be unacceptable for others based on gender, religion, or race? Why would it be acceptable not o challenge a 90/10 gender disparity in a profession like we have in cases such as
Bringing females into professions such as police, firefighting, prison guards, sports reporters, etc. why is it acceptable to require or suggest male nurses may need a chaperone but females do not...is that natural selection or reverse discrimination. The medical society has marginalized or dismissed male patients until we no longer feel part of the community as consumers or providers....men are violators not victims in our society...Don
In regards to healthcare gawking is a four letter
word and from what I have seen it appears to be
getting worse. Odd this spectator behavior is never
addressed in medical schools nor nursing programs.
Excellent article you wrote Maurice about the ethics
of gawking and maybe this article just might wake
people up about this disgusting behavior.
PT
I wanted to let you all know that Patty Avery did a radio talk interview about Medical Patient Modesty on a radio talk show in Orlando. FL last Monday. You can listen to it by going to http://americanadversaries.podbean.com/2013/06/17/335-june-17-2013. You will need to click on the icon that says audio mp3 to listen to it. Cathy of East Orlando Tea Party spoke first on this show so it might be about 10 minutes before you all will hear Patty. I believe that you can skip to the interview about MPM on some formats.
One lady, Diane called in the radio show commenting how her dad refused to go back to the hospital because of patient modesty concerns and that he died. That is really sad. You will be able to hear her on the radio show as Patty talks.
Please let me know of any radio talk shows you think we should check out to see if they would be willing to raise awareness about Medical Patient Modesty and patient modesty issues.
Misty
I've never really understood the difficulty for so many men in standing up for their personal and moral rights. Maybe it's because I grew up in a very religious family where opposite gender nudity is very taboo, or that I haven't had much of a need for intimate examinations or procedures in my life, but I've never had a problem with demanding same gender intimate care. I also learned at a young age that the medical world doesn't care about you as a person, they'll always do what's easiest for them.
Why is it such a problem for most men and boys to insist on being treated with respect? Is it peer pressure, intimidation by medical women or the fear of having their masculinity insulted? Is it acknowledgement that everyone that wears scrubs or a white coat is right so what they feel inside must be wrong? Do they think that the terrible way people (mostly men) are treated in a medical setting is the societal norm so it has to be respected? I just don't get it.
I try to convince myself that as long as I stand up for myself and those I care about it doesn't matter if cowardice, stupidity or low self-esteem causes other people to let themselves be humiliated by medical workers. But it is so outrageous to me that I can't help but wonder how society, "political correctness" and religion can preach complete gender segregation when it comes to restrooms, locker rooms (except female reporters), exposing themselves in public, etc but expect us to be totally fine with getting naked at the drop of a hat in front of anyone wearing scrubs.
Despite what most medical "professionals" believe, they aren't gods, superhumans or special in any way. Don't let them convince you otherwise. Don't let them force you to do anything you aren't comfortable with. If they ambush you don't take their crap, and if they do it behind your back (when you're unconscious) do everything you can to make sure they won't do it again. Let's change the future societal norm for our children.
GE
Oops! I accidentally rejected the following from "Anonymous" today so I am publishing it now. ..Maurice.
"Take of the coat and that doctor becomes a man or a woman, but the coat is almost costuming presented for social comfort of both parties."
Sorry, to me wearing a white coat doesn't make that person gender neutral or professional. Any idiot or pervert can put on a white coat.
GE,
You have made many excellent points. I am not sure what kind of religion you are. But many people who come to Medical Patient Modesty’s web site have moral or religious convictions that opposite sex intimate medical care is wrong. It is pretty common for your wishes to be disregarded once you are under anesthesia.
I encourage you to read the below articles on Medical Patient Modesty’s web site if you have not already:
1.)Male Patient Modesty
2.)Why Patient Modesty Is Important?
3.)Why Patient Modesty is a Serious Issue?
You may be interested in this article from Truth Magazine, Modesty and Your Physician.
Medical professionals should always work to honor patients’ wishes. They are supposed to serve patients rather than thinking about what might be convenient for them.
We are always looking for volunteers to help us at Medical Patient Modesty. Check out volunteer opportunities.
Misty
There was a very disturbing picture of a female patient who was being prepped and positioned for surgery on the front of Outpatient Surgery magazine for June 2013 at http://outpatientsurgery.uberflip.com/i/134982/0. It looks like she is having hip surgery.
Most doctors and nurses won't even tell you how much you will be exposed while you are under anesthesia. I noticed that all of the 3 medical professionals in this picture are men. If you zoom in, you can see that she has an urinary catheter. I wonder if she was asked for consent about the urinary catheter. It was probably unnecessary. It is very likely that one of those guys inserted the urinary catheter. It’s most likely that this female patient has no idea how much exposed she was for surgery.
This is why we need to educate people about how much modesty they could lose once they go under anesthesia and how to get maximum amount of modesty. Surgery patients are most likely to have their wishes for modesty violated because they are under anesthesia and cannot advocate for their rights. This is why every patient should have an advocate not employed by the medical facility present to make sure that her/his wishes for modesty are honored while she/he is under anesthesia.
It is also prudent for every patient to refuse sedation and IV until after he/she has been prepped and positioned for surgery if he/she cares about his/her modesty.
What are your thoughts?
Misty
Misty, while I certainly respect your view, my personal opinion is what you don't know can't hurt you. I mean it is major surgery so exposure is required correct? What difference does provider gender make in this case? While I generally agree with your position on unnecessary urinary catheterization, we're not qualified to say that's the case here. Personally, my issue is whether the patient consented to pictures being taken and published.
Ed
I think I would rather avoid surgery than risk this sort of exposure. JT
Maybe what is missing here in this discussion about what is the standards and practices for successful and safe surgery including patient modesty issues in the operating room is that my visitors here are making conclusions based on only "hear-say" evidence for the most part. What is necessary for my blog visitors to better gain the full picture of what is going on would be to attend a number of surgeries as an "operating room visitor" along with responses to specific visitor questions from the OR staff. Unfortunately, that could not be accomplished without the approval of the hospital or clinic and as been stated here as a requirement, specific approval of such a "visitation" by the patient him/herself. Though I fully understand my blog visitors concerns, those concerns cannot be resolved or substantiated without attending and communicating. ..Maurice.
I agree with Maurice. Did anyone read the full article Misty is referring to? One of the big issues with surgery is pressure ulcers. Not only is positioning important, but the skin needs to be checked not only before surgery but sometimes during the surgery itself. That requires exposure. This is not to say that improvements can't be made with exposure -- but this is a patient safety issue at heart.
Ed,
I wanted to respond to some statements you made below:
“My personal opinion is what you don't know can't hurt you. I mean it is major surgery so exposure is required correct?” This is totally untrue. It is true that not knowing that you were naked during surgery does not kill a patient. But it does make many patients upset when they find out that they were exposed surgery and were not informed. Some patients end up with emotional problems because they were traumatized by the thought that they were naked in front of some people against their will. Also, if a patient finds out that his/her private parts were exposed to an opposite sex nurse or doctor, it may affect her/his relationship with her/his spouse if they have made a commitment for their spouse to be the only person of the opposite sex to see their private parts. Unconscious patients’ wishes for modesty and/or same gender medical team should be honored as if he/she were awake. Medical professionals should do everything they can to protect a patient’s modesty. I do not feel they did a good job in this case at all.
Also, many male nurses and doctors have taken advantage of women under anesthesia to sexually abuse them. Female doctors and nurses could also abuse male patients. For example, look at what happened with Dr. Sparks, the female ENT doctor who did non-consensual genital exams on male patients ( http://e-ditionsbyfry.com/Olive/ODE/OSM/default.aspx?href=OSM%2F2010%2F01%2F01&pageno=35&entity=Ar03500&view=entity). There was actually no reason for those male patients to be naked anyway. All patients should be able to wear at least surgery shorts for surgeries that involve nose, throat, or ear.
What difference does provider gender make in this case? Gender is a huge factor in surgery cases where modest patients’ private parts have to be exposed to opposite sex medical providers. I wonder if this lady has any idea that those male doctors and nurses saw and handled her genitals and put the catheter in her. It is impossible to wear a full underwear or short for hip surgery because of the way the hip is connected to the person’s body. But there should be something that covers the genitals completely for hip surgery. Many hip surgery patients are never told the truth about how much they will be exposed in surgery. This is wrong. Every patient should be informed about how much of their body would be exposed for each surgery and the maximum amount of modesty they can have so they can make a decision about if they want a same gender team. I recommend that all hip surgery patients who do not want opposite sex intimate care to get a same gender team if they really require hip surgery. It would be easy for a man to find a male orthopedic surgeon to do his hip surgery, but he might have a challenge in finding all male nurses. There are not many female orthopedic doctors so it would be a challenge for a woman to find a female orthopedic surgeon. She might have to drive 5 hours to find one, but it is worth it.
If this was knee surgery, there is absolutely no reason for a patient’s underwear to be removed since knee is not close to the genitals. Only the knee needs to be worked on.
Dr. Bernstein: I actually like the idea of having someone in the operating room. I think that every patient should have an advocate of their choice present for their surgery to make sure that the patient’s wishes are not disregarded.
Misty
Does everyone writing to this thread actually believe that every patient entering an operating room needs their own chaperon? And the chaperon will arrive with what education regarding the patient's wishes and with what education regarding the standards of practice regarding the details of performing the operation? What will the patient and their chaperon expect with regard to the clout of the chaperon? Should the chaperon interrupt the procedure in progress and call a halt to what was been carried out or is the chaperon's role primarily as an observer and then communicate those observations later to the patient? Since the goal of all surgery (entering some part of the human body to correct a disease or disorder) is for a satisfactory conclusion for the procedure and the absolute safety for the patient, will an activist chaperon guarantee their role in the surgery will not prevent accomplishing those goals?
What is lacking in these thread discussions is the implication that trust between the patient and the professionals is simply absent and that the patient entering the operating room is simply the object of some prurient interest or goal. I disagree. To put yourself "under the knife" for your surgical condition requires trust that rationally puts aside the rare, even if valid, scary stories of criminal behavior in the operating rooms. If trusting the professional is so fragile, what options remain for a patient with a fractured hip, a breast mass or cervical or anal cancer amongst a host of other surgically treatable disorders? A chaperon? And will you even trust that individual, if not trusting the professionals? ..Maurice.
Even if you have the utmost trust in your surgeon, I believe that you should still have someone to look after you. The surgeon will not be with you the entire time that you are out. If they use versed in pre-op, you will have no memory from that point forward. Yes, I believe that every patient should have someone, either a private nurse or family member with them the entire time that they are under any type of sedation. I live in Delaware and about a year ago there was a resident physician at Christiana Care Hospital that molested several female patients. The administration ignored the first complaint. He went on to molest 3 more women before he was allowed to escape back to country that he came from. Basically, he escaped.
How about a same gender team for those who need it?
belinda
We seem to be struggling for what is the norm or what is the universal answer when there really isn't one. Each patient is different with different needs and wants. I consider myself modest but while uncomfortabvle am able to accept opposite gender when I am out. this is just me, while it is uncomfortable, if I do not experience it, I can tolerate it. that is not the case for everyone. BUT to your comments Dr. Bernstein, no we do not trust providers because while I believe they know this, they attempt to treat us all the same for their benefit. Now I think the vast majority of people trust providers not to molest them, I believe the people who fear this are a small minority. However I think a significant number when it comes to modesty do not feel providers have their best interest at heart. Do I fear abuse, no not at all. do I think when it comes to patient modesty providers put my wishes and needs infront of their agenda, do I think that they feel sacrificing my comfort for there schedules and ease is reasonable....absolutely. And that is why i do not trust providers, for me I do not need a chaperone, I just need to to voice my own desires and stand up for it....don
Misty, we will have to agree to disagree. If unconscious in the OR, I'm not embarrassed or modest. I believe the vast majority of providers are truly professional and ethical folks doing an admirable job trying to keep us healthy. While there certainly are exceptions, I'll trust the odds are in my favor by selecting physicians and hospitals that I'm comfortable with.
Personally, I think the idea of a patient advocate in the OR is laughable. I can't imagine a single physician or hospital would ever agree to such a presence.
Ed
Did anyone notice one of the men in the OR picture is not even wearing gloves ? (Hardware tec ?)
Yes, Dr B, we do need chaperones...or a video of the procedure if we want.
While modesty is an issue for me, I have an even greater issue with lack of trust that my wishes will be respected once I am "out." This is due to a previous bad experience where a doctor promised me one thing and then did something entirely different, with no explanation or good reason. I truly felt betrayed.
LJ
Forgot to add:
Ed, what a patient doesn't know & finds out later you intentionally withheld from him, causes a sometimes permanent lack of trust in doctors, and a wish to avoid them at all costs. (Happened to me)
LJ
Maurice
Most states have laws requiring hospitals to
report cases of sexual abuse of patients while
hospitalized within 24 hours to law enforcement.
These laws were not easy to get passed and
in many states took years. The need was obvious and
speaks volumes about how many patients are actually
assaulted while hospitalized.
If nurses are so professional then why are they
all now required to be fingerprinted with a background
check which in my opinion dosen't diminish the
probability that someone will act unprofessional or
think unprofessional.
If all nurses and physicians are all so
professional then tell me Maurice,why do state medical
and nursing boards all say " protecting the public" ,
on their websites.
Finally, at what point does the word modesty
reach a limit when there exists a concern for
misconduct and/or gawking which you so eloquently
put on your site.
PT
Dr. Bernstein,
You have asked many excellent questions. We could have a long discussion about this topic. One of Medical Patient Modesty’s goals is to fight for the rights of patients to have advocates not employed by the medical facility to be present for their surgeries and procedures. We feel it is important for every patient to have the right to have an advocate of her/his choice present for procedures especially if he/she will be under anesthesia. I find it very interesting that you bring patient safety issue because I also feel very strongly about that issue. I believe that an advocate not employed by the medical facility could help to ensure patient safety.
I believe that an advocate not employed by the medical facility can help:
1.) To reduce sexual abuse cases
2.) To reduce patient modesty violation cases (There are many cases where patients’ wishes for modesty or same gender medical team are violated once they are under anesthesia. Many doctors and nurses have deceived patients that their wishes that will be honored.)
3.) To reduce deaths (doctors and nurses would be more cautious about how they do certain things because they know they are being watched by an advocate who would be a witness if they did anything negligent. It is very hard to sue when a doctor is negligent because there was no witness. Other medical professionals will rarely testify against a negligent medical professional. Most people feel there is no hope for winning a medical malpractice case due to the fact that the patient was under anesthesia and could not see what all happened).
4.) To reduce infections (an advocate could demand that all medical professionals wash their hands in front of her/him before touching the patient)
Patients could choose an advocate who she/he trusts to be a part of her/his surgery. The advocate could be a retired nurse, a family member, or friend. The patient should communicate all of his/her feelings to the advocate about what cannot happen during the surgery. They also should take time to communicate with all medical professionals that will be involved in the surgery. For example, if a knee surgery patient could write his/her wishes on consent forms that he/she does not consent to urinary catheter and that his/her underwear and surgery shorts must stay on at all times. Look at how I shared steps about a patient who is concerned about his/her wishes for gallbladder removal surgery on the article, Concerns During Gallbladder Removal Surgery can take to ensure that his/her wishes are honored. The advocate would be very useful for a lady who does not want any male medical personnel involved in her surgery. They both could make it clear that the surgery must be cancelled if any male medical personnel comes unless the males leave. An advocate is very important to ensure that a surgery patient’s wishes are not disregarded once he/she is under anesthesia. She could sit near the entrance of the operating room to ensure that no males come in the operating room at any time. I encourage you to look at how a husband, William Ferrone on How To Stand Up For Your Rights prevented a male scrub technician from coming in the operating room where his wife was having a C-Section.
Doctors and nurses would feel obligated to honor the patient’s wishes if an advocate was there because they know they could face litigation if they did anything against the patient’s wishes.
An advocate would also help to prevent sexual abuse because all of the medical professionals would be aware that they were being watched by the advocate.
Misty
We would see a big drop in patient deaths because doctors would be much more cautious in operating on patients if they knew they were being watched by an advocate due to medical malpractice and litigation. Let me share about a tragedy in my family that happened 13 ½ years ago. My paternal grandmother went in to have an elective surgery on her kidney. She was supposed to have a much more experienced doctor operate on her. For some reason, a young and inexperienced doctor substituted for him and did the surgery. He was so negligent and let my grandma bleed to death. A nurse who was present told my aunt what happened, but she would not testify against the doctor. Most nurses will not testify because they could lose their jobs if they report doctors. If I could have gone back, I would have found a good medical malpractice lawyer to sue the doctor and the hospital. But it would have been hard to win the case because we had no witness who would testify. If my aunt had been there as an advocate for her mom, I think her death could have been prevented because my aunt could have demanded that the surgery be cancelled because they gave her a different doctor who was not supposed to operate on her. This particular aunt was a nurse practitioner so she would have been a great advocate. I wish that I could have at least reported him to the state board. It is sad to think that he may been negligent with more patients after what happened to my grandma.
One of my friends’ husband got a terrible MRSA infection from a knee surgery at the same hospital he worked at. He almost died. I think the outcome would have been different in his case if his wife could have been there as an advocate because she could have demanded that all medical professionals wash their hands thoroughly in front of her.
No, patients should not blindly trust doctors. They have proven themselves too many times to be untrustworthy. Gender neutrality at all levels of medical training and practice is the root of all of the modesty and abuse issues. Medical Patient Modesty received emails from two different women who were sexually abused by male doctor and male technician today. When I first started MPM, I had no idea that sexual abuse in medical settings was that bad.
I am concerned when you say that it is rare for patients to be abused. Sexual abuse is more common than you can imagine. Modesty matters to many people even when they are under anesthesia. The only way to guarantee that your wishes are honor is to have an advocate not employed by the medical facility to make sure your wishes are not disregarded once you are under anesthesia.
Misty
Ed,
Ed,
While some people do not care about their modesty once they are under anesthesia, there are many people who do care about their modesty when they are under anesthesia. A lady who requested an all-female team for her hysterectomy was very upset that she was deceived that no males would be part of her surgery. You can find her full story under Maggie from Utah .
Also, the argument that nothing matters when you are under anesthesia would mean that all crimes committed while someone is attacked while unconscious such as with date rape drugs, would not matter either because the victim was unaware of what happened. I am sure that many female patients have been fondled while they were under anesthesia and they did not know it.
It does not matter what doctors and hospitals think about patients bringing in patient advocates. If medical facilities and doctors were truly patient centered, they would allow each patient to have an advocate present. There should be nothing for medical professionals to hide. We have a law student who is a Registered Nurse doing some volunteer work for us this summer who agrees with us that a patient should be able to have an advocate not employed by the medical facility present for her/his surgery. Her dad is also a doctor so she is not against medical profession. She is very concerned about how patients are treated. Doctors and medical facilities would lose a lot of money if patients started refusing surgeries without personal advocates. Patients should be able to control their healthcare.
I do not know if you were aware, but many years ago, husbands were not allowed to be present for their wives’ C-Sections. Fortunately, that changed about 30 years ago. C-Section is a major surgery. Patients have to fight for their rights to have someone present for their procedures if they wish.
Misty
Dr Bernstein,
I was molested by my GP monthly when I was 15 years old due to a large cyst on one ovary which caused excruciating pain every month. After doing an extremely thorough pelvic and BREAST exam on me every month for 5 consecutive months, he finally sent me to a teaching hospital in Boston. The doctor there found the problem immediately and asked my mother if she would allow me to be examined by "resident doctors" (pleural). She refused but she signed all the forms he gave her. I have no doubt now that medical students repeatedly violated me after I was put under but I will never be able to prove it because noone in there was truely on my side to protect me. A medical advocate wouldn't be there to tell the surgeon how to operate but to make sure the patient's rights are protected.
I think that picture of three men working on an unconcious naked woman is disgusting. I know an operating room nurse who has told me that women are often left exposed in preperation while people walk in and out and who knows who is watching from the viewing areas in teaching hospitals. Once a patient is put under her modisty is thrown out the window in many cases. They would not act this way if the patient were awake or if the patient had an advocate present.
Jan
Jan’s story is very sad. Many women have been sexually abused by male doctors who did gynecological procedures or exams on them.
As some of you may know, some medical schools still allow medical students to do non-consensual pelvic, rectal, and genital exams on patients under anesthesia without their consent. Patients under anesthesia are most vulnerable to patient modesty violations and abuse because they cannot advocate for themselves.
One of my friends was stripped naked for wisdom tooth extraction in a hospital in Connecticut more than 20 years ago. Fortunately, it was different for me. I got to keep all of my clothes on for my oral surgery to remove my baby teeth when I was 12 and the removal of my wisdom teeth when I was 17-18 years old.
I got another email from a lady today who is very emotionally distraught about a male surgeon who sexually abused her. It will be hard for her to have a case since only nurse was present. This male surgeon has already gotten away with abuse of other patients. Nurses will rarely testify against doctors so that’s why it is important for patients to have a personal advocate not employed by the medical facility present to protect her/him.
Misty
To All. I would like to comment about the comments of late. Some of the long time readers will remember me as the guy who advocated for my wife during her cancer treatments. We left the hospital because they refused to have her urology procedure done by the female.( They said she was busy doing prostate stuff.)This time it's about me. I also was one of those kids who had his physical done in school. I was about 9 at the time. It was done by a female doctor in front of a female nurse. I had no idea what was to happen. When they told me to drop my pants I couldn't believe what they wanted me to do. I couldn't move. I guess I wasn't fast enough for them and before I knew it my pants were down around my ankles. When it was time to play sports I already knew what would happen. I knew the health providers, coach and the school didn't give a damn about my modesty concerns. That's when I changed. No one would ever make me do something I didn't feel comfortable with. That has stuck with me for over 50 years. For those of you who like to do the studies. Many of the jocks I knew in school have had several failed marriages and children out of wedlock with different women. Anyone think the early continuous exposure with female providers had anything to do with it. Maybe someone should study that. And yes I believe people should be able to have a advocate to help protect them. Thank. AL
Al,
It’s good that you all walked away when they refused to respect your wife’s wishes that a female doctor do her procedure. Patients have to walk away if their wishes won’t be honored.
I am sorry to hear about your bad experience in school. One of Medical Patient Modesty’s goals is to help to educate parents about how to protect their children’s modesty in medical settings. Many children and teenagers have been traumatized by bad experiences in medical settings so you are not alone in the way you feel.
Yes, it is possible for people’s relationships to be affected by opposite sex intimate medical care. In fact, I have heard of some marriages ending in divorce because one spouse had opposite sex intimate care.
You may be interested in joining the “How Husbands Feel About Gyn Exams” group.
Misty
Misty. The difference between then and now is I'm not a little boy anymore. I hate being bullied and it's very hard to intimidate me now. I have no problem getting in anyone's face if you try to bully me. I should really thank those people all those years ago for making me the way I am. It's hard for me to understand how people can say , what you don't know can't hurt you. Would you feel the same way if your financial advisor was skimming excess money from you ? This B.S. about it's just a body part. Ladies forgive me, but I don't have a clue how women think. But I do know something and men. We are very visual creatures. We enjoy seeing naked women. I seen my wife naked thousands of times and it didn't take much to get my motor running. The only difference between me and a doctor is he knows if he acts on it his career is over if he's caught. For to many years things went their way and I believe we should have a say so in the type of care and by who. Save this gender neutral Crap for people who really don't care. This whole problem would go away if they would only ask first and follow thru with what you say. Thanks again. AL
Misty. As far as joining the " How Husbands Feel About Gyn Group." We advocated for ourselves. Both my children were delivered by a female Ob-Gyn and everyone present were female. How do I know ? I was with her the entire time she was in there. That was 39 years ago when it was harder to find a female Ob-Gyn. But if that was what you wanted you had to look and be willing to drive for it. She never went to a male Ob-Gyn. I believe if you feel strongly about that , you can't just leave it to chance. You need to take control and make your feeling known. Best of Luck. AL
Al,
I am well aware that men are visual creatures. It is very natural for a man to be sexually aroused when he sees a naked woman. Doctors are human beings like everyone else. We have researched plenty of cases where male doctors sexually abused women. You are right that many male doctors would not act on those sexual thoughts they may have toward female patients.
I am sure that you would be interested in reading Important About Sexual Abuse By Doctors.
I like the example that you used about financial advisor.
Misty
Al,
I am so pleased to learn that your wife had a female OB/GYN 39 years ago and that she never went to a male OB/GYN. Female gynecologists were rare in 1970s. I do not believe there were any female OB/GYNs in the city that my younger sister and I were born in so my mom was stuck with a male OB/GYN in 1979 and 1983. My cousin was the first family member to be delivered by a female OB/GYN in that city in 1993. I am glad that medical schools are very open to females today and that is why we have many female gynecologists today. Unfortunately, many small towns still do not have enough female gynecologists. Even some towns in the US have no female doctors.
How long did you both have to drive for a female gynecologist? I agree it is worth driving to ensure that you have same gender doctor for intimate care. How big was the city that you all found a female gynecologist in 39 years ago?
I do not know if you ever read the article that I wrote about same gender maternity that was published on Dr. Sherman’s blog about patient modesty and privacy concerns. It makes me sad about how many women have horrible birthing experiences because their wishes for all female team and modesty were not honored. Birth of a child should be a joyful time for both wife and husband.
I appreciate you being an excellent advocate for your wife.
Misty
For those who express concern about their uncovered body (perhaps specifically genitalia) being observed by others during anesthesia in the operating room, could you explain the psychodynamics (the emotional basis) for that concern? Is it simply lack of specific informed consent about that such exposure would be occurring and this missing consent provokes anger toward the OR staff? Is it that the patient's unwavering contention is that those parts of the patient's body cannot, must not and should not be seen by anyone other than the patient's spouse? If not that, then of no other human, of the gender opposite to that of the patient?
On the other hand, could the psychodynamics be that the patient does not want their private parts seen by anyone (period!) while the patient is asleep and therefore unable to emotionally participate in the exposure event. When I say "emotionally participate", I mean to have the opportunity to personally be aware and be able to personally and positively participate in the "showing off" of their parts or contrarily be able to defend themselves and attempt to prevent the "showing off". Would the attempt to prevent the exposure be due to any shame or negative feelings about the appearance of those genital parts?
If there is some other mechanisms as the basis for the concerns, let me know.
If these are the possible "psychodynamics" would you therefore expect those individuals who, in other settings, permit photos of their naked bodies with recognizable faces to appear on internet websites to be a less likely part of the patient population who have concerns about genital exposure during anesthesia?
Finally, if you are wondering why I am writing on this topic, I think that resolving or mitigating the operating room concerns presented on this thread need first an understanding of the basis and psychologic component of those concerns. ..Maurice.
Look at how one lady, OverItAll on July 3, 2013 had her close friend as an advocate for her foot surgery at http://forwomenseyesonly.com/2013/04/19/sexual-abuse-under-guise-of-health-care-presents-barriers/#comment-8666. This web site is not associated with Medical Patient Modesty at all, but I comment there from time to time.
Misty
Dr. Bernstein,
Let me respond to your questions:
Is it simply lack of specific informed consent about that such exposure would be occurring and this missing consent provokes anger toward the OR staff? Is it that the patient's unwavering contention is that those parts of the patient's body cannot, must not and should not be seen by anyone other than the patient's spouse? If not that, then of no other human, of the gender opposite to that of the patient?
Yes, lack of specific informed consent about exposure of private parts make many patients upset. One man who had neck surgery was very upset and embarrassed when he woke up to discover that he had an urinary catheter inserted without his consent. In his case, there was no need for the urinary catheter to be inserted. His daughter asked the nurses why he had an urinary catheter and they said because he could not walk. That is not a good reason for an urinary catheter at all. It is horrible that many patients who have had surgeries on hands, knee, nose, etc. had their underwear taken off while they were sedated or under anesthesia. There is no reason for underwear to be removed for surgeries that do not involve genitals or body parts very close to genitals.
I believe every patient should know about what body parts will be exposed during surgery.
Many patients who only want same gender medical team for intimate surgeries such as prostatectomy, hysterectomy, or any surgeries that expose their genitals are very upset when they have one opposite sex medical provider involved in their surgery. When those patients’ wishes are violated, they often won’t trust medical professionals again and may even avoid medical treatments in the future.
One of my friends who is 42 today is still traumatized by the fact that she had a male gynecologist when she was 14 years old. She is also very upset that she was stripped naked for wisdom teeth extraction while she was under anesthesia years ago. She has some emotional problems.
Yes, many patients indeed would like to see who all medical professionals could have seen his/her private parts. Many patients would find more comfort in being under anesthesia if they could be guaranteed that their personal advocate could be present to watch the surgery and prepping and to ensure that no opposite sex medical professionals come in. For example, many women who are only comfortable with female doctors and nurses for gynecological surgeries would be at ease if their husband or a female advocate not employed by the medical facility could be present to make sure their wishes for all female medical team not be ignored. Many patients are much more comfortable with interacting with doctors and nurses when they are awake because they can walk away if they see that their wishes won’t be honored. For example, a male patient needs a scrotal ultrasound and he goes to a medical facility with no male technicians, he can walk away and find another medical facility with a male technician.
Let me answer this question you asked: Would the attempt to prevent the exposure be due to any shame or negative feelings about the appearance of those genital parts?
There are many reasons why people feel strongly about their modesty in medical settings. The most important thing is medical professionals should always work to respect patients’ wishes for modesty regardless of reasons. I think it’s ridiculous that the medical profession does not follow the same standards as other settings. There would be outrage if locker rooms and public restrooms became gender neutral. I found it very interesting to observe how shocked a man was when he saw my sister coming out of the men’s restroom (it only had one toilet and you could lock it) at a restaurant last year. The women’s restroom with only one toilet was in use and my sister needed to use bathroom so badly she decided to use the men’s restroom since it was just one toilet with a lock. I would assume that this man would be very upset with a female nurse doing intimate male procedures on him.
The truth is many people who care about their modesty in medical settings are actually not ashamed of their genitals. Many modest people feel their genitals are sacred and private. Many married people are not ashamed to expose their genitals to their spouses at all. Many married people feel that their spouse should be the only person of the opposite sex to see and touch their private parts and their feelings are still the same in medical settings. One female medical professional told me she was offended when a male patient asked for a male medical professional to work with him instead of her because she was more experienced. But she said that she begun to understood when she was told that the man was a Christian who wanted to protect intimacy in his marriage. Many married people feel their bonds with each other are weakened when they have opposite sex intimate medical care.
Think about this scenario: Let’s say that a 20 year old virgin who has committed to saving sex for marriage also has strong convictions that her future husband should be the only man in the world to see and touch her private parts after puberty needs to have a large ovarian cyst surgically removed. This woman has requested an all-female team for her surgery. In order for this lady to be guaranteed that her wishes would be honored, she would need to have a female personal advocate present for her surgery to ensure that no males come in the operating room at any time. The advocate can sit near the entrance of operating room to make sure no males come in. If this lady’s wishes were violated, she will have a hard time getting over the fact that a man who was not her husband may have seen her naked even if she was under anesthesia. This could affect her relationship with her future husband because she would feel that the male medical professional stole something from her that was intended for her husband only.
I have a lot of respect for Kirk Cameron, the main star of Fireproof who made a commitment to not kiss any woman who was not his wife in movies. They had to fly his wife in for the kissing portion of the Fireproof. This reminds me a lot of medical settings. Patients are expected to let go of their convictions in medical settings like many films.
For your last question, most people who allow pictures of their naked bodies with their faces to appear on pornographic web sites would not care about their modesty in medical settings at all.
I hope I have provided you with helpful insights about why many patients feel the way they do.
Misty
I have to be perfectly honest and say i cannot relate to a lot of the latest posts. I do not fear molestation, I think women are just as visual as men, just not as open about it, and violations are not given the same concern i.e. female teachers with minor male students, female reporters, guards, etc. I would however agree with Misty's latest post, Dr. Bernstein how outraged would providers be if an opposite gender plumber, electrician, janitor walked in while they were naked in the shower or changing room to do their job. Providers claiming gender nuetrality does not mean patients buy into it. You yourself indicated you have issue with female reporters in male locker rooms, yet female reporters demand they have the right to be there as it is a workplace and the atheletes should be fine with it. Does this mean all atheletes are fine with it? Why would providers expect all the anxiety associated with this issue to disappear because of nesecity and because providers tell them they should be fine with it. What are the psychodynamics of the anxiety with nudity infront of opposite gender in any situation, at a minimum some of them are carried forward into the medical arena. If your female neighbor walked in while you were sleeping naked would it bother you when you woke up and were told? i realize they are not exactly the same but there are some paraells. I am far less concerned about exposure while I am out, though not totally comfortable. i do however understand those that are....don
Don,
I like the examples you use. As a woman, I would not walk in a public men’s restroom because I believe that men should have their privacy and modesty protected. Think about how upset many men would be if a woman walked in a public restroom with them using the urinal. I like your example about female neighbor seeing a naked sleeping man without him knowing that she had seen him naked. Why should it be different in medical settings?
I believe medical professionals should treat all patients with dignity. I wish that patient forms had this question: Do you prefer male or female medical providers for intimate medical care? I think that question is as important as asking patients if they have any allergies.
Misty
Great example with the female neighbor seeing a naked sleeping man. I would feel upset and humiliated by that, no matter her profession. Conscious or not. What really makes me angry is hearing an example of that where the neighbor lady would say "It's OK, I'm a nurse".
If it helps Misty, I'm a Mormon. I'm not saying that it's Mormon policy not to be seen naked by the opposite gender in medical situations, I know it is quite common. But growing up with high moral values is also common in the Mormon church and some of us don't believe it should be any different in medical settings. Doctors and nurses are no more or less human than we are and they should follow the same standards as the rest of society.
Regarding the "I don't care what they do to me when I'm asleep" opinion, my morals and dignity don't change when I'm unconscious. If it's wrong for women I'm not married to to see me naked or fondle my privates when I'm awake, the same goes when I'm asleep.
I don't know if it had anything to do with having my knee surgeries in a Mormon community or not, but I was allowed to wear underwear and my everyday shorts during the surgeries. No ethic or morality worries at all. I imagine it's common outside of Utah as well, but I think my being the same religion with all or most of the medical participants really helped me accept the general anesthesia given to me.
Unfortunately I've also heard many bad medical experiences from friends and family that happened in Utah as well, so maybe religion wasn't as important as I thought. I might have just lucked out with a good, reponsible, caring staff those particular days.
GE
WHEN a healthcare professional believes it's appropriate for a man to get naked in front of random women is an interesting dynamic. They believe:
If it's in front of medical women, it's OK (mandatory), in front of other random women it's wrong.
If a man is FORCED to get naked it's OK, if he CHOOSES to get naked it's wrong.
If he is humiliated by his nudity it's OK, if he ENJOYS it it's wrong.
I strongly advise all who come to this blog thread to read the article in Mormon Matters by Reuben Collins titled "Musings on Modesty and Mormonism". I think that the article applies to everyone and not just Mormons. Reuben bases his conclusion that search of the Bible finds nothing implying God's view of modesty except in 1 Timothy 2:9-10 "“In like manner also, that women adorn themselves in modest apparel, with shamefacedness and sobriety; not with broided hair, or gold, or pearls, or costly array;” and which Reuben concludes "this passage seems to be more about avoiding expensive or pretentious clothing than making sure we cover specific body parts. The lack of specific guidance from God leads me to believe that He expects us to determine our own definition of what is modest and what isn’t – perhaps even that God isn’t particularly concerned about what parts of our body we cover and what parts we don’t. He concludes that " I believe that the principle of modesty is primarily about having respect for each other – that society has constructed a set of cultural norms and expectations for what people should wear at various times and places, and that we should dress modestly according to what those around us are wearing, or what they expect us to wear. " And finally, writing something I fully agree with: "context": Based on my understanding, modesty has much more to do with context than anything else. It’s inappropriate to wear revealing clothing within a context where it will be unexpected or unappreciated. Of course, by adopting this understanding, I’m also acknowledging that it may be appropriate to wear revealing clothing within certain contexts – provided that our intentions aren’t to objectify ourselves. But I believe that individuals are best suited to decide for themselves what is appropriate and what isn’t for every occasion – while allowing societal expectations to inform their decisions."
Yes, it's the context in which the modesty is to be applied. Modesty in the toilet environment is one context. But modesty as part of a medical examination or procedure is a matter of another context and the value of modesty (the benefits vs "harms") should be likewise considered independently. This is something which I have been repeatedly inferred on this blog thread. ..Maurice.
I'm sorry Dr. Bernstein. No one should have to choose between their physical health and well being versus their requirements for modesty and not being subjected to opposite gender intimate care/nudity. And that's the problem with the current health care system and providers like you who just don't get that it's NOT a contextual issue for many of us.Believe it or not, some of us don't want to get naked in front of anyone of the opposite gender that's not our significant other regardless of the "context". The outcome of someone seeing me naked who has no right to is not contextual! Why should we have to choose between getting naked (or incrementally exposed)to the opposite gender in any situation if it's against our social/emotional /moral composition just because "that's how it is and always has been". The idea that doctors and nurses, et al are Gods with some superhuman ability to put their thoughts and feelings on hold because of the "context" in which they're viewing the naked body is baloney. And even if there were some super being of this nature,I still shouldn't have to be subjected to intimate care from them. They have no greater right to my most intimate areas than any other "professional". We need a medical system in which men and women do not have to subject themselves to the discomfort and humiliation of being exposed to the opposite gender yet still have their medical needs met. It is possible,it's just not always "convenient"!! And until enough of us walk away from physicians and others who just don't get it, nothing will change. And emotional ruin should not be the alternative to physical health!!
To Anonymous 5:57pm today and all: I cannot accept that professionals in medicine are "Gods" or anything other than human beings with all the same internal desires both good and bad and personal concerns than any other human including any other patient. What keeps some desires in check is in the context of their professional obligations and limits in their relationship to the individuals and to society. And, yes, as medical professionals we do expect that the humans we attend will likewise behave in the context of a patient with the goal to work with the professional to attain the goal of recovery and health. This may require the patient in that context to allow the opportunity for diagnosis and treatment to trump the modesty issues which would be more appropriate in the toilet or on the street or other environments where the person would not be expected to be treated as a patient.
Are there problems currently present in the communication of expectations both by the medical professional and their patients? YES, YES, YES. And deficiencies in communication go in both directions. The deficiency includes bilateral discussion of modesty issues. If this deficiency was eliminated, there would be no need for this current blog thread. ..Maurice.
To Anonymous 5:57pm today,
You made some very excellent points. I agree with you that patients should walk away from doctors and nurses who do not respect their wishes.
Too many patients who feel strongly about their modesty give in because they feel intimidated by medical professionals. Many medical professionals try to push patients in giving up their modesty and convictions in medical settings.
Misty
Maurice, PT referred to it perfectly when talking about gawkers.
The modesty issue would probably not be such an issue if there was some ethical consideration to the patient's feelings regarding who is in the room, what is their purpose and how necessary? This, with complete informed consent from the patient would eliminate much of the problem for the "mainstream patient".
Misty speaks of modesty issues as a right and it is. But...what if someone was legitimately abused in a healthcare setting previously and had issues because of an egregious act of cruelty and degradation? Now this becomes a medical issue in addition to a psycho social issue.
Much of the problem has come from outrageous behaviors from staff for different reasons that cause people to have polarized feelings about healthcare.
So I ask you again, to please answer the following question. Does the medical community have a moral and ethical responsibility to help those who have been mistreated previously to feel safe and protected when hospitalized even if means programs for same gender care are created?
While I recognize that everyone has a right to their privacy, this group deserves some consideration due to damage created by strangers in a healthcare system. These patients return to the same place, dealing with strangers. How can one feel they are in a trusted environment under those circumstances?
belinda
Belinda, a history of sexual abuse toward the patient is one of questions, beyond sexual preferences,sexual acts, sexual diseases, sexual frequency which should be asked in the initial history taking of the patient under the category of "sexual history". And it is important that the patient be frank and answer these questions.
Without a history told by the patient of sexual abuse in the past, the physician must assume that none has occurred unless the patient's questioning and concerns appear to pertain to sexual issues or physical modesty.
Therefore it is critically important that the patient speak up to the doctor about their previous sexual traumatic experiences and that this can be a path to discussion of modesty issues of upcoming examinations and procedures.
And, of course, all physicians should look at a history of sexual abuse and continued psychological injury with concern and need to treat appropriately as they do with cases of other trauma or non-psychologic bodily diseases. But the physicians must be made aware by the patient speaking up.
It would be wonderful if consent for all examinations and procedures included discussion of sexual or modesty or provider gender issues and that all patients would speak about their concerns freely and all doctors would listen and offer whatever resolutions are practically available. But that, obviously, is not yet a standard of practice both by the medical system and the patient. If this became a standard for routine communication between doctor and patient that would enhance the possibility for that "trusted environment" to develop. ..Maurice.
Ref: Friday, July 05, 2013 3:20:00 PM, Maurice Bernstein, M.D.
It's a two-way street. MDs want our intimate details, but where's the trust? We are suppose to accept MDs at face value because they have several pieces of paper framed on the wall that can be printed on a home computer and also pay rent on office space. Why don't MDs spend some time establishing rapport with the patient and have a stack of resumes on the check-in counter? I know some of their excuses, but then don't expect patients to bare their souls.
We can "research" MDs, but what info is available? Probably I just need to be informed on how to do the research. Up to several years ago, the CA Med. Board provided details on MD disciplines, but no longer. [Good
details are available for lawyers.]
At the first visit to my current MD, I asked the receptionist for the MD's curriculum vitae. She said that
they were "fresh out". Of course, she had no idea what I wanted, but that didn't keep her from an answer. I have never encountered a medical person that said "I don't know", except for MDs.
BJTNT
Maurice,
Thank you for attempting to answer my question. I will rephrase it for clarity.
The question is..in a hospital environment where the patient discloses previous abuse in a hospital and the need for same gender care, morally and ethically, doesn't the medical community have a responsibility to make sure that the patient receives the kind of care required to make them feel safe and free from feeling degraded by having opposite gender care present where there is bodily exposure? Secondly, what kind of response would you think would occur if that patient came to the hospital with a letter from a ph.D in psychology stating that she supports the patient's need for same gender care based on that patient's experience, that the patient is mentally competent and that subjecting said patient to mixed gender care would be detrimental to the mental health of that patient?
belinda
Recently, while visiting a long trusted MD, another doctor's name came up in conversation. The doctor told us that said doctor was dismissed for doing a sexual exam when said doctor in his specialty had no reason.
When trying to verify this information (not questioning the doctor who shared the information, rather to see if it could be traced), the only thing I found was that said doctor transferred to a hospital in another state.
This is what's happening in healthcare. The information is hidden just waiting for the next attack, very much like what happened in the Catholic church.
belinda
Dr. Bernstein, context is key but no more than perspective and you answered fromt he perspective of a provider. 1st your version of modesty in the bible ignores mans beginning in the Garden of Eden where one of the first ramifications of the fall from grace was Adam and Eve realizing they were naked and were ashamed and sought to hide their nakedness. The implication of shame and embarrassment go hand and hand throughout the bible. It is a basic premises repeated over and over.
And you left of the most important observation of you article regarding context where he stated and context is best left to the individual. In the medical community you have decided for us the context negates our embarrassment, you decided gender neutrality applies, you didn't ask us, in fact you dismissed us for decades. (I of course use you as the medical community rather than you individually). That is why we are having this discussion, we are trying to assert ourselves in an environment where providers set and enforced the rules and told us how we should feel....don
Greetings all,
Just found this blog to my surprise, as it's not often I hear much chatter regarding patient modesty. I've found that the very act of talking about it to a health care professional can cause embarrassment.
To make matters worse, the over-used line that they have "seen a million of im" doesn't quite bring any comfort. I'm glad this is being brought out into the open, as I believe this shared frustration can birth vision for changes and solutions.
This is my hope! I was inspired to design a first of its kind garment for bathing and personal care, when I care for my mom. (No more embarrassment) IT made a big difference for caregivers, and have since founded a nonprofit called Dignity Resource Council to help others. www.dignityrc.org Have since met Misty and have been encouraged that this important quality of life topic is getting attention and may help usher in change in the way people are treated.
Thanks for the blog, and allowing me a few words.
~Robin Lenart
I am very impressed with the modesty garments Dignity Resource Council came up with. Those garments really help to protect patients' modesty.
Misty
NOTICE: AS OF TODAY JULY 6,2013 "PATIENT MODESTY: VOLUME 55" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 56.
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