Bioethics Discussion Blog: Patient Modesty: Volume 58





Monday, September 30, 2013

Patient Modesty: Volume 58

Discussion, discussion, discussion. Bioethics Discussion Blog is just that: a place for discussion.  Discussion: talking about the issue, listening to different views, responding to them civilly and attempting to achieve a decision acceptable to all participants. The patient modesty issue has been open for discussion here for the past 8 years.  Unfortunately, the discussion has been one-sided in that it has been hard to find views in general conflict with the majority view here.  It may be that the title "Patient Modesty" fails to attract the attention and subsequent access to this website thread by all those patients who may think the issue is a "non-issue" in terms of personal health management and there are more important factors involved such as medical expenses and achieving the goal of resolution of the symptoms safely and effectively, curing the illness and moving on with ones life.

But a one-sided "discussion" is literally "preaching to the choir".  Let's encourage those visitors who come and look but have a more temperate view of patient modesty issues in medical practice put in their "two cents" into this blog thread by writing a commentary.  ..Maurice.

Graphic: From Google Images and modified by me with ArtRage



At Monday, September 30, 2013 3:05:00 PM, Blogger Maurice Bernstein, M.D. said...

For continuity in discussion an important point in how patients are treated in the medical system, here are the last two postings from Volume 57, one by Doug and the other by myself. ..Maurice.

At Monday, September 30, 2013 11:12:00 AM, Blogger Doug Capra said...
Here is an article that exemplifies the problems with communication within our health care system. Modesty violations can be the result of these communication problems. Read this and then ask yourself how important you think modesty issues are to healthcare professionals when this kind of communication failure exists with basic medical care.

At Monday, September 30, 2013 12:36:00 PM, Blogger Maurice Bernstein, M.D. said...
Doug, when I read the story I ended up with the same questions and conclusions as this reader commented: "so what's the ending of this? What did the CT show? Would this have changed the course of his care? Or is the article written to give us just the flavor of how confusing and jolting the experience was?"

Though it is reasonable and proper for the bumps and jolts or even worse patient experience to be publicized (and I am all in favor of this to show what the patient is experiencing being a patient in the medical system) BUT.. for complete and fair understanding of the situation should be also the clear detailing of the facts of the scenario both relative to the patient but also the facts regarding the administrative and procedural issues that burden the hospital and the hospital staff. None of the latter was presented to the reader of the article...just the impact of what occurred on the patient and the family.

In all our discussions here, remember..we are complaining about the system but we are not getting any facts or rebuttals by the system. And that information is essential for a complete understanding of problems by all parties engaged in discussing and hopefully mitigating those important problems. ..Maurice.

At Monday, September 30, 2013 3:34:00 PM, Blogger Maurice Bernstein, M.D. said...

What follows is Doug's followup comment written to Volume 58 regarding my above response to the article on kevinmd...Maurice.

"In all our discussions here, remember..we are complaining about the system but we are not getting any facts or rebuttals by the system. And that information is essential for a complete understanding of problems by all parties engaged in discussing and hopefully mitigating those important problems." ..Maurice.

Thanks for your last response, Maurice. Yes, you're correct. But I have found that the system is very reluctant to engage in public discourse about much of this. Part of this is understandable. Too often, the healthcare system is raked over the coals unfairly. That's true. Generally, they don't trust the media to fairly portray the situation. Sometimes it's fear of HIPAA violations. But the system needs to engage more and effectively. There's too much CYA. Note who wrote that URL I posted and that you're responding to. It was written by a doctor. So I must assume that the doctor who wrote this had some inside information as to the whole picture. Face it, Maurice. The system often has so many internal issues going on that communication gets messed too often. Too many people -- doctors, nurses, techs, cna's -- add them all up and imagine the problems in trying to communicate about one patient. The result can be tragic. Mostly it's not. But even if it doesn't result in the patient's death, the perception of the public (and in the case of this article, a doctor) is that no one really knows what's going on. Whether that's true or not, that's often the perception.

At Monday, September 30, 2013 6:02:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I agree with your comments and I commend you for being willing to stand in the line of fire with so many on the opposite side. I have not forgotten this forum is for discussion. Just as i understand providers feeling passionate about and sticking to the mantra regarding patients avoiding care for modesty sake I think providers have to understand patients are even more passionate about modesty concerns that affect them. Disagreement is as much a part of discussions as agreeing. I am sorry but I disagree with your position on this, I doubt anyone will ever convince you avoiding medical care for modesty sake is an acceptable or rational position. You will have the opposite opinions but similar conviction on the other side of the issue,
Doug I think your catagories leave out the majority, those who have modesty concerns to one degree or another, but seek and accept medical care anyway. I have modesty concerns, opposite gender care for intimate procedures disturb me but I have had numerous screenings and procedures because I believe my health is more important to me and those who depend on me. That doesn't mean I don't have concerns and no amount of communication will change that. It might effect whether or not I accept it but it won't change that it is a concern or a problem. I think that is the majority, those who have concerns and problems, but will deal with it one way or the other. I have met very few people who have not expressed feelings about the medical experience from the ridiculous gowns to embarassement, being uncomfortable, to humiliated. I have met very few that didn't care, and I have met very few that absolutely would not seek care. I have however met more than a few who delay and put off screenings and seeking care for one reason or another including modesty. And again, I would contend, medical care and modesty do not have to be mutually exclusive of each other. Instead of communication, would not accomodation be more desirable?....don

At Monday, September 30, 2013 6:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Don, you write " Instead of communication, would not accommodation be more desirable?"

My view is that effective accommodation cannot be established without communication between the patient and the appropriate healthcare providers. That's why I think my repeated advice "speak up" is essential for both the patient and the medical system to follow.

If one questions as to why the system should "speak up" to the patient, it seems the ethical thing for the system to do rather than "hide" system protocols affecting the patient's experience.

That's my argument in favor of communication as a introduction to accommodation. ..Maurice.

At Monday, September 30, 2013 7:02:00 PM, Anonymous Medical Patient Modesty said...

I agree it is very important to communicate your wishes about modesty in medical settings. But many patients do not feel empowered to speak up. Think about patients who may have never been in the hospital or had many examinations in their life shocked when they have their modesty violated. Also, many patients do not know the truth about what happens to them once they are under anesthesia. I had a number of people approaching me at a conference that MPM was an exhibitor at who shared how upset they were that they were stripped unnecessarily for surgeries. So many patients are put in vulnerable position and this is how their modesty is violated. This is exactly why Medical Patient Modesty exists. It always gives me joy when people contact us about steps to take to ensure that their wishes are honored and then they have wonderful experiences.

For example, I had no idea that male nurses could give female patients a bath until 4 years ago when my grandma was in the hospital for a heart bypass surgery. It took me off guard. If I had known how gender neutral nursing assignments were, I would have spoken up and talked to the nursing supervisor about how male nurses could not do any intimate procedures on my grandma. I also would have looked into putting a sign on her room that male nurses were not allowed to do any intimate procedures on her. I wish that all medical facilities would at least give forms to family members and patients asking them if they require same gender nurses and doctors for intimate procedures. I think that this question is as important as question about allergies.


At Monday, September 30, 2013 7:23:00 PM, Anonymous Anonymous said...

Study after study says that those with problems with medical procedures (specifically abuse victims facing an intimate procedure) will not disclose that they are have issues or concerns going into the procedure. When you take estimates that anywhere from 5 - 25% of the population is effected, it's a large number of patients!

I've read a ton of training regarding pap smears that state that doctors should ALWAYS ask open ended questions that allow their patients to disclose they have issues.

I really think that it needs to go beyond pap smears and be a routine part of all procedures. "Is there anything bothering you about this procedure? What can we do to make you more comfortable?".

There are some groups that are starting to recognize that patient trauma is a real issue that can be addressed. The Childrens Hospital of Philadelphia has a Center for Pediatric Traumatic Stress that has recommendations for how to screen children and their families and provide intervention as necessary. What if all hospitals took up that process?

Think about all these stories where the primary complaint is patient mistreatment. What if these patients were screened for how they were feeling after their procedures, and encouraged to utilize support resources if they were disturbed? What if all hospitals had a unit specifically for counseling all patients (not just those deemed "mentally ill") and those that had problems in the hospital were encouraged to come back and utilize those services? What if those services were then able to use the feedback to spot trends and report it to the hospital to provide improvements?

Doesn't the ACA - which requires coverage of mental health services - make this possible to implement?


At Monday, September 30, 2013 7:47:00 PM, Blogger Doug Capra said...

Don wrote -- "I have modesty concerns, opposite gender care for intimate procedures disturb me but I have had numerous screenings and procedures because I believe my health is more important to me and those who depend on me. That doesn't mean I don't have concerns and no amount of communication will change that"
Don -- "Concerns" are one thing. And, yes, I agree that most people have "concerns" about their modesty. But these concerns can be mitigated with trust, and trust and be established by many methods, including empathetic, honest and authentic communication. If, as you say, "no amount of communication" will change your "concerns," then perhaps they are more fundamental than just "concerns."

At Monday, September 30, 2013 7:49:00 PM, Anonymous Anonymous said...


You are suggesting that simple communication
is the solution to this problem, I believe it is more
than that.I appreciate your comments as I am certain
everyone else on this blog does as well, however, I
would suggest you read the 636 comments made on
that facebook/nurses page.

At which point I'll ask the question, what does
communication have to do with their behavior. Most
colleges are public and privately funded and it is
disturbing how these female nurses talk about the
other gender considering the bulk of their education
was paid for by taxpayers.

No where on the web will you find another
group of health care employees who talk in such
a sexual manner about their patients, not
physicians, male nurses, medical technologists
nor medical imaging staff. Believe me, I have
essentially looked at every medical forum out
there, female nurses are the worst by far.

Furthermore, you are seeing this mentality
expressed by female nursing students as well,
they see the standard, they adopt that standard.I
have read all 636 comments, these people have
a facebook page and they are real,just as their
comments. Communication is not going to solve
this problem and certainly not at the patient-care
giver level.


At Monday, September 30, 2013 9:14:00 PM, Anonymous Medical Patient Modesty said...

I wanted to comment on very important insights that LKT shared today:

Wow, what a disturbing read on Facebook. The fact that this is the mindset of the people taking care of us when we are at our most vulnerable is worrisome. So much for the "Ivory Tower" ethics courses and "professional" training. I realize that most of them probably maintain a certain professional composure during patient care, but apparently find much hilarity in our bodies behind the scenes and enjoy their access to our genitals. This brings about the question as to whether we as patients should care about the mindset of our caregivers and the things they say about us among themselves (or on Facebook) if they treat us professionally at the moment of care? Would be interested in what bloggers here think. LKT

I share the same concerns as LKT. She is right that many nurses and doctors who may find hilarity in patients’ bodies behind the scenes and enjoy their access to their genitals will maintain professional conduct. I am sure that most of those female nurses on the Facebook page that PT referred maintain professional composure while they take care of patients while they are aware. A man who was very concerned about patient modesty shared with me about how disturbed he was that his ex-girlfriend who was a nurse in Trauma would make fun of the genitals of male patients she took care of while they were unconscious with her nurse friends. Also, many male doctor have lustful thoughts about their female patients when they do intimate examinations. Most male gynecologists follow “professional standards”, but that does not prevent them from having lustful thoughts. Look at how at least 25% male gynecologists admitted that they had some kind of sexual contact with their patients according to a newspaper article in New York Daily News. Dr. Nikita Levy who was a well-respected gynecologist secretly took pictures of his female patients while doing pelvic exams on them. He delivered many babies and did many successful surgeries on women. I am sure that without a doubt that he acted professional most of the time.

For those who are concerned about patient modesty, how many of you would be disturbed to learn that your nurse or doctor may have maintained professional composure while doing intimate procedure on you, but then made fun of your genitals or breasts on facebook or with their friends without you ever knowing?

At Monday, September 30, 2013 9:35:00 PM, Blogger Doug Capra said...

You've brought up some interesting points that I've wanted to address.
First of all, you say "simple communication." Communication is not a simple process. It's very complex. Yes, I think communicaiton is the answer, but not just "simple" communicaiton -- rather, honest, empathetic and authentic communcation. That involves much more.
Secondly, I am as much distrubed by those nurse comments as are you. Here's what I think might be going on.
1. Nursing is not the vocation it used to be. I still believe that most nurses are very good people and doing their best. But it's a different world. No excuses, just a fact. Too many people either go into health care today for reasons other than helping people. Even worse, a significant number who have gone into the medical professions to help people have become jaded and burned out and end up hating their jobs, but can't or won't leave the profession.
2. But there's also a new generation of nurses coming along, and as the years go by, this young generation is the web generation, the texting, twittering, facebook, ipad, iphone generation. The issues you point out are issues we're seeing with many members of this generation -- not just nurses and nursing students. Now, I'm making no excuses for them, just pointing out what I see happening. This new generation seems unable to grasp the notion that the web is not private, it's not the break room, it's not a private chat among colleagues.
3. What you're seeing on those nursing blogs is immature, young nurses and, yes, some immature older nurses who need to grow up. It's the same kind of garbage we see with junior high school, high school, and college students. They post stuff on the web as if no one will see it but their friends, or, they don't really care who sees it because they think they're really under cover -- that their cute little usernames are really secret and no one will ever find them out.
4. I don't excuse this, but it's a product of our current technolotical culture. I'm not sure how these immature, offensive texts translate into the actual behavior of these nurses toward their patients. I have a hard time believing that it has no effect. But I can't believe it defines them as people or nurses. But it does tend to diminish the profession producing less respect among some patients.
I have some other thoughts that I'll save for future posts.

At Monday, September 30, 2013 9:52:00 PM, Anonymous Anonymous said...

The problem with "patients need to speak up" is this:

We know that patients won't volunteer the information. But if they are asked, then they'll speak up. So make it a routine to ask.

One example: Study after study shows that those who've been abused or assaulted won't bring it up to their doctor unless directly asked. Most current pap smear training specifically instructs caregivers how to prevent trauma to the patient. The caregiver needs to ask the patient about their previous experiences with pap smears AND previous trauma. They recommend that all patients be offered a mirror to watch the exam so the patient feels empowered. They recommend that the women be walked through and told what is going on. They provide scripts of what word choices to use. The training is out there - but I've found most doctors think it's unnecessary to do such things when they should be doing it for all women. And it shouldn't be just for Pap Smears!

Is it really that over the top to suggest that caregivers, when a procedure is being scheduled or planned, ask about how patients feel or what their concerns about the procedures are? Patients won't speak up about it, so we need to start asking them. We also need to look for ways to empower the patients in all procedures.

(I'm defining caregivers as all staff members including doctors, nurses, technicians, etc.)

The Children's Hospital of Philadelphia is one organization that is starting to recognize medial trauma is an issue. Their Center for Pediatric Traumatic Stress has guidelines for preventing and screening both children and their families for trauma.

Imagine those guidelines were followed everywhere. Imagine every surgical, emergency room, or hospitalized patient had someone come and check in with them to make sure they were mentally and emotionally coping with their experiences. Services could be initiated right inside the hospital.

Those providing the services could use the patients feedback to guide future hospital policy.

I think the answers exist. But unless the people giving medical care believe the need is there, they won't implement solutions.


At Tuesday, October 01, 2013 1:13:00 PM, Anonymous Anonymous said...

'care givers' are not interested in what you, as a patient, want. the hospital is 'their' work space, you are just a visitor. they don't care. it is all about them. they have 'seen it all before'. you are just a piece of meat to all of them.

At Tuesday, October 01, 2013 4:24:00 PM, Anonymous Anonymous said...

RJ, I can't imagine how it would make a women feel empowered looking at her genitals while everyone else is too. Psychologically, it could do the opposite and further humiliate the patient.

At Tuesday, October 01, 2013 4:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous or "anonymouses" from this afternoon, please give us all your pseudonyms ending what you write so we will all know which anonymous is which.

RJ it would be helpful for some of us if you could provide some reference at least one or two of the "study after study"

By the way, I agree that physicians (just as I teach my medical students before doing a history and/or physical) to get medical care providers to encourage patients to express themselves about how they feel about an upcoming procedure.

The problem, frankly, is that doctors want to keep procedures particularly involving the genital area as professionally "sexually neutral". It is important to the doctors professionally not to imply any sexuality into what is about to occur. And keeping the procedure sexually neutral includes not bringing up or requesting any comments about sexual implications regarding carrying out that procedure. Talking to the patient about or having the patient talk about sexual implications from those genital procedures is suspected as provocative and is not on the "agenda". I hope this explains this professional explanation for not "asking the questions". ..Maurice.

At Tuesday, October 01, 2013 5:00:00 PM, Anonymous Anonymous said...

Dr. Bernstein, well put, I agree communication does lead to accomodation. I would however need to think through the issue of whose responsiblity it is, while I think it should fall on providers, it won't happen so it does fall on the paitent to fend for themselves. That is unfortunate and says something about providers, but I agree we need to comunicate to protect ourselves.
Doug, I have to disagree with you, if it were simply a matter of respect, trust, empathy, etc gender would not matter. But it does, if you ask 100 women we have two equally qualified NP's and one male one female both met the 100 women and both had all of the qualities you say mitigate gender concerns, and then asked which one they wanted to do their pelvic exam, would 100 say it doesn't matter. Would you bet your life savings that the majority would not pick the female? I recently had a conversation with our new hospital administrator. He was so thrilled because they had just signed a contract with a new FEMALE ob/gyn. He said they were in such demand he was happy our small town hospital could sign one. Just for kicks I said is there that much preference for female gyn? He looked at me like I had just sprouted a 3rd eye. His simple answer was What do you think? Why are the vast majority of new ob/gyn' female? My point is simple, all of the things you put forth mitigate the issue but they do not erase it, they are still female and male providers and in intimate care I would still maintain a significant number if not a majority have a preferance., and it matters to them...don

At Tuesday, October 01, 2013 9:42:00 PM, Blogger Doug Capra said...

But you see, Don, I don't think gender would be such a big factor if the care women had in the past from a significant number of male ob/gyns had been accompanied by honest, empathetic and authentic communication. It wasn't. Now, I'm not saying men can't communicate that way. The lack of these qualities has more to do with the historical paternalistic medical culture (which still lingers) than it does with other things. It also has to do with cultural changes regarding bodily modesty, esp. in the last few decades.
But you're correct as far as the current situation with women. Maybe it's too late for the kind of communiation I describe to change the current trends -- but it would certainly make the medical experiences for patients much better.

At Tuesday, October 01, 2013 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Maybe, Doug and Don, the reason that men enter the specialty of gynecology is the view that was written by Dr. John M. Smith years ago n his book "Women and Doctors" that a strong subconscious motivation for many men who choose
gynecology as a specialty is the "need to be in a powerful and controlling relationship with women." If that is really the motivation of these physicians, one could understand why "empathetic and authentic communication" with their patients might not be a reasonable expectation. But is Dr Smith's theory valid? Who can tell us the answer? Do women, uniformly on their exposure to their male gynecologist, confirm that theory. ..Maurice.

At Tuesday, October 01, 2013 10:37:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, after I wrote the last commentary, a thought came to my mind. Maybe, just maybe, the reason men who write here are rejecting female nurses doing their usual nursing duties is that the clinical relationship in which the nurses are interacting with those men is characterized by those men being put in a position of losing that "powerful and controlling relationship with women." And those men who would not be interested in the career of gynecology and would look at women as nurturers towards men would be highly tolerant of the intimate clinical procedures that those female nurses must perform. How is that for a analysis of the current ongoing discussion here? ..Maurice.

At Wednesday, October 02, 2013 5:47:00 AM, Anonymous Anonymous said...

Maurice: I don't know what to say other than I think you are over analyzing the whole issue. I tend to agree with Don. A lot of people, myself included, would choose a member of the same gender for intimate care even if the communication factor was equal for any provider. I have to disagree with Doug about the reason a lot of women choose female OB/GYNs. I find those exams to be terribly difficult, even with a female doctor, and so avoid them altogether (actually they're completely unnecessary for asymptomatic women but's that's another discussion altogether). But in my younger days when I was forced into them to get the pill I did my best to find a female, so I never tried a male and probably wouldn't even if I found one who was open, compassionate, etc. Let's face it: having someone's face in your most private area is hard enough let alone having someone of the opposite sex. And I think your reason also doesn't hold water because younger women (who haven't been exposed to the previous male paternalistic attitude) choose female OB/GYNs in greater numbers than older women do. When all is said and done a lot of people just feel more comfortable with same gender intimate care and there may not be any more complicated reason than that. Jean

At Wednesday, October 02, 2013 5:49:00 AM, Anonymous Anonymous said...

In response to Dr. Bernstein's last two posts I would offer the following. If Dr. John M. Smith's assertion that a strong subconscious motivation for many men who choose gynecology as a specialty is the "need to be in a powerful and controlling relationship with women" is true wouldn't it logically follow that for many women who choose urology or nursing that the "need to be in a powerful and controlling relationship with men is a strong motivation?
Secondly, I disagree with his suggestion that "the reason men who write here are rejecting female nurses doing their usual nursing duties is that the clinical relationship in which the nurses are interacting with those men is characterized by those men being put in a position of losing that "powerful and controlling relationship with women. Isn't it more likely that most men, like myself, have no desire to exert power and control over women and do not attempt to do so but we are also quite uncomfortable with women exerting power and control over us.

At Wednesday, October 02, 2013 6:06:00 AM, Anonymous Anonymous said...

Doug, I think you're off on why women don't go to male ob/gyn.

I went to male ob/gyn for years, had a nice relationship with them, admired their sensitivity, however, as soon as women came into this field, I and many other switched to a female provider.

The reason is simple. It's just more comfortable going to someone of the same gender. Even though I never felt terribly uncomfortable, it was enough to get me and many others to switch.

There are innate differences between women and men's sensibilities and while we should be treated as equals regarding rights, these differences must be recognized in how people are treated.

For example, more women develop PTSD than men. There sense of modesty is somehow more engrained in their being. I believe it's one of the reasons men don't speak up. While it's paramount to some, the need to be protected by same gender care and is not greater than their male tendency not to speak up. Women on the other hand are tired of abuse, and being ill treated and do speak up.

Some may disagree, but look at the results. Why are men not being accommodated? Because they're not complaining

At Wednesday, October 02, 2013 8:42:00 AM, Anonymous Anonymous said...

I've never seen any suggestion in the literature that patients shouldn't be asked by their providers; it's very consistent that they should ask:

"With recognition of the extent of family violence, medical groups have issued recommendations for screening all patients (especially women) for histories of abuse. Patients overwhelmingly favor universal inquiry about sexual assault."

American College of Obstetricians and Gynecologists, Adult Manifestations of Childhood Sexual Abuse

"Most trauma victims do not seek mental health services. Instead, they look for assistance and care in the primary care setting."

"Medical providers in VA frequently encounter patients with PTSD (often undiagnosed) related to severe prior traumas (especially combat, sexual assault while in the military,
prisoner-of-war experiences or childhood physical and sexual abuse). PTSD has profound effects on physical and emotional health and social functioning; it also influences health care utilization and a patient’s ability to interact effectively with the health care system.

To increase the identification of PTSD, medical providers should routinely screen for PTSD, using simple available instruments. Medical providers also should routinely
screen for exposure to traumas, including combat, sexual assault and domestic violence."

Veterans Health Initiative: Post Tramatic Stress Disorder: Implications for Primary Care

"It is generally a good idea to find out whether a female patient has been sexually traumatized. Although most gynecological providers do not ask women about their history of sexual trauma, the overwhelming majority of women indicate that they would like to be asked this question. Few survivors are likely to offer this information without being prompted."

Sexual Trauma: Information for Women's Medical Providers

"It is important to note that physicians, dentists, chiropractors, nurses, and others may be reluctant to ask direct questions regarding CSA histories fearing these inquiries may be to personal or intrusive. However, CSA survivors will rarely spontaneously offer abuse information. Recent data indicates that women who are asked direct questions regarding their histories find it useful in the provider/patient interface."

Enhancing the Health Care Experiences of Adult Female Survivors of Childhood Sexual Abuse

"Routinely ask patients how you could help them feel more comfortable with the examination, procedure, or test, and if there is anything they think you should know before proceeding. Consider a possible abuse history if patients show signs of anxiety or tension. A "universal precautions" approach indicates an awareness of the prevalence of abuse, and sensitivity to any signals that may suggest an abuse history. It also demonstrates respect for the patient and offers them control and input into the test, examination, or procedure without necessarily needing to disclose their history."

Suggestions for Physicians and Primary Care Nurses

"Therefore, we suggest that all women, and especially those who have not had regular pelvic examinations or appear particularly uncomfortable, should be asked about a history of prior trauma. Preferably, this information should be elicited during the initial interview with the patient fully clothed or at least obtained before starting the examination, with the patient in a seated rather than supine position."

The Challenging Pelvic Examination


At Wednesday, October 02, 2013 6:25:00 PM, Anonymous Anonymous said...

Newbie here. Thank you ALL for sharing so much validation.


At Wednesday, October 02, 2013 6:30:00 PM, Anonymous Anonymous said...

We are taught, over and over from a young age that exposure to the opposite gender. It is reinforced over and over and over throughout our lives. Is it unreasonable then to think that at a minimum there would be at a minimum residual feelings carried into the medical arena. Do you really think that walking through the doors of a building or wearing scrubs completely erases that for all or most people? If it is about communication and so on and not gender why does same gender care not meet the same resistance when these things are not present? Female reporters claim they are professionals in a work place in the locker room so it isn't an issue of their gender...sound familiar?

And I agree, one would have to logically think if men went into ob/gyn to control women it would be logical to assume that females go into nursing, especially urology to control and humilaite men in a its our turn now mode, I have a friend whom is a Dr. and loved delivering babies, he said so much of his practice was pain, and sickness and sometimes death. The process of bringing a child into the world was about joy and new beginings....was he in it to control? We can debate this forever but the fact is some people just feel more comfortable with same gender, they don't have control issues, they don't have deeper issues, and they aren't looking for empathy or deep communication, it is just who they are or how they were that so hard to understand and accept?....don

At Thursday, October 03, 2013 5:43:00 AM, Anonymous Anonymous said...

"We can debate this forever but the fact is some people just feel more comfortable with same gender, they don't have control issues, they don't have deeper issues, and they aren't looking for empathy or deep communication, it is just who they are or how they were that so hard to understand and accept?"
Well said, Don. That sums up pretty much exactly how I feel also. I have generally come to the opinion that when I do seek medical care it is my decision who treats me and I shouldn't have to explain my choice. The way I look at it is it's my body, my choice. I don't see the medical culture changing any time soon, if ever, so I can only address this on an individual level to get the care/service that makes me comfortable. Jean

At Thursday, October 03, 2013 4:17:00 PM, Anonymous StayingFit said...

"Why are men not being accommodated? Because they're not complaining"

Quotes like this one have become too common on this blog. I agree that it would help if more men complained. However, this smacks of victim-blaming. Individual men don't complain because they have been socialized not to, because they fear being labeled a "whiner" if they do, and because they don't know that they have options.

So, please, if you want to encourage men to speak up, and to educate them that they really can and should receive better treatment, that's great. However, don't tell them that the abuse that they endure, and the PTSD that they suffer, is their own fault. Unless, of course, you want to accept the blame for your own ill-treatment at the hands of the medical establishment.

At Thursday, October 03, 2013 6:58:00 PM, Anonymous Anonymous said...

Staying Fit,

Nobody blames anyone for being victimized, but suffering from ill treatment is and was a problem for both genders.

The only reason things got better for women is because their need to change things was bigger than there reluctance to being labeled a complainer, whiner. Frankly, who cares what someone calls you if your needs are not being met.

I can't think of a gender more comprosmized by "talking to much, whining, complaining than women!

So before spouting off, let' look at the facts and the proof of the pudding.

At Saturday, October 05, 2013 12:48:00 PM, Anonymous Medical Patient Modesty said...

I have the book that Dr. Bernstein referred to, Women and Doctors By Dr. John Smith, a former gynecologist. It looks like only used books are available, but I'm sure that many of the people here would be interested in buying and reading his book. It was published in 1992 so it is about 21 years old, but it is a book worth reading. You especially will be interested in reading Chapter 4: The Miscasting of Males as Gynecologists. He talks about non-consensual exams and what happens when a patient is unconscious. He even talked about how some of his colleagues (male gynecologists) would walk to the operating room to lift up the sheet on another doctor's patient (female) to admire her breasts. I really appreciate his honest opinion that men should not be gynecologists. I agree that men should not be gynecologists. Dr. Smith also talks about what really goes on in the operating room. He also discusses about common it is for male gynecologists to abuse female patients and take advantage of them by doing unnecessary procedures such as hysterectomies. Hysterectomy is a big money maker for doctors and hospitals.

I really appreciated Jean’s great comments . I have never gone to a male gynecologist before and I will never go to one no matter how compassionate and good he is. Compassion makes no difference. Compassion and ability to communicate well does not change the gender of the doctor. I was very shocked as a kid when I found out that my mom had a male gynecologist and what he did. I was taught that a woman should not let any man except for her husband to touch and see her private parts. I made a decision as a teenager to never let any man who was not my husband to touch and see certain parts of my body. I’m like Jean. I will only go to a female gynecologist when it is absolutely necessary. There are so many unnecessary exams. Jean is right that pap smear is unnecessary for a birth control prescription.

I really appreciate Don’s great points. I think it is strange that many people think that female reporters in male locker rooms are wrong, but that it is different in medical settings. Female nurses in urology clinics have a lot in common with female reporters who go in male locker rooms. I know many men in this group who are only comfortable with male intimate care will agree that a compassionate female urologist or nurse makes no difference in their wishes for only male staff intimate care.


At Saturday, October 05, 2013 6:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Rather than Dr. Smith's conclusion as to the motivation for men to enter obstetrics/gynecology how about instead of a matter of "power", can anyone find a more humanistic reason to explain that selection? Couldn't the participation in birth and the preservation of fertility and the specific health of the mother-to-be or established mothers a more likely motivation? Is there not some other possibility other than "power over women" and prurient self-interest? ..Maurice.

At Sunday, October 06, 2013 4:22:00 AM, Anonymous Anonymous said...

"I had a vasectomy at my PCP's office and it was just him and me. No assistant, a friend of mine had female nurse he personally knew "assit" on his, he said all she did was hold his penis tot he side."

Is there a better example than that of "fondling" or "unnecessary"? How can anyone be gutless enough to allow that to happen?

At Sunday, October 06, 2013 12:43:00 PM, Anonymous Anonymous said...

Maurice, Let's look at the culture of medicine. Men probably went into gynecology for the same reasons men went into other areas of medicine.

There weren't women in the field, so someone had to care for women.

The make up of these individuals is as individualistic as the make up of the general population and why they do things.

I do think there is probably a strong sense of being needed despite the inconvenience of working hours dictated by delivery times. The power trip...not so much as a feeling of awe and pride that they were partially responsible in some cases for a health delivery for both mother and child.

Then there are the deviants...and I'm sure there are some of them in the mix.

This question can't be settled with a general reason just like any other reason to choose a specialty, or...even whether to become a doctor. It takes a certain "make up". Then, it takes a more individualistic view of why go into one specialty vs. another.

Doctors are only human and if we put them under the same microscope that they put the patients under, you will find all the same frailties and strengths, as are in everyone, because we are the same species...believe it or not.

At Sunday, October 06, 2013 2:32:00 PM, Anonymous Anonymous said...


Excellent commentary! I don't know when
people are going to figure out that men such as
myself don't really have an issue with modesty, I
just want the same care and sensitivity that women
get in healthcare.

Odd that female nurses know, they absolutely
know without a shadow of a doubt that when they
arrive at their mammography appointment in the
morning they will be certain a female will perform
their mammogram. When they arrive at their post-
op gyn floor they will know there will be no male
nurses nor cna's that day taking care of them. Why
should they know, they engineered it that way.

Yet, it is some how engrained, that they are
entitled to walk in, be present for every single
intimate procedure that was ever invented for
male patients. To them the more people they invite
to the arena the better. So much so that it becomes
a comedy event with no repercussions to discuss this
and how many nursing students can't wait to see
more penis on their nurses Facebook page.


At Sunday, October 06, 2013 8:11:00 PM, Anonymous Anonymous said...

Can doctors, nurses and medical staff ever completely de-sexualized a medical procedure that involves what is often called “intimate areas” of the human body? It is a serious question. If it is truly a case that it can never be completely de-sexualized, it is therefore sexual in nature regardless of the gender of the personnel. How does having the same gender staff make intimate exams suddenly non sexual? You do realize some people are homosexual don’t you?


At Monday, October 07, 2013 8:31:00 PM, Anonymous Anonymous said...


Of course the ratio of homosexual orientation
is higher with the female nursing population at 95%.

The big question is which patient gender does this
benefit and if so are there really any benefits at all.


At Tuesday, October 08, 2013 5:22:00 AM, Anonymous Anonymous said...

If this discussion is about the feelings of the patient based on gender preferences, then the sexual preference of the provider is completely irrelevant.

At Tuesday, October 08, 2013 10:51:00 AM, Blogger Doug Capra said...

This "feelings" issue, it seems to me, is mostly a control issue. We're never going to really know a provider's feelings are. We need to focus on things we have control over. We don't have control over people's feelings. Our concern should be over a provider's behavior, what they do and how they do it, what they say including the tone behind it. That's about as close to "feelings" as we may get. These are visible, somewhat objective criteria.
The concern about offensive remarks on nurse blogs is relevant, but vague as are most blog posts. We can't even be sure that actual nurses are posting the most offensive remarks. I'm sure some are, but we can't paint the whole profession in one color based upon unverified evidence. Face it, we don't even know who most of the people posting on this blog are, including their integrity, baggage and agendas.
One more point -- the more experience I gain dealing with hospitals and doctors -- the more I'm convinced that this battle must be fought mostly on a one-on-one basis between patient and provider. Those not "inside" the medical culture, non-medical professionals, will only get on the "inside" when they or their loved ones are patients -- due to the private nature of medical care and HIPAA. You'll never get in the exam room or the OR or the ICU unless it's you or a loved one. And that's when the honest communication and challenging of practices needs to take place -- right when it happens. At that moment -- followed up, perhaps, with letters.
You can work with hospital boards all you want and even influence mission and policy documents. But as the mission and policy work their way down to the on-the-ground providers, you need to be there to see what really happens. And that will only happen when the patient is you or our loved ones. that's when you need to be observant. And when modesty violations happen, that's when you need to be civil yet assertive.
This is where we need to be working -- educating patients to be more assertive and to communicate on this level. And it won't take a vast majority of patients to do this. It will take only a few. There is a tipping point, and research shows that it doesn't take a majority to institute change -- only a active vocal minority who is not afraid to confront the behavior that needs changing.

At Tuesday, October 08, 2013 2:55:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree with Doug. As I have repeatedly written "speak up!" and that is also how I got educated to the issue by those "speaking up" on this blog thread. ..Maurice.

At Thursday, October 10, 2013 10:52:00 AM, Anonymous Medical Patient Modesty said...

The reason we did not have many female gynecologists many years ago was due to the fact that medical schools would not admit women. Fortunately, that has changed today. About 80% to 90% of ob/gyn residents are female today. Look at how this particular OB/GYN residency program only has one male OB/GYN resident.

Many women were forced to lower their moral convictions that no men except for their husbands should see and touch their female organs 25 years + ago because there were hardly any or no female gynecologists. My mom was very uncomfortable with a male doctor at first. She actually declined a pap smear by her male family doctor when she was 19 around 1970.

My personal opinion is that men should have never been allowed to become gynecologists and that medical schools should have only allowed women to be gynecologists in the beginning. So many male gynecologists have abused women. It is also so sad about how women were forced to lower their convictions in the name of medicine. There are plenty of other specialties that men can choose from if they want to be doctors.


At Thursday, October 10, 2013 7:10:00 PM, Anonymous Anonymous said...

And what about the women who don't care or want a male, do we deny them choice? And how do we apply that to the rest of the medical profession, only male urologist, but what about females with urology problems. And nursing, do we have segretated hospitals one male one female. Sexism is sexism regardless how we cloak it. The key is not single gender it is informed, uncoerced, and freely offered choice.....don

At Thursday, October 10, 2013 9:42:00 PM, Anonymous Medical Patient Modesty said...


Let me answer your questions from my personal perspective. It is very obvious that all of us on this discussion have varying opinions. It is fine if we agree to disagree on some issues. I have really appreciated the excellent insights you have provided on this blog.

First of all, I am a Christian woman who believes that nudity after puberty before opposite sex should be reserved for spouse. There are some people who share my conviction and there are some people who do not share my conviction. I am well aware that there are some women who do not care about their modesty and have no problem with going to a male gynecologist. But that does not change my opinion that men should have not been allowed to be gynecologists. I have received some emails from women who shared that they regretted letting male doctors do intimate procedures on them because they were abused. You may have seen this article that I wrote about why women should avoid male doctors for intimate procedures. it always breaks my heart to hear about countless women being abused by male gynecologists. I am very grateful that Dr. John Smith, a former male gynecologist was very honest about the abuse by his colleagues that he witnessed. It is very rare for doctors to share the truth about what really goes on.

I’ll share my personal opinions about the other questions you asked. I wish that male urologists only worked on male patients and that they required all female gynecologists to be trained in female urology so they could work on female patients. Are you aware that there are some urogynecologists that deal with female urology and gynecological issues only today.

I also wish that they had only allowed male professionals to do male intimate procedures. Over 30 years ago, many hospitals did not allow female nurses to do intimate procedures on male patients. Male orderlies and doctors did urinary catheterizations on men then. I am well aware there are a number of men who do not care about their modesty.

I cannot force morals on people. Everyone has a choice, but that does not mean that I have to support their choice. I personally wish that cigarettes had never been invented because they have ruined so many people’s lives, but I cannot force anyone to quit smoking or to not smoke.

If I could have my way, I would establish some all-male medical staff and all-female staff hospitals in the US for patients who value their modesty. I do not feel gender of the medical provider matters for non-intimate procedures. I think it is so strange that most public restrooms are gender specific, but that we are expected to give up our modesty in medical settings.


At Friday, October 11, 2013 4:09:00 AM, Anonymous Medical Patient Modesty said...


I encourage you to read some comments some ladies especially AllieDoc78, a female cardiologist and I made on Mothers in Medicine: Reverse Sexism in OB/GYN. I really appreciate the female cardiologist’s honesty about why she refused a male OB/GYN.

I personally do not doubt that a male could be trained to do gynecological procedures and deliver babies. That’s not the issue here. I am simply against them doing intimate procedures on women to whom they are not married to from a moral perspective. I also believe that women can be trained to do urological procedures, but I do not support them doing that for moral reasons. I do not doubt the skills of doctors.

If we could claim that it is sexism to not allow medical professionals to do intimate procedures on the opposite sex, I guess we could also claim that it was sexism to restrict public restrooms for the same gender only. Also, think about how female reporters could accuse us of sexism because we do not believe that they should be in male locker rooms.


At Friday, October 11, 2013 2:40:00 PM, Anonymous Anonymous said...

Misty, What about the rights of individuals regardless of their gender who want to go into medical specialties?

My opinion is that no one body should step on the toes of another body and that every person male or female who wants to be a doctor may choose their specialty.

Now...once they that have that right, it's up to the patients who decide whose practice they want to support.

If there are enough female patients who don't want a male caring for them for ob/gyn, then the fall off would be that fewer and fewer men would choose that specialty.

I do understand where you're coming from, and the end result is the same.

It's a slippery slope when we don't allow both genders to exercise their rights to be whatever they want and it's up to public demand or lack of it to dictate what happens to those professions.

We've already seen what happens. There are far fewer men going into the field of ob/gyn because the current culture doesn't support them.

This is why it's so critical for men to start petitions because the doctors who specialize in male issues need to know that the population isn't happy with the female staff providing intimate care.

Let's put this another way. What if someone did a survey and the results were that income would double if a practice had same gender care?

At Friday, October 11, 2013 6:39:00 PM, Anonymous Anonymous said...

Belinda put it better than I. One has the right to fell as they choose. One has the right to practice as they feel appropriate for themselves. It is when we attempt to define what others should or should not be able to do based on our definition of right that creates the issues we struggle with as patients. Providers are choosing to define what is right for us as patients based on what is right for them as providers. If they simply provided us with real, informed, non judgemental options, would this blog be running for this many years. I don't know what is right or wrong when it comes to what we think. I just really feel denying choice is wrong regardless of which side it lays...don

At Friday, October 11, 2013 7:18:00 PM, Anonymous Medical Patient Modesty said...


Thank you for the questions! Just because someone is able to do something does not make it morally right. I stand by my moral convictions about opposite sex intimate care. There will always be opposite sex intimate medical care. It bothers me when many urology clinics do not employ any male assistants or nurses for men and ob/gyn practices have no or not enough female ob/gyns. Many women do not realize that if they choose a mixed practice that they usually cannot be guaranteed a female ob/gyn for the birth of their child (unless it is scheduled) or emergencies. This is exactly why I wrote the article about same gender maternity care. It is sad about how many women are shocked to learn that a male ob/gyn is on call when they are about to have a baby.

If I were the CEO or owner of a new medical facility that just opened, I would not allow opposite sex intimate care at all. I am sure that the medical facility would attract a lot of patients who do care about their modesty. Patients who do not care about their modesty or prefer opposite sex intimate care can easily go to another medical facility. If I owned a restaurant, I would not allow smoking at all. I am very against smoking because I have seen so many health consequences of smoking. My paternal grandfather died at age 66 of esophageal cancer that caused by a mixture of smoking and alcohol. He was a heavy smoker and an alcoholic. It was so sad for me as a kid to watch him suffer. I know of so many other people who suffered greatly from cancer and other illnesses due to smoking. I cannot force people to stop smoking. My great aunt who is a heavy smoker keeps ignoring the warning that smoking can kill you. She even continues to smoke today after her brother suffered from a horrible throat cancer caused by smoking. People have the right to smoke, but that does not mean I have to support smoking.

I agree with you that if there are enough female patients who refuse male ob/gyns, it will drive more males away from pursuing OB/GYN. Many young female patients do not want a male ob/gyn. I’m sure you saw Dr. Sherman’s article about gender preferences in healthcare. He discussed about how younger female patients prefer female OB/GYNs. Many women over 30 years ago did not have a choice because most OB/GYNs were male because medical schools were not receptive to female doctors. That has changed today. I did a little research and found one OB/GYN residency program that has no males at all.

I believe the reason there are more all-female ob/gyn practices than all-male urology clinics is due to the fact that women go to the doctor more than men and they are more likely to speak up. Some men never even go to an urologist until they are in their 50’s or older. I agree that men need to speak up.

I certainly believe that all same gender practices for intimate health issues do tend to bring in more patients. Many patients are even willing to drive an hour or more to get same gender care. It would not surprise me if some men drove 3 hours to the all-male urology clinic in San Antonio. I learned that there were a few other all-male clinics in Ohio and Maryland as well.


At Saturday, October 12, 2013 8:30:00 AM, Anonymous Meidcal Patient Modesty said...

I wanted to share several articles that two of my friends sent me over the past week with you all.

Why do nurses abuse patients?

Patient Rights a CNA Should Know About

3.) New Report: Preventable Medical Mistakes Account for One-Sixth of All Annual Deaths in the United States - This article does not discuss patient modesty, but I really appreciated the paragraph about safeguarding your care while hospitalized. This paragraph mentioned that it was best to have someone present with you. As many of you know, I believe every patient should have a personal advocate present for surgeries to ensure that their wishes for modesty are honored. Also, a personal advocate would help to reduce medical mistakes because doctors and nurses would be much more cautious if they knew that they were being watched.


At Saturday, October 12, 2013 11:49:00 AM, Blogger Doug Capra said...

Here's a very interesting quote from your third source, Misty:

"Now, here's what people need to do. They need to understand that when they are faced with hospitalization, the most powerful person in the most entire hospital system is the patient.

The system works on the assumption that the patient will not claim that power... You might have set that up with a document. If you have a power of attorney, a living will, or other types of paperwork or someone is responsible, then we know who's responsible. But let's say that it's just an ordinary situation—the patient has the most power.

A patient can say, "No. Do not touch me." And they can't. If they do, it's assault, and you can call the police. Now, they might say, "Well, on your way in, you signed this form."

You can unsign it. You can revoke your permission. Just because somebody has permission to do one thing, it doesn't mean that they have the permission to do everything. There's no such thing as a situation that you cannot reverse. If you can make amendments to the U.S. Constitution, you can change your mind about your own personal healthcare. It concerns your very life. You don't want to cry wolf for no reason, but the patient has the potential to put a stop to anything; absolutely anything.

If the patient doesn't know that, if they're not conscious, or if they just don't have the moxie to do it, the next most powerful person is the spouse. The spouse has enormous influence and can do almost as much as the patient. If the patient is incapacitated, the spouse can probably do much more than the patient.

If there is no spouse present, the next most powerful people in the system are the children of the patient... You'll notice that I haven't mentioned doctors or hospital administrators once. That's because they don't have the power. They really don't. They just want you to think that you do. It is an illusion that they run the place. The answer is – you do. They're offering you products and services, and they're trying to get you to accept them without question.

... [W]hen you go to the hospital, bring along a black Sharpie pen, and cross out anything that you don't like in the contract. Put big giant X's through entire clauses and pages, and do not sign it. And when they say, "We're not going to admit you," you say, "Please put it in writing that you refuse to admit me." What do you think your lawyers are going to do with that? They have to [admit you]. They absolutely have to...

It's a game, and you can win it. But you can't win it if you don't know the rules. And basically, they don't tell you the rules. In Hospitals and Health, we do."

At Saturday, October 12, 2013 6:22:00 PM, Anonymous Medical Patient Modesty said...

... [W]hen you go to the hospital, bring along a black Sharpie pen, and cross out anything that you don't like in the contract. Put big giant X's through entire clauses and pages, and do not sign it. And when they say, "We're not going to admit you," you say, "Please put it in writing that you refuse to admit me." What do you think your lawyers are going to do with that? They have to [admit you]. They absolutely have to...

At Saturday, October 12, 2013 7:18:00 PM, Anonymous Medical Patient Modesty said...

For some reason, parts of my previous comments were cut out.

I meant to say:


Thank you for your excellent insights! I really liked this paragraph:

... [W]hen you go to the hospital, bring along a black Sharpie pen, and cross out anything that you don't like in the contract. Put big giant X's through entire clauses and pages, and do not sign it. And when they say, "We're not going to admit you," you say, "Please put it in writing that you refuse to admit me." What do you think your lawyers are going to do with that? They have to [admit you]. They absolutely have to...

I wish more patients knew that they could cross out anything. Patient modesty is not my only concern when you are admitted to the hospital. I am also concerned about patient safety. It is pretty common for patients to be overmedicated. The local hospital in my community got in trouble a number of years ago because some patients were given the wrong medications. There was at least one patient death.


At Saturday, October 12, 2013 9:47:00 PM, Anonymous Anonymous said...

I made my decision to have home births after my first miserable hospital birth. There were at least 10 people in the delivery room as was pushing, and other than the nurse and midwife I didn't know who any of them were or why they needed to be in there. None of them introduced themselves to me. now I understand I had the right to kick them all out but my mind and energy were focused on birthing the baby, not monitoring the comings and goings in my room. I had my subsequent births in the comfort of my own bedroom.

At Sunday, October 13, 2013 9:51:00 AM, Anonymous Anonymous said...

I do not believe this blog was meant to air medical
mistakes. That is an entirely different subject that
could encompass many blogs and would only tend to
distract our main focus here. Yes it is a hugh problem
in healthcare but so is depriving patients of privacy.

There must be some educational relationship the
TSA shares with all the nursing schools. They both
have a knack for depriving patients and travelers of
privacy. Recently, the TSA has been harassing
disabled veterans at airports, asking them to remove
their artificial limbs and then stand. Most recently at
a major airport a 92 year old female in a wheel chair
was essentially strip searched. She said the ordeal
was someone that should be reserved for prisoners.

It seems our society has some kind of a fetish for
this sort of behavior, strip searches. Join the military,
get a strip search, sick at the hospital,get a strip
search, need to board a jet, get a strip search. Grade
school elementary children go to the principals office
for a strip search.


At Sunday, October 13, 2013 11:12:00 AM, Anonymous Anonymous said...

It's great if you are able to birth at home but I wonder how one would feel if their child ended up with a severe disability or death because the proper emergency equipment wasn't at hand.

At Monday, October 14, 2013 5:06:00 PM, Anonymous Medical Patient Modesty said...

Anonymous on Saturday, October 12, 2013:

I am sorry to hear that you had a horrible hospital birth. Sadly, many women have horrible hospital births. This is exactly why I wrote an article about steps women need to take to ensure that they have a positive birthing experience.

I support hospital, birthing center, and home births. It concerns me when a lady chooses to have her baby at home and she does not have a back-up plan. It is important for any woman who plans to have her baby at home or a birthing center outside the hospital to have a back-up plan in case she has complications. One of my friends was planning on having a baby with a midwife, but she ended up having to go to the hospital because her baby was breech. She got her wishes for a female OB/GYN, but this doctor was insensitive to her wishes that she did not want any medical students present.

Not all women can have their babies safely at home so hospital birth is required for women with high risk pregnancies. Most women with low risk pregnancies can usually have their babies safely at home or a birthing center with a midwife.


At Tuesday, October 15, 2013 8:13:00 PM, Anonymous Anonymous said...

Misty, do you think a man should divorce his wife because she picks a male OB/GYN instead of a female one?

At Tuesday, October 15, 2013 9:37:00 PM, Blogger Maurice Bernstein, M.D. said...

I know the following question might stir some surprise and denial but in analyzing motivations for the issue certainly I am bringing up one reasonable possibility:

Does anyone think that the caregiver gender selection issue has more to do with communication comfort rather than concerns about physical modesty comfort?
"Communication comfort" would be comfort to bring up issues and express desires or requests with someone of the same gender. It being easier for a man to talk to a man and a woman to talk to a woman: the same genders having similar understandings and motivations.

Physical modesty therefore being only a side issue primarily created and provoked by inability to comfortably and effectively communicate with that opposite gender. How about that as a reasonable possible mechanism? ..Maurice.

At Wednesday, October 16, 2013 2:52:00 AM, Anonymous Medical Patient Modesty said...

Anonymous on Tuesday, October 15,2013

No, I certainly do not think that a man should divorce his wife if she picks a male ob/gyn. It breaks my heart that many marriages have been strained or ended in divorce because the wives went to a male gynecologist. I have been a part of the How Husbands Feel About Male Gynecologists for a number of years and it saddens me to hear about husbands having problems because their wives refuse to switch to a female gynecologist. I would just simply suggest that a husband communicate with her wife about how much he loves her and that he desires to have the privilege of being the only man to see and touch her private parts.

I feel that when a divorce happens because of opposite sex intimate care that it’s like saying the medical profession won. I can understand the damage that opposite sex intimate care can do to a marriage, but I feel that couples should do whatever they can to restore their marriages. Some men in the How Husbands Feel Group have had great outcomes because they were able to get through to their wives. Many women switched to female gynecologists at the request of their husbands.

John on another forum made great comments. I think it is important for dating couples to make their feelings about opposite sex intimate care clear earlier in the relationships before they consider marriage. This same guy, John broke up with one girl a number of years ago because she went to a male gynecologist.

My dad fell to the cultural blind spot that male gynecologists were okay so that’s why he accepted them. He said that he would have never thought about this issue if it was not for me. The truth is so many men have no idea how intimate gynecological examinations are because they are not allowed to be present with their wives.


At Wednesday, October 16, 2013 3:00:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

The ability of a doctor or nurse communicating well with patients make no difference in the way many patients feel about opposite sex intimate medical care. The truth is there are many male gynecologists who can actually communicate very well with female patients about intimate health issues. I’m sure that many patients do find it more comfortable to talk to same gender medical personnel about intimate issues, but that still does not change the fact that many patients do not want opposite sex intimate care under any circumstances. I’m sure you are aware that many men would not want to discuss their sexual problems such as ED with a female doctor or nurse.

There are many reasons why people are uncomfortable with opposite sex intimate care. For me personally, it is a moral issue. I do not believe that it is appropriate for a person of the opposite sex except for a spouse to see or touch the private parts of a person of the opposite sex.


At Wednesday, October 16, 2013 6:37:00 AM, Anonymous Anonymous said...

Misty. I just wanted to let you know that I was present for every OB/GYN visit my wife had. She asked the Doctor if I could be present and she agreed. She made a comment that she was happy that I was that interested in my wife's health. She would show me the changes my wife was going through when she was pregnant. The two of them would tease me about what I did to her. ( Got her pregnant .) I realize that her OB/GYN was a very special lady. We were very lucky to have her as her Doctor and that was 40 years ago. A friends wife had her baby breech . That would usually mean that the husband had to leave the birthing room. Her comment to him was " Oh goody a breech. I haven't done one for awhile ". Then showed him what was happening. May God bless this special Lady. Take care. AL

At Wednesday, October 16, 2013 7:45:00 AM, Anonymous Anonymous said...


Does anyone think that the caregiver gender selection issue has more to do with communication comfort rather than concerns about physical modesty comfort?

Maurice, No, the gender issue is more about mental comfort and replacing the uncomfortable feelings of embarrassment with neutral feelings.

It is interesting that I went to my primary physician yesterday. Her assistant is a male and we know each other. When entering the room he handed me a gown and said that today was a complete exam including a cardiogram.

This practice knows of my issues and have been clear with him.

His response was that he would be doing the cardiogram and I said, "no". He rushed out of the room and a woman came in. He seemed offended and it annoyed me.

Next, the doctor comes in and tell me that there is a nurse practitioner in today and would I mind if they observe(I note the gender of that practitioner is not tole to me).

What bothered me about these encounters is that knowing my issues, they still insisted on the entitlement of gender neutrality.
The doctor was told no as well.
Perhaps, if the nurse practitioner was a woman and it were presented to me that way, I would have said yes. I can bet it was a male and that's why the doctor presented the information in that way.

At Wednesday, October 16, 2013 8:56:00 AM, Anonymous Anonymous said...

Your query about nudity versus communications raises puzzling thoughts for me. I am a very modest man and don't believe in something called "non-sexual nudity." Yet, until recently I used mostly female physicians - GP, cardiologist, dermatologist - but nothing below the belt. I did have a male urologist and gastroenterologist. I chose the female doctors largely due to their conversation style, not that their medical competence was irrelevant. These female doctors were more open to conversation, inclined to say "Is that all right with you?" and other pleasantries. I went through several male urologists, all of whom were abrupt and domineering. I could have resolved the dilemma by having my female GP do the prostate exam, but I found that choice personally unacceptable. I now have a male GP who exhibits female conversational styles and can do much of my personal work. My thinking about male - female conversational styles has been sharpened by the writings of Deborah Tannen ("You Just Don't Understand" and "That's Not What I Meant." Dr. Bernstein, you have often commented that you didn't find intense patient concern with nudity during your long medical practice. This may be explained by your gentle personal style and the trust people had in you. DES

At Wednesday, October 16, 2013 10:10:00 AM, Blogger Doug Capra said...

Misty and belinda
You keep delving into unknown territory and comment on it as if it's known based upon your own views. I strongly disagree with your use of the word "many" to describe the number of patients who agree with your point of view. We don't know. I would say "some" patients. And there's little real evidence out there as to how communication affects attitudes toward same or opposite gender care. Again, I would say that for "some" patients communication isn't a factor as to whether they'll accept opposite gender care. Until I see some data, I won't agree that it makes little or no difference to most patients.
I'll grant that there are sufficient studies about some issues like chaperones that support the issue, although it's unclear with men. Men say they don't want any chaperones of either gender which really takes gender out of the picture. There are more studies about women and their choices than there are about men and their desires. Misty and belinda -- both of you, when you talk about patient modesty, almost always learn heavily toward female perceptions and examples and don't really get into men's issues.
So -- If you have the solid evidence regarding how men as a group feel about these issues (communication and opposite gender care) and that means many studies, that support your position, please post them.

At Wednesday, October 16, 2013 11:40:00 AM, Anonymous Anonymous said...

I answered a question based on my feelings. Dr Mo asked an opinion and I gave him mine.

This is not the first time that you have lumped Misty and I together. We could not be further apart on our thinking about this issue.

At Wednesday, October 16, 2013 12:31:00 PM, Anonymous Medical Patient Modesty said...


It does not surprise me that your wife’s female gynecologist allowed you to be present. It is pretty common for female gynecologists to be much more receptive to allowing husbands to be present than male gynecologists. I am still so amazed that your wife had a female gynecologist about 40 years ago. Female gynecologists were very rare in 1970s. I loved this great article: Modesty and Your Physician. It was written in 1974 when female gynecologists were hard to find. I wish that my mom could have had a female OB/GYN in 1979 when I was born.

What state did your wife find a female gynecologist in? I believe that female gynecologists were more common in California, New York, and Texas in the 1970s.


I have to be honest with you. Your latest comments were disturbing. I care deeply about male patient modesty. In fact, I’m very disturbed that there are hardly any male CNAs or nurses at the nursing and rehab center that my grandfather is at right now. I have received many heartbreaking cases from male patients who were had their modesty violated in medical settings. I think male patient modesty is as important as female patient modesty. I heard from a female medical professional who was offended that a male patient did not want her to care for him, but then she changed her mind later when she heard that he was a Christian man who wanted to protect the intimacy in his marriage by not having a female care for him. There has been some discussion about male gynecologists and childbirth lately and that’s why I’ve focused more on female patients in some of my latest comments.

I am really pleased that there are several all-male urology clinics across the US and I hope more urology clinics will follow similar path. Dr. Sherman has done many great articles about male patient modesty. He shared in one of his articles that sometimes men do not even have any intimate examinations or procedures until they are in their 50’s. Men are less likely to speak up about modesty concerns that they have than women and that is why I think there are not that many studies. Also, men are much more likely than women to avoid the doctors.

One of the board members for MPM shared a great article about chaperones that I thought you would be interested in reading if you have not already read it:

The role of patient chaperones in clinical practice I encourage you to look at the comments of male_advocate on March 18, 2013.

Many patients actually care about their modesty, but most will not speak up because they have been conditioned to accept that they must let medical professionals do anything in the name of medicine even if it goes against their wishes and convictions. Also, it feels intimidating to speak up about a very sensitive issue.

It also concerns me about the critical comments that you made about Belinda. She just shared her personal feelings based on Dr. Bernstein’s question. Belinda did a great job standing up for her wishes that no males be involved in her care the other day. We all have varying reasons for the way we feel about our modesty.


At Wednesday, October 16, 2013 12:49:00 PM, Anonymous Anonymous said...

Not trying to pick a fight here but Doug did you not infer on your Sept post that most patients have concerns but they can be mitigated with empathy, communication, etc and if no amount of communication could do that there must be deeper issues. Are their studies to back that as fact? I do agree that I feel Belinda and Misty's comments in general favor the female perspective and female concerns. I would guess that is because they are I assume female. That is the very point I have been trying to make. Providers approach this subject from of a providers perspective, females have a different perspective than males, a male who grew up in one environment or culture has a different perspective than one who didn't. Why are we willing to accept a female who is muslim desire for modesty and yet dismiss another woman's concerns...because we know or think we know the cultural influence of the muslim woman's desire but ASSUME the non muslim would not have some of the same concerns and further a non muslim male should have no or little concerns at all. How hard would the medical staff work in an attempt to convince a muslim woman to accept a male nurse for intimate care? To say communication, empathy, etc erases the concern ignores the individuality of each and every patient and the life experiences that have made them who they are. We all tend to make generalizations from our personal perspective, which is why we are here. I go back to Dr. Bernsteins comment that communication leads to accomodation. That is right on the money, let the providers know WHAT we want and need, what we expect. They can or will accomodate or we will go elsewhere. They are free to try to change our minds and we are free to decline...providers should in my opinion seek to accomodate but they do not so communicate for that accomodation as an individual, you don't have to justify other than that is what want and or need....don

At Wednesday, October 16, 2013 3:47:00 PM, Blogger Doug Capra said...

Well -- I'm willing to retract my "most" to a "some" if others are, too. My point is that there's not a lot of research out there on this subject -- just too many assumptions.
Also, I do realzie, Misty, that you do advocate for males as well as females. I don't mean to imply that you don't. Don is right -- we do make many assumptions based upon our own genders. And belinda -- don't mean to lump you in with anyone.
Communication -- How we say what we say and how we do what we do and how we say what we say while we're doing what we're doing -- makes a signinficant difference in how people feel about what we say and what we do. How significant? Very significant. Read the research of Albert Meribian. Our body language and tone pretty much control what we're communicating. The words mean little outside of those contexts.

At Wednesday, October 16, 2013 5:32:00 PM, Anonymous Medical Patient Modesty said...


You made excellent points. You cannot assume that a group of people might not care about their modesty and then another group cares more about their modesty. Medical Patient Modesty has interacted with people from all kinds of backgrounds who care about their modesty over the past few years. We have interacted with Atheists, Jews, Muslims, Christians, etc. who feel modesty is important. There are many reasons why patients care about their modesty. Not every patient who cares about their modesty has the same reason for modesty. Medical professionals should always assume that patients might care about their modesty. I wish that there were medical forms that asked patients about their preferences for intimate medical care. I personally think this is as important as allergies.

The male advocate made excellent points:

However, men have been conditioned by society to believe they should have no modesty and anyone who does, is denigrated as being childish, silly or sissy. This attacks a man at his core of manhood and further humiliates and degrades him in a medical situation. That is why the majority of men just suck it up and bite their lip and let it happen rather than complain as they are afraid of the reaction they will get. Men act differently to embarrassment situations. Some make jokes to hide this, often as sexual bravado to mask their true feelings. Some blush and go quiet or complain softly. Some get angry. However, very few will complain about their embarrassment as to admit this only increases their humiliation. They cannot even complain when they get home as male friends will make fun of them and women say they should not be silly. So the status quo continues with no-one willing to drive the changes needed to make healthcare fair to all.

The board member who shared this link with me shared great insights: Imagine a Gynecology office with a female physician and an all male staff? This makes no sense. Urology procedures are every bit as intimate as gyn procedures!!


At Wednesday, October 16, 2013 6:16:00 PM, Blogger Maurice Bernstein, M.D. said...

DES from 8:36am today, thanks for your comments about the importance and value of communication between physician and patient (and of course vice-versa) both in terms of general communication and modesty issues. I am sure that the visitors to this thread have no idea how sensitive empathetic communication is stressed by all instructors teaching first and second year medical student in teaching how to interact with the patient. Proper communication often is more important in the taking of the history than that what is found or not found on physical examination from the point of view of obtaining a diagnosis but is also essential in relating professionally with the patient. Hopefully what is taught in those early years of teaching is carried on, though one wonders how that is possible when communication time is often limited to 3 to 10 minutes in the office or often the same or not too much longer within the hospital ward.

A good example of the importance of communication and the great and valid concern of those writing here is that of the "gawkers" or in fact medical students performing pelvic exams in the operating room while the patient is unconscious as an example of total lack of communication between patient and those others.

Therefore, I still think that what can be more important than gender differences is the presence of considerate (both of the patient and the doctor/nurse) humanistic communication. ..Maurice.

At Wednesday, October 16, 2013 8:17:00 PM, Anonymous Anonymous said...


Any finger pointing, anger and blame should
be directed at the nursing industry. This is all their
fault, the very existence of this blog is all their fault.

The lack of trust, intregity and professionalism
is all their fault. Most of the medical mistakes are all
their fault. Nurses who hate their jobs, it's their own
damn fault. No one made them go into nursing.

Anyone who hates hospitals hates nurses, it's
the nurses who make people hate hospitals. There
should be a hate the nurses day. I just want to stop
seeing them in their nasty scrubs at the grocery
store, spreading germs everywhere.


At Wednesday, October 16, 2013 8:20:00 PM, Anonymous Anonymous said...

Don, Doug,
This is the last time I'm going to verbalize my opinion.

How many times (and those of you who read regularly have hear me say this over and over) that this issue is not a gender war, that everyone has a right to the same level of privacy, and that accommodations should be made to anyone who feels the need.

I have also said that in order to get what you need, that needs have to be verbalized to the right people. So, if one gender is more communicative and have received benefit from that communication, then the same holds true for anybody and any cause on the planet. Without movement, there is no reaction. There must be action to cause reaction

I have also said that abusers come in both genders and the medical personnel are just a cross section of the population although deviants do gravitate to positions that foster access to vulnerable people. That is not to say that the medical field is full of deviants, but that there might be a higher incidence especially in low level positions, where there isn't so much to lose if you get caught.

Gender neutrality in medicine is unacceptable. It is the status quo.

It's terribly disturbing to know that the medical community knows the damage, their right of entitlement and still will does nothing to make patients feel more comfortable during intimate exams.

Standard of care practices are backward and emotionally damaging without regard to the feelings of the vulnerable patient and no attempt to honor their dignity.

Everyone deserves respect, privacy and that the needs of abuse victims and victims of rape need special handling. Senator Patty Murray has been supporting special protocols for vets who have a history of sexual abuse in our military hospitals.

Don, while I advocate for both, I am female but feel no more entitled to the same gender care that I need then members of the opposite sex who need it too.

While there may be lopsided nursing personnel as far as gender, once you get into an operating room, everyone is presented with both genders in the care team.

This privacy issue is part of a bigger problem with rights of entitlement, lack of informed consent, patients being lied (overtly or by omission) gives patients the wrong message. That message is that hospital workers cannot be trusted and patients in general have a low opinion of the medical profession once they have been abused by the system in any way.

At Wednesday, October 16, 2013 8:21:00 PM, Blogger Maurice Bernstein, M.D. said...

On the other hand, PT, I have seen males (either doctors or techs) outside the hospital grounds wearing their scrub suits. ..and I groan. ..Maurice.

At Thursday, October 17, 2013 1:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, I fully agree with you that "gender neutrality" in medicine is a wrong concept for any practitioner of medicine to think about or act upon. One of the first things we teach our medical students is to determine the patient's gender. For it is the gender on inspection or the gender which the patient considers themselves critical for further communication and professional management of the patient. If doctors or nurses or techs look at or excuses their approach to the patient or actions as "gender neutral" they are fooling themselves and their patient. I have never considered myself or my patients with that non-nonsensical description. Period! ..Maurice.

At Thursday, October 17, 2013 2:50:00 PM, Blogger Maurice Bernstein, M.D. said...

"Gender neutral" has been an ongoing topic on this thread. Back in March 2009, I wrote the following comment:

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

So there!

At Thursday, October 17, 2013 4:53:00 PM, Anonymous Anonymous said...

Maurice, Thank you for explaining this so simply and so completely. Have you ever shared your views with colleagues and if so, did most of them agree with your position?

What if a team of doctors got together and wrote an article and submitted to JAMA supporting patient comfort, dignity and the plight of those who have had unfortunate negative experiences pointing out that gender neutral at best only works for one side and can cause damage to the other.

Pressure from the outside together with pressure on the inside would really help this issue in a way that would benefit both sides.

At Thursday, October 17, 2013 5:01:00 PM, Anonymous Anonymous said...


This is where I vehemently disagree with you,
it is a gender war. With 95% of all nurses female it
is the feminine healthcare industry that has purposely
orchestrated the vast discrimination against males
in healthcare as well as male patients. By limiting
the numbers of male nurses they control their male
patients, limiting choices. This is precisely why you
don't see males in most aspects of feminine health
care. What other industry portrays themselves as
professionals on the one hand, yet discriminate so
freely on the other. There is nothing you can say,
prove nor present that will ever sway my opinion
on this subject.

It's very evident by the countless admissions on
every nursing forum, blogs and sites that expose
the unprofessional comments and behaviors that
female nurses,cna's and others exhibit. Of course
I didn't need to read any of this to know it's true,
I have seen it myself for years.


At Thursday, October 17, 2013 5:42:00 PM, Anonymous Anonymous said...

Now lets be honest while we may have digressed abit to acting just a little like middle school girls...oh yeah is kind of entertaining.
Belinda you missed the point of my post, I was not accusing you of partcipating in a gender war or ignoring, demeaning, or devaluing the importance of modesty to males. My point was your post do have a female slant are female, of course they would be have a female perspective, would we expect them to have a male perspecitve when you have never been a male anymore than i could come from a female perspective. Who we are and what we expericence affects everything we do and say. Doesn't mean we can't be empathetic, understand or support. But this is an interesting example of how easy it is to misinterpet others feelings and what they are saying. Silence or not reisting of care we find uncomfortable or stressful is interpeted by the medical community as acceptance or being comfortable with that care. Just because your posts are slanted from a female perspective doesn't mean you don't care about the other side, I wasnt saying nor did I mean that but it doesnt change who you are...don

At Thursday, October 17, 2013 6:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Ah! Doesn't all that has been written recently and the responses by some to the comments by others on this Volume about gender issues demonstrates clearly that communication or insufficient communication is the essential director of the gender-modesty concerns. There probably be less critical gender-modesty episodes if communication was more directed toward adequately expressing the views of each of the parties in a healthcare provider-patient relationship...and most importantly each party taking the time to listen. Communication. ..Maurice.

At Thursday, October 17, 2013 6:14:00 PM, Anonymous Anonymous said...

Don, thanks for explaining your position.

PT, how do you feel about this? I'm asking because you (as Don mentioned) see things in a certain way just like we all do.

Nursing from the beginning was a female position. How do you know there aren't other factors? Female techs in mammography did not come from the nurses perspective. Isn't it just possible that this same gender care for females came from society's perception that women need to be protected because they are the "weaker" sex and that the majority of sexual offenders are male? Couldn't it be because women would want a chaperone and it would cost the medical facility double to put two people in the mammography suite?

I'm not saying that these are the reasons. What I'm asking is how it evolved. I'm only suggesting that there is more than one way to look at this situation.

It is an interesting topic and would make an excellent subject for a dissertation

So, until there are some full proofs, nobody is arguing that there is a dominant female population in nursing but the reasoning behind it may not be what you think it is.

Isn't it possible?

This gender bias to men ends when you go into the operating room where there are multiple genders of people everywhere (even in C sections, I might add).

At Thursday, October 17, 2013 7:14:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, female statistical dominance in nursing, I am sure is due to the fact that "nursing=mother", a centuries long relationship in which a "father" just didn't fit with this medical occupation. Now all this may be changing. With more women working outside their home and parts of the day away from "nursing" their children and, in fact, more men as fathers are taking over their household responsibilities including significant previously "motherly" care of their children (at least that is what I read in the news and magazines) perhaps the gender role in nursing will have a change in gender proportions and there will be more men in that profession. But it may take society time to make that change that "nursing=either mother and father". What do you think? ..Maurice.

At Thursday, October 17, 2013 8:44:00 PM, Anonymous Anonymous said...


Mother=childbearing and not necessarily
advocating for other human beings. In mathematics
and = plus, I'll assume you meant mother or father.

For many years men were orderlies and
male patients were perfectly fine with the notion. It
was the homosexual perspective that the feminine
healthcare machine pawned off as a tactic to limit
males in healthcare.

This same tactic was used by the female
teaching industry. Interesting that more and more
female teachers are being arrested for having sex
with boy students. Don't forget it's predominantly
women who steal babies and of course women
prisoners who always claim the male guards are
having sex with them.

But of course it's the female prison
guards who now have the highest distinction of
having sex with male prisoners according to the
Dept. of Justice.

All male gynecologists are perverts
according to women such that female OB-gyn
residents outnumber male residents. Interestingly
it's always female healthcare workers who are
assaulting nursing home residents, taking
inappropriate cell-phone pics or posting private
photos of patients on Facebook. Are you beginning
to see the pattern here?


At Friday, October 18, 2013 8:30:00 AM, Blogger Maurice Bernstein, M.D. said...

Misty wrote the following response to PT yesterday. I am running into publishing problems because Misty you are loading multiple copies of the same text onto the blog. Please try to send just a single copy.


I have found numerous articles in the news about male gynecologists secretly videotaping or taking pictures of their female patients' private parts.

I remember the link to facebook page for nurses that you mentioned a few weeks ago. It was disgusting to see how they put a caption saying that nurses saw more penises than prostitutes.

I'm sure you've done some research. Have you found any articles from news sources that mentioned that female healthcare workers took pictures of male patients' private parts? If so, can you please post the links here? I am well aware that there are some female healthcare workers who do abuse male patients.


At Friday, October 18, 2013 11:56:00 AM, Anonymous Anonymous said...

I too dislike the practice of male gynecology and look forward to its disappearance from the scene. The thought that good communications - kind words, an open mind, smooth talk - can trump nudity (or sexual arousal, as I would phrase it) has more validity than some would credit.
Over the years I have followed numerous web sites where women have discussed this subject - do you or do you not go to a male gynecologist? Women who say yes assert that they have no problem with men doing their pelvic exam, citing the doctor's ability to put them at ease, listen to their problems, and otherwise use good communications. Likewise, those women who use female gynecologist merely say that they feel more comfortable talking to another female about their problems. Both assert ease of communications, neither discuss nudity, sexuality, the potential for male arousal. Rarely will you hear a woman say she doesn't use a male because he will"get off on me."
Puzzled by this, as it is my intuitive sense that men cannot perform that intimate task without it having sexual meaning,I sought evidence within the medical community itself. In a textbook published by the AMA in 1981 (Sexual Problems in Medical Practice by Lief, ed. I read: "The medical student or physician who does experience erotic sensations (while doing a pelvic exam) should recognize that this response is neither unusual or abnormal. Precluded are a physician's sexually exploitative behavior, not his or her feelings, which are to be controlled."
In a similar vein, from a publication of the British National Health Service (The Council For Regulatory Excellence, 2008, p. 20), "Medical students must be taught that there is nothing unusual about having sexualized feelings toward certain patients, but that failing to identify these feelings and acting on them is likely to result in serious consequences for their patient and themselves."
The most candid and dramatic comment on the sexualized nature of the pelvic exam is presented in the Archives of Family Medicine, a now defunct publication of the AMA in its May/June, 1999 edition. The article "Time and Tide" is the reminiscence of a male doctor as he describes his conflicted but profound feelings while performing a pelvic exam on a young patient. She is a beautiful woman, unmarried and virginal, and in his dreamy mind escapes the sterile confines of the medical office and cavort with her on the beach, like any lovers. A year later when she returns for her annual exam, the same rush of emotions sweeps over him, but this time she is engaged to be married and the subject of birth control comes up. Eventually the intimate exam begins and, in the author's own words "the nurse takes her place, standing guard over the patient, over me, and over the deep. I pull away the drape, look up, and suddenly lose myself in her eyes."
The young doctor seeks council from an old colleague who promptly cautions him about his behavior. In all three incidents, the medical establishment recognizes that "men will be men", and only concerns itself with improper action.
So what is going on? The medical establishment acknowledges the erotic nature of a man handling a woman's genitals, but women patients avert their gaze, preferring to discuss bedside manner.


At Friday, October 18, 2013 12:12:00 PM, Anonymous Anonymous said...

I have had many male ob/gyn's through the years and never had a problem with any of them.

Switching to female providers happened AFTER a horrific experience that involved female and male providers and now, it's a source of comfort to have that same gender care.

Abusers and perverts come in all sizes and shapes and even male and female gender. Trying to say who is worse is ridiculous.

PT paints the world that if you're female you deserve to be abused and we all deserve what we get.

Misty, yes there are articles and many of us on this blog have experienced abusive or deviant care. We are a product of the environment.

The medical industry has done nothing to secure patient safety in this arena and for years refused to accept it as a real problem. It is. Both genders are responsible.

At Friday, October 18, 2013 1:05:00 PM, Anonymous Anonymous said...


I will agree with your accusatory comment but
rather all female nurses deserve the abuse right
back. Since we are on the subject I thought I would
bring up the fact that about 99% of all nurse case
managers are female. What does a case manager
do? They work at hospitals and coordinate care and
services for the patient before and after the patient
leaves the hospital.

Nurse case managers also work for insurance
companies. They are the ones Belinda who might
Dis-approve that urgently needed test or medical
care that a patient might need to save their life. I
am sure you have heard stories like this.

Nurse case managers also work for medical
malpractice attorneys. These nurses will also work
in risk management for hospitals, looking for ways
so you cannot sue the hospital. Perhaps when the
nurse did not wash their hands when doing wound
care, thus causing the patient peritonitis. How do
you like the little nursing industry now.

Imagine you the patient acquiring a severe
infection while a patient all because the nurse
didn't wash her hands. But now you can't get the
care you need all because another nurse at your
insurance company decides on some vague criteria
and you are denied the care you need. You attempt
to sue but are further stymied from receiving care
all because a third nurse reviewing the medical
malpractice claim decides you don't have a case
against the hospital.


At Friday, October 18, 2013 1:30:00 PM, Anonymous Anonymous said...


One more thing I forgot to mention. There are
well over 3 million licensed nurses in the United
states. The vast number of these nurses probably
on a regular basis perform some kind of intimate
care on male patients. Yet, I'll say with certainty that
most don't see a male gynecologist or most male
physicians for that matter.

I will say with absolute certainty that "IF" there
were such a thing as male mammographers they
wouldn't be getting their exam from that male
either and it's pretty much a written rule among them
they don't seek care from the same facilities they
work at. Dosen't that make them a hypocrite and
what does that say about their personal intregity
and trust as far as advocating for their patients.

The typical female embraces this status quo, that
it works for you so to speak. One gender, male is
dis-enfranchanized and discriminated against for the
benefit of the female. Dosen't that make you a
hypocrite as well!


At Friday, October 18, 2013 7:30:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I’ve noticed that sometimes when I try to comment and then I enter the right letters and numbers in the verification box, it will return and give me this message: The characters you entered didn't match the word verification. Please try again. One day when I tried to comment, it kept on bringing me to that verification box. I certainly think it is a good idea for you to require people to verify that they are not a robot because there are many spammers out there. In fact, use similar verification boxes for most of the forms on the web sites I’ve developed. This has reduced some spam. However, some spammers are still able to get through and it is very frustrating because I will get multiple submissions from spammers some days. The verification boxes are not always accurate. It is strange, but sometimes comments are submitted even when the words are not same as the verification code. It’s a programming flaw. I believe that sometimes certain Internet Browsers affect your submission. It’s not something you can really fix since it was a feature that came with the blog. It’s not my intention to post multiple times. I am sure that others have had problems from time to time as well.


At Friday, October 18, 2013 9:11:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, although this conversation is "off topic", I do think it is important to clarify this issue here since this thread "Patient Modesty" is, of course, the most commented of all my almost 900 distinct threads.

I have to tell you that your multiple identical postings are the only postings which I have experienced. Perhaps your particular computer is entering non-visible characters without your intent and causing the problem where you get an error message but the postings are nevertheless submitted to me for moderation. Perhaps other more computer system educated visitors here might have the answer to your problem so they should provide suggestions or you should describe your issue with Google's

At Saturday, October 19, 2013 7:07:00 AM, Anonymous Anonymous said...

PT, You are making assumptions about who nurses see as their personal providers, and worse than that lump every female into being a hypocrite.

It is further interesting that when one questions your rationale, you go into attack mode.

Most of your postings have no basis other than your personal observations that are slanted to fit your mindset.

I'm not saying your wrong, just that you haven't provided any proof any time you are asked, even from Dr. B.

One cannot label every women or any group a hypocrite by nature of their gender. This kind of thinking is the foundation of discrimination and is unacceptable.

At Saturday, October 19, 2013 4:12:00 PM, Blogger Maurice Bernstein, M.D. said...

I'm not publishing PT's comment following the last comment by Belinda because it appears to me as an ad hominem remark. None of the visitors here should argue a point based on the person or personality of the one presenting the view. The argument should be made based on the available referenced facts pertinent to the issue. The facts themselves should be shown to be reliable and, if appropriate, generalizable. For example, there is no doubt that there are deviant and non-professional behavior in the medical profession with news items presenting cases brought to trial and conviction after proven sexual behavior by healthcare providers with their patients. These isolated cases while disturbing that there should even be one case cannot be used to make generalized statements of significant sexual misbehavior throughout the medical profession. Neither can published journal or book statements by members of the medical profession or otherwise expressing just their views or estimations. Neither can comments made on allnurses or wherever of penis peeping and penis characterizations in the writings of totally unidentifiable anonymous individuals who may not even be healthcare providers themselves. Even though one case of sexual battery or misbehavior is terrible for the appearance of the medical profession, one should otherwise not make generalizations from these descriptions.

So lets keep the discussions here away from any inference of personality attacks upon the visitors. Should we even also consider whether this patient physical modesty topic has after all these 8 years reached it's maximum value and should be halted and then each visitor just going off and following up on the repeated suggestions for attempting to resolve the various issues presented? What do you think? ..Maurice.

At Saturday, October 19, 2013 4:29:00 PM, Blogger Maurice Bernstein, M.D. said...

p.s.- PT, if I mischaracterized your submitted posting, I surely will apologize publicly. I would like you to write me e-mail and explain what you meant in your posting:

Unfortunately, I have virtually no e-mail address access so I can privately write e-mail directly to all my anonymously signed visitors when an issue arises. ..Maurice.

At Saturday, October 19, 2013 7:09:00 PM, Anonymous Anonymous said...

In Sweden female patients may no longer choose
the gender of their gynecologist. If they show up and
there is a male gynecologist,too bad! That is who they
are stuck with. Don't like it go elsewhere! Haven't some of us heard that before?
Personally, this should be implemented here in the
united states. The reasoning in Sweden, it's discrimination to the male gynecologists. My opinion, if one gender cannot be accommodated and respected, then neither gender should be accommodated and certainly it would not bother me one bit, male patients are not respected anyway so no loss.


At Saturday, October 19, 2013 7:12:00 PM, Anonymous Anonymous said...


End this worthless blog, it's non productive. The
healthcare community will never get it.


At Saturday, October 19, 2013 7:51:00 PM, Anonymous Anonymous said...

Keep this blog. It has considerable traction not only because patient modesty is a significant issue, but our comments and criticisms apply to the entire medical operation culture.

At Saturday, October 19, 2013 8:48:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, the "blog" is actually the website "Bioethics Discussion Blog". "Patient Modesty" volumes is actually a posting of a topic which is termed thread. I don't intend to eliminate my blog but I question about continuing the thread postings titled "Patient Modesty". Any additional comments of this thread's value or now absent value. I would say it is about time to evaluate what is going on here, isn't it? ..Maurice.

At Saturday, October 19, 2013 9:05:00 PM, Anonymous Anonymous said...


I am imploring you to end this modesty
blog. It was a failure from the beginning, why? As
I mentioned a number of years ago that modesty
has nothing to do with the issue. Even you had
mentioned that it was a subject you had little
understanding of or perhaps you never considered
the matter during your practice.

The medical community at large truly is
incapable of solving problems from financial to
patient care and safety. For most of them it's just
a paycheck and it gets old to hear the one sided
views continually.

Closing this topic ends an unproductive
chapter and only affirms what I have been saying
all along. That the medical community is for the
most part unwilling to advocate for their patients,
particularly male patients. I'm suggesting the
industry is a failure for the most part only because
it is a feminine dominated industry.

The medical industry is a financial failure
as well as failing to provide a service commitment
to patients. The medical boards, nursing boards as
well are failures. So is this blog, so please end it.


At Sunday, October 20, 2013 6:42:00 AM, Anonymous Anonymous said...

Dr. Bernstein,
I urge you to continue the Patient Modesty Thread section of your blog. Reading this thread over the past few years has greatly increased my confidence and assertiveness in refusing to accept any violation of my modesty in medical settings.
In addition, this Thread has encouraged me to talk openly with other men about medical modesty and I'm certain I have been able to help some of them be more assertive as well. One of only several examples involves a friend whose doctor simply "informed' him that there would be two students studying to be PA's observing his physical exam. My friend told me that without our conversations he would have believed that he had no choice in the matter despite the embarrassment it would cause him. Instead, he politely informed the physician that he did would not agree to the presence of the students and they were told to leave.
So, even though the Thread may sometimes get off track, I believe it has value for many of us who read the posts and ultimately for those who have not yet discovered it.

At Sunday, October 20, 2013 8:20:00 AM, Anonymous Anonymous said...

The entity that might really benefit from this blog are the people who work in healthcare.

They should understand the law, understand patient rights, be more empathetic and turn in those who abuse patients and/or the system.

Those people only give fuel to those of us who have seen first hand the absurdities of what's expected, to the abuse of some.

I'm not sure there's much more for us to learn as much as a place to share ideas, express feelings and someplace to go. Maurice, only you can decide if you feel the blog is working.

Shutting in down, however, might have more consequence than leaving it on into perpetuity.

If you do decide to shut it down, I'm sure someone will start a new one. So...the discussion will never stop and I ask you this....

Have you ever shared some of the issues that have come up on this blog through your teachings in medical school, involvement with an ethics board or just a discussion with colleagues over lunch? you know if any of your colleagues have bothered to read some important lessons on this blog to take back with them to their hospital/physician work?

At Sunday, October 20, 2013 10:10:00 AM, Blogger Maurice Bernstein, M.D. said...

Belinda, yes I have noted this blog thread and the consensus views presented here to both my colleague instructors and my own student groups both currently and in the past. However, to those I have informed,presenting these views is like "preaching to the church choir". First and second year medical students and their instructors are well aware of the patients concerns regarding the patient's physical modesty necessity, ethics and professionalism of the matter of consent and listening to patients with regard to consent and attention to modesty in examination. Beyond that, as I have noted previously, I myself alone and then later with Doug Capra wrote a total of 2 articles to AMA News with its primary medical professional readership about the modesty issue described on this thread. We emphasized a need for bilateral communication with the patient on this matter. Again, as I already mentioned, I have no idea of what impact the articles made on the professional readership.

I personally don't feel the urge to close this thread but I wish that the comments here move away from personal criticism of others who write here or simply "moaning and groaning" about past experiences but more directed to documentation of facts which can lead to conclusions and with presentation of ideas how to effectively resolve the issues of modesty or gender inequalities in the treatment of patients. And then work together on this thread to develop an advocacy group or groups to put those ideas to work. If that would happen, then this thread would have great merit in accomplishing something in the way of "a good" for perhaps all patients. ..Maurice.

At Sunday, October 20, 2013 10:12:00 AM, Anonymous Medical Patient Modesty said...

I wanted to comment on some very important points that Belinda made on the struggles that both genders face in getting their wishes on Wednesday.

The below paragraph in Belinda’s comments is very important:

While there may be lopsided nursing personnel as far as gender, once you get into an operating room, everyone is presented with both genders in the care team.

It is pretty common for patients’ wishes for same gender team to be disregarded in the operating room. It is much easier to get your wishes for same gender team in a doctor’s office because you are awake. It is very easy for a female patient to get her wishes for an all-female team in an OB/GYN office. There are a lot of all-female practices especially in big cities today. I encourage everyone to read the case of Maggie from Utah who had a hysterectomy. She chose an all female ob/gyn practice because she did not want any males involved in her care. However, her wishes were disregarded in the operating room.

Look at important comments that Maggie made about how the hospital responded:

When I contacted the hospital to find out why, when 90% of all nurses are female, would they put males to assist for gynecological surgery, I was informed that gender does not matter, all nurses are professionals.

I pointed out to both the doctor and the hospital that not one OBGYN in the area has males assist when the patient is wake and that woman should be treated with the same level of respect when unconscious as they are when conscious. Both said that surgery is different--"that's why people are sedated." Hospitals/surgeons don't want patients to know what's happening during surgery--"it's not necessary. Most patients like you would just object, so sedation helps everyone."

Your wishes are more likely to be ignored in the operating room once you are under anesthesia. This is exactly why it is prudent to have a personal advocate such as your spouse or friend not employed by the hospital to be present with you at all times for pre-op, surgery, and post-op to make sure that your wishes are not ignored. This is a problem for both male and female patients.

It is harder for male patients to be guaranteed an all-male team in an urology clinic because many urology clinics do not employ male nurses or CNAs. Male patients need to walk away from those urology clinics and let them know that they will not have any urological procedures done there unless they can be guaranteed that no females would be involved in their care. I’m glad that there are some all-male urology clinics in the US and I hope that more will be established.

I encourage all patients who only want intimate same gender care to walk away from medical facilities that refuse to accommodate their wishes and find another medical facility that is willing to accommodate their wishes.


At Sunday, October 20, 2013 10:29:00 AM, Anonymous Medical Patient Modesty said...


I agree with you about male gynecologists. I am just curious. Are you a part of the How Husbands Feel About Male Gynecologists group? I learned about the article, The article "Time and Tide" from that group.

I learned about another male gynecologist in Baltimore area who secretly took pictures of female genitalia the other day. Many people think that doctors with many years of experience cannot abuse patients. I bet that he has abused patients for many years and he was just recently caught. This case reminds me a lot of Dr. Nikita Levy. I wonder if they were friends since they lived in the Baltimore area.

Belinda: I agree with you that we cannot assume that female healthcare providers always choose female gynecologists. In fact, I know of some female nurses who chose male gynecologists. I personally know of a female medical assistant who is very modest in other settings who chose the male gynecologist she used to work for to be her doctor. I also was very shocked that a Christian woman who is more modest than me chose a male gynecologist. She thinks that modesty is very important in other settings, but that it does not matter in medical settings. This lady only wears long skirts or dresses. This lady probably would consider me immodest because I wear shorts a lot. I often wear shorts that are not knee length.

The truth is there are some good female nurses who care about male patient modesty. In fact, a man who was concerned about his modesty during colonoscopy a few months ago who contacted me asking me what steps he should take to ensure that his wishes for an all-male team were respected spoke to a head female nurse at a clinic who was sensitive to his wishes that he only wanted males and colonoscopy shorts. The head nurse said that they would order colonoscopy shorts for him and that they wanted him to be comfortable. I do agree that there are some female nurses and CNAs who mistreat male patients.


At Sunday, October 20, 2013 10:38:00 AM, Anonymous Anonymous said...

I have never ever seen a male circulating nurse
in the operating room and most scrub techs are
female. It is very easy for a female to get an all
female team, it's virtually all females that work there.
You choose your surgeon and you can choose
the anesthiologist, what is the issue? Not possible
for male patients, in fact I would say virtually

Maurice, what is taking you so long to pull the plug?


At Sunday, October 20, 2013 10:52:00 AM, Anonymous Medical Patient Modesty said...

I agree with MG that this blog about patient modesty should not close. I am glad that MG has talked to his friends about how they can refuse certain people for procedures. One of the board members for Medical Patient Modesty and I often discuss people’s comments on this blog even though we are not happy with some of the discussions here. We both disagree with some things here. I always love helping people to get their wishes for same gender team and modesty. I have learned a lot from this blog and I certainly have used some insights from different people on this blog for articles I’ve written for Medical Patient Modesty’s web site. I always love posting links to articles that one of the board members for MPM who does a lot of research and I find to help people here who are concerned about patient modesty.

I wish that the personal criticism would end and that we can focus on how we can help to change things in the medical settings.

I disagree with PT that there is no hope for the medical profession. There are actually some good doctors and nurses who are willing to advocate for patient modesty. There are certainly some female nurses who understand male patient modesty and they will happily work to find a male nurse to help male patients. Patients must speak up and that’s how we can get our wishes for modesty. The more patients speak up, the better chance we have of changing the medical profession. We will never be able to make all medical professionals sensitive to patient modesty. We must let medical professionals know that we will go somewhere else if they do not accommodate our wishes.

I believe that the reason there are more all-female ob/gyn practices than all-male urology practices is due to the fact that women are much more likely to speak up than men about modesty concerns. Also, many men do not go to the urologist unless they have a problem. Men are also much more likely to wait until later in life than women to have any intimate procedures. Women are usually required to see a gynecologist earlier in life because of childbirth.

Medical Patient Modesty has gotten a lot of modesty violation cases, but we have received some cases from patients who had positive experiences because they found a team of medical professionals willing to accommodate their wishes. It always gives me joy when I hear of patients standing up for their wishes and have positive experiences. I love how Belinda spoke up recently at her doctor’s office and refused to let any males be involved in her care. It was amazing that AL and his wife made efforts to find a female gynecologist in the 1970s to deliver their baby. Female gynecologists were rare in 1970s. You might have to drive farther to find a medical facility to accommodate your wishes, but it is worth it. I also thought it was amazing that Don was able to have a vasectomy with a male doctor without any nurses.


At Sunday, October 20, 2013 11:05:00 AM, Anonymous Anonymous said...

One particular way that emergency rooms mistreat
male patients is by giving them a urinal to void in
there in the room. They figure you are a dog, you can
go anywhere. On the other hand female patients are
walked to a restroom nearby.

Of course everyone walks into your room without
knocking and if your room has curtain dividers, well
you know the deal. Male patients are never given the
option of being shown where the restrooms are.

If this happens to you gladly accept the urinal and
make an attempt to void as much as you can into the
urinal. Then pour the contents of the urinal onto the
frame rails and onto the floor, but insure about 25 ml
of urine remains in the urinal.

25 ml of urine is an adequate volume for any lab
test urinalysis. When the nurse comes into the room
let her know it was difficult voiding into the urinal. Of
course most of those idiots will in some way criticize
you for spilling the urine.

Make the comment " you could have shown me the
restroom.". Housekeeping will be notified to clean the
spill but more importantly, the nurse's job is to clean
the frame rails of the bed.


At Sunday, October 20, 2013 12:08:00 PM, Anonymous Anonymous said...

Misty said "There are actually some good doctors and nurses who are willing to advocate for patient modesty." There are many good MDs and nurses who are willing to advocate patient modesty, but they are not the decision makers. The owners of medical operations respond to their customers, i.e. governments and health insurance companies. We need a campaign for modesty with these organizations.

At Sunday, October 20, 2013 12:29:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, I fully agree with your analysis and advice. Now, Misty, with your website and your own organizational experience what is actually happening in the United States, for example, in terms of serious advocacy pressure on the medical organizations, insurance and government about which BJTNT suggests? ..Maurice.

At Sunday, October 20, 2013 1:42:00 PM, Blogger Doug Capra said...

I've said it before and I'll say it again. This battle ultimately needs to be fought on the ground level by patients who refuse to accept undignified, gender-discriminating treatment at the moment it happens. Now, if this thread on this blog, Misty's blog, and Dr. Sherman's my blog can help empower patients to speak up -- than they have a purpose and should remain. Here are some other suggestions:
Is someone willing to find a grant to have previous threads reoganized and indexed by topic and then reposted and possibly made available as an e-book?
We should try harder to get some of these ideas put into articles that can be picked up by mainstream newspapers and magazines. Mysty has done some of this, as I have and Dr. Sherman and Maurice. Are others willing to do this?
How about interviews on radio or television? Certainly there may be resistence and some adverse reactions, but the goal is to get this topic into the public discourse.
Still, as Misty, and I and Maurice and Dr. Sherman and some others have been saying, we need to help patients not be intimidated to speak up. That will be the ultimate key. Demanding dignified treatment at the moment that meets their values about same gender care. And as I said before, it won't take a mass-movement. It will only take small but significant vocal minority.
I have some specific ideas that I've posted in the past. See, that's part of our problem on this thread. Some of us who have been her for a long time keep having to repost the same ideas over and over again. That's why Dr. Sherman and I started a new blog with articles that try to collect ideas under themes and put some into coherent form. Most people finding this thread will not go back and read several years worth of threads. But if they can be brought back to specific threads by topic and then directed to specific dates, they could find what they are looking for.

At Sunday, October 20, 2013 1:49:00 PM, Anonymous Anonymous said...

Doctors and lawyers were male jobs while nurses and flight
attendants were female......That time is over

A male nurse applied for employment in the operating room at a hospital in mexico, Missouri and was denied employment because he was male. The hospital said they preferred to have a female nurse in the operating room where female patients were being

No, you do not get a mix of gender when you go
to the OR!


At Sunday, October 20, 2013 3:07:00 PM, Anonymous Anonymous said...

PT -

The article you linked too includes:

"The hospital’s failure to attract and hire women into the higher paying surgeon and anesthesia positions does not justify its insistence that it have female nursing staff in the OR."

They aren't providing female-only care for female patients. They are providing all male care with only one female present for all patients.


At Sunday, October 20, 2013 5:26:00 PM, Anonymous Anonymous said...


That is your assumption and was not the core
complaint. A female supervisor stated " she would
not consider a male for a nursing position." Upon
further investigation it appears this is not the first
time the eeoc has taken a position against this


At Monday, October 21, 2013 10:09:00 AM, Anonymous Anonymous said...

Regarding my comment on Friday, Oct. 18, 11:56 AM - I had hoped for some response from the veterans of this thread about reconciling the "in-house" admission of the American and British medical establishment about the potential erotic nature of a pelvic exams, in contrast to their public denial. It seems at the very least, the establishment is guilty of deceit.

The doctor is a seller and the patient is a buyer in this marketplace, and for the market to work properly, the buyer must have full disclosure. To properly inform the female patient, in my fondest dreams, I see a notice posted in each medical office - "WARNING - When performing a pelvic exam the male doctor may experience sexualized feelings. Be assured there is nothing unusual about this emotion and no illegal or improper action will be engaged in."

Perhaps a copy of the article "Time and Tide" could be available for each female patient to peruse before entering the exam room.

Misty- Yes, I am a member of How Husbands Feel and no I did not get the article "Time and Tide" from that site. I found "Time and Tide" right after it was published and came up on the internet. For any of you who have not read it, it is a most damning statement. Since we can't arbitrarily close all male gynecology offices, at least let's give women fair warning.


At Monday, October 21, 2013 5:30:00 PM, Anonymous Anonymous said...


I am certainly with you on this subject and
for decades the husband was never considered in
the equation. From time to time I will read this topic
on topix and other forums and the damning
comments will often come from single women who
suggest the husband get therapy.

Are there equitable scenarios whereby the
wife or girlfriend felt uncomfortable when their
husband or whomever was subjects to opposite
gender care. Most men know the role of the
gynecologist or urologist when women are patients.

The question is do women know the role
of female nurses, female Urologists or any other
patient scenario when their husbands, significant
other are patients?


At Tuesday, October 22, 2013 6:12:00 AM, Anonymous Anonymous said...

Yes PT, there are wives/girlfriends who know what happens to their men in ORs, urologists offices, and hospitals in general and detest it! If you can't tell, I'm one of them. I think it's just as vile having my husband viewed and cared for intimitaley by female medical personnel as many men detest having their wives in the same situation. And you're correct, women have a much easier time of requesting(often demanding)same gender care and actually getting it versus men who are significantly outnumbered by female health care providers and made to feel they are being ridiculous or childish when they and their spouses request same gender care for them. It's truly a shame (but also a reality) that some people (perhaps many?) will not address physical needs due to the knowledge that their modesty needs will not be accomodated. And I emphasize NEEDS as most times these are not frivolous requests! No one should have to sacrifice physical well being for their mental well being. It shouldn't be such a struggle to accomodate both!

At Tuesday, October 22, 2013 2:24:00 PM, Anonymous Anonymous said...

To solve the problems, both Dr. Bernstein and Doug Capra proposed different solutions recently. Dr. Bernstein believes in placing "advocacy pressure on the medical organizations, insurance and government" while Doug Capra proposes a grass roots effort "by patients who refuse to accept undignified, gender-discriminating treatment." Why not try both?

Each of us patients can and should question who will participate in certain procedures on our bodies. We can also complain at the physicians' offices about the lack of two genders for assistants. I have seen some posts in this blog that some physicians use a lame excuse that they cannot find male nurses or assistants. It may be harder to find them but not impossible. One female physician who I currently see has a male assistant. I have seen other male medical assistants in my travels.

At the same time, each of us should contact our insurance companies (my understanding is that beginning in 2014, everyone must have one or pay a fine) and request that their websites include information about the gender makeup of certain medical offices. If it is not on the insurance company's website, try their "call a nurse hotline" and ask. Eventually, they will likely tire and provide this information if enough people call.

Misty, I believe that you stated in a previous post that you created a list of all female OB-Gyn offices in the U.S.A. That should have been quite easy since all of them are 100% female with the exception of a few male physicians. I doubt there is a single OB-Gyn office in the U.S.A. that employs male assistants or even office staff. If your concern is the physician's gender, most insurance companies already make it rather easy to see the gender makeup of physicians in each office. Some websites include the physician's gender in the search and/or results. For the websites that do not have this, usually the name of the physician will suffice. If the physician's name is insufficient to determine the gender, one may look at the medical licensing board for that state and determine the gender. It is much harder to find, say, a urology office with male assistants. One could count them on the hands of a careless sawmill worker. A listing of these few offices would be extremely valuable. I might even contribute something to such undertaking.

A third thing that we males can all do is write our political representatives to encourage extending affirmative action to require medical clinics to recruit more males. Many non-medical companies have had to pay more for and sometimes accept less qualified females for decades now. Some companies have had to offer scholarships specifically for females and minorities. Of course applying this to medical offices could end up causing more modesty concerns for female patients in the long term. We must be careful to prevent that. Gerald

At Tuesday, October 22, 2013 4:55:00 PM, Anonymous Medical Patient Modesty said...

The lady (anonymous on October 22, 2013 at 6:12 AM) shares the same views as me. I know some of you may find this hard to believe, but many years ago when I was a teenager, I thought about how I never wanted any female medical professionals to examine or see my future husband’s private parts and how I wanted to be the only woman in the world to have intimate access to his private parts.

Some wives of the husbands in the How Husbands Feel About Male Gynecologists Group are very against their husbands having intimate procedures done by female nurses or doctors. In fact, we have one female nurse who is a member of the group who has concerns about how there are not enough male nurses for male patients. This female nurse definitely does not want her husband to have any intimate procedures done by female medical professionals at all.

I still remember a conversation I had with a teacher assistant at my high school when I was around 15 or 16 years old. She talked to me about how men did not have to really worry about their modesty (because they did not usually go to doctor for intimate examinations) and that women had to go to a gynecologist regularly. She was wrong of course. I believe about a year later, her husband had a massive heart attack and had to have heart bypass surgery. I think she probably gained different insights when her husband was hospitalized. She shared with me that she was there with him pretty much of the time and that she was the one who gave him bath.

I feel that gynecological procedures are as intimate as urological procedures on men. I find it so strange that many urology clinics do not employ any or enough male nurses or CNAs for male patients.


At Tuesday, October 22, 2013 5:32:00 PM, Anonymous Medical Patient Modesty said...


You have some excellent ideas. I am glad that the blogs and Medical Patient Modesty have helped to empower patients to speak up. There are not that many resources about patient modesty so I’m glad that people have found the blogs and MPM’s web site.

I agree with you that we should have more articles in newspapers and magazines. Dr. Sherman mentioned to me once that CNN contacted him about the sports physical article. But for some reason, they dropped it without explanation. I wish that CNN had moved forward with interviewing Dr. Sherman. Parents and teenagers need to know the truth that genital / hernia exams do not ensure the safety of playing sports. Dr. Sherman is certainly a reliable source because he has many years of experience as a cardiologist.

A lady who worked for us part-time did a couple of radio talk interviews for radio talk shows in Florida. I hope we can do more in the future. A lady called in to one of the radio talk interviews and shared that she really appreciated our work and that her dad died because he refused medical care due to modesty concerns.

I agree with you that a few people could make a difference. Medical facilities and medical professionals need to hear from patients. Too many patients feel intimidated and we need to change that.

For patients who have good experiences getting their wishes for same gender intimate care, I strongly recommend that all of them write thank you letters to medical facilities and medical professionals for respecting their wishes so they will continue to work to accommodate patients.

I appreciate the way Dr. Sherman and you have organized different topics on the blog for Patient Privacy and Modesty Concerns. I agree with you that it is hard for people to find all of the links that we have shared on Dr. Bernstein’s blog for many years.

As for grants, they are very hard to get. Medical Patient Modesty has only gotten some very small grants. We have applied for some very large grants. Not many foundations are interested in funding organizations that deal with patient advocacy and education efforts. We applied to two great healthcare foundations, but they got so many applications that they could only fund some non-profit organizations. I looked in applying for grants at a couple of foundations that dealt with consumer / patient advocacy and education, but they both are not giving out grants right now.

I’ve been pretty busy trying to get ready for a fundraiser event in November. I hope to write more articles after the event. I really want to write an article about unnecessary underwear removal for many surgeries that do not involve the genitals such as hand, knee, etc. We can always use volunteers to do research for us.


At Tuesday, October 22, 2013 6:32:00 PM, Anonymous Anonymous said...

Trisha Torrey does a blog on medical advocating. She was called to the carpet for her addressing men's modesty and medical care in the usual suck it up mantra. She recently did an article about the surveys that obamacare require and are tied to compensation. She noted that the facilites with the highest approval score and the highest scores for results were not the same. Her point was why does it have to be an either or proposition. Why does compassionate care and good medical care have to be exclusive instead of the inclusive. Why cannot good care be kind care. This is very similar to the argument we have made in why is it a choice between modesty and good care? Why should they not be AND? And yet the medical community frequently acts if you have to chose one or the other. I just found it interesting that a provider would see clearly that compassionate care and good care should be hand in hand but have to be hauled to the carpet to see that respect for modesty and good care should be treated the same....or perhaps she sees this BECAUSE she was hauled to the carpet. Which brings us back to the current conversation, communicate and expect, that is the seed to change. It starts at this level not at the top, perhaps that is one of many things that shows the value of this thread...don

At Tuesday, October 22, 2013 8:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Of course, I have always felt that the solution to the problem of modesty and gender selection is a two pronged approach: encouraging the patient to "speak up" to their healthcare provider (something which may have been missing in my medical career experience: either no patient ever "spoke up" to me or I was doing everything they desired with regard to modesty, since as I have written many times, I was never made aware of issues of modesty that have been brought up on this thread.)

The other is with multiple voices in an advocacy group speaking directly to the power elements of the medical system. As some of you know, within the past year, I tried to get a petition going on a web petition site ( but got only 42 "signatures" between September last year and the end of December. It was good some came from visitor here but I wanted hundreds, thousands like some of the other issues on that site were receiving. But, again, I think the approach should be two pronged.

My evaluation of this thread is: yes, it does provide a "comfortable place" for the "moaning and groaning" over personal modesty issues and a place for spreading the word to "speak up" which seems to have caught on according to the recent postings. But that's about it. To change the medical system, something more is needed beyond this thread and that of Doug and Dr. Sherman's or Misty and her website. Am I not correct in this evaluation? ..Maurice.

At Wednesday, October 23, 2013 1:14:00 PM, Anonymous Anonymous said...

I do hope that this blog is continued. I find it interesting that even some people who say "shut it down" are still posting comments. Obviously, it serves a useful purpose.

Dr. Bernstein is absolutely correct in that a full solution is outside of this blog. However if you read this blog, you will find that some people have been helped. Gerald

At Wednesday, October 23, 2013 2:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Ok, let me tell you all what I did. I belong to an international medical school teacher's listserv and I wrote the following:

What are the "official rules and regulations" regarding the necessity for explicit informed consent of patients for participation of medical students in the examination and participating in procedures on the patient's body? Explicit meaning that a specific named medical student and the specific participation will be identified as part of the patient's informed consent for the procedure. What is the current status in the United States, for example, of one or more medical students performing pelvic exams for learning purposes on an anesthetized woman who would be undergoing a surgical procedure but without the patient's prior approval? Has this been "officially" outlawed and now is purely a "misbehavior" of the past. How much do medical educators depend on the assumption that patients who enter a publicly known "teaching hospital" are thus fully informed by those words and thus are entering with full informed consent with regard to any of the teaching activities which they may encounter? Or are the words "teaching hospital" inadequate information for full consent? Any comments about this? ..Maurice.

In response, one subscriber returned with the link to the policy statement of the American College of Obstetrics and Gynecology. I want you all to click on this link, go to the website and read the entire (brief) document and return. However, here is a section that I wanted to reproduce here for discussion.

Although patients are given the opportunity to consent to or refuse treatment by learners, the obligations of the profession, the institution, and patients should be uniform and explicit. Professional obligations include disclosure of the risks and benefits inherent in the teaching setting and provision of adequate supervision at all levels of training. The patient should be encouraged to participate in the teaching process to contribute her fair share to the development of a new generation of health care providers. A situation may arise in which a patient refuses, for whatever reason, to have a learner involved in her health care. For example, a patient may express concerns about receiving care from an inexperienced learner or a learner of a particular gender or even cultural background. Such refusals should initiate discussion and counseling and should be handled with compassion and respect. Respect for patient autonomy requires that patients be allowed to choose not to be cared for or treated by learners when this is feasible

Of course, I, too, scratched my head when I read the last four words.

But at least one medical organizaton, ACOG in 2011 was at least acknowledging a need for attention to the patient not just as an object for teaching but as a person for whom all teachers and students should be doing the right thing. ..Maurice.

At Wednesday, October 23, 2013 5:30:00 PM, Anonymous Anonymous said...

I need to reread and think about it but my first impression is while there is on the surface recognition of patient autonomy, right to choose, and the power embalance it ignores the reality. As I relayed before my brother was referred to the best cancer surgeon in the area by his PCP whom was at a teaching hospital. The consent form required a signature with no alteration for admitance. Included on the form was consent to allow students to partcipate in his care. So while the message acknowledges the issues, the reality does not match the message. Further when they address a patient refusing a student based on things including gender...the response is to counsel the patient as if something is wrong with them and they need help....there seems to be more concern about the power differential between provider and learner than provider/learner and patient. there were some positives in that at least there was recognition but from a patients side....that is my perspective....don

At Wednesday, October 23, 2013 7:01:00 PM, Anonymous Medcial Patient Modesty said...

Don made excellent points. It bothers me that ACOG encourages counseling for patients who do not want opposite sex intimate care or medical students to participate in their care. It feels like they hope that counseling will force patients to change their minds. Patients have the right to decide who all can be present and medical professionals need to respect their wishes regardless of reasons.

Gerald: Some all-female ob/gyn practices actually have males working in the front offices. In fact, I know of some all-female ob/gyn practices that have male practice / business managers, but they have nothing to do with the clinical part. They primarily focus on finances and administration. Some female gynecologists’ husbands are practice administrators. I do not feel this is a big deal as long as they stay in office and never have anything to do with the examinations and procedures.

One of my friends’ former female gynecologist had a male ultrasound technician. I was shocked to learn that he does transvaginal ultrasounds. They should have placed him in a clinic for male patients instead.

The all-male urology clinic in San Antonio has all-male clinic staff. But they do have one female who works in the office. She does not participate in any procedures though.


At Wednesday, October 23, 2013 7:10:00 PM, Anonymous Anonymous said...

Frankly, I've paid my dues with the healthcare system. It is unacceptable to me to have any extraneous beings in my presence that cause me emotional discomfort.

Today I had a test at the hospital.
They handed me a consent form that if things didn't go as planned that I might have to undergo certain procedures.

After doctoring the forms myself, the technician disappeared and said she had to speak to the doctor. I was waiting for them to tell me that they weren't going forward because I was refusing treatment if there were certain complications.

I suppose that after explaining my feelings, the fact that there was a low risk of anything going wrong they proceeded on my terms.

The medical system needs to recognize that every time they treat someone improperly, force patients to lose their dignity,that eventually things are going to backfire. They already do because more and more patients are speaking up AFTER having a serious problem.

Maurice, perhaps you can answer this question. This gender issue affects more people than not. Why won't the healthcare system recognize that patients are unwilling to compromise their dignity to get healthcare? I sit, very ill and yet my conviction of doing things my way is greater than myself, than any illness that may come my way, that this cause is important enough to play "hard ball". I'm winning one battle at a time.

Next week I'm off to speak to a surgeon. Perhaps I won't be so lucky this time. How can one sacrifice everything they believe in, forced to comply with a system that doesn't share my belief system?
People have died for far less.

I am just one and yet when I vocalize my concerns and objections to the healthcare system, I feel like everyone who feels that this is a paramount issue is standing there with me.

Every time is an opportunity to educate someone who will listen. Who knows, perhaps one day I'll meet someone who will choose to move things forward.

At Wednesday, October 23, 2013 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, as it was with me until reading these many Volumes, I thought the main goal of the patient coming for my care was to relieve symptoms and cure the condition. And I am sorry to say to this audience, that I feel confident in stating that virtually all physicians will have the same concept as the basis for the visit. After all, we look at ourselves as attempting to provide the patient's good health and freedom from the discomfort of disease. And we can't even imagine that there is something in the patient's mind at the time that trumps the patient's health and well-being. Now, I know better but the other doctors.. well, they will have to learn something different from their patients.. if the patient's will only "speak up".

Misty has concern about that word "counseling" in the ACOG document. However,that counseling is actually a two-way process: to counsel is "advice or guidance, especially as solicited from a knowledgeable person" (American Heritage Dictionary). Well, both the doctor and the patient are "knowledgeable persons". You might then ask "what does the patient know what the doctor doesn't?" and, of course, the answer is "him/herself".

Belinda, I am sure we all send best wishes for a healthy but also emotionally comforting outcome. ..Maurice.

At Wednesday, October 23, 2013 11:19:00 PM, Blogger Doug Capra said...

There is a problem with the word "counseling." The word is most often used to describe a person who doesn't have a dog in the fight, someone who is outside the person being counseled, someone who has no personal interest in the dicision to be made. The staff of a teaching hospital with the policy statement like the one above, cannot be considered objective counselers. At best what they're doing is trying to convince the patient to do things their way. At worst they're intimidating the patient, perhaps even bullying. That's not counseling. As as has been stated above, the reason for the counseling is because, in their view, there is something wrong with the patient. If it's done as pure education, i.e. making sure the patient understands the whole picture to help them reconsider their position, that's one thing. But because the counselors are staff who have a personal interest in the patient's decision, there is considerable danger that the counseling can turn into a blatent attempt to make the patient uncomfortable enough to change his/her mind or just give up. The policy shows they are aware of this power difference between patients and staff.
The "when this is feasable" portion of the policy is also tricky. I can see a life and death emergency situaiton, say, in the ER. Some students are assisting, a severe case comes in, the students are needed to help with the procedure to save the patient's life. Otherwise, who decides the definition of "feasible?"
The policy is moving in the right direction. And as I've said in the past -- patients are not stupid. Most undertand the necessity of hands on training for medical students, and most patients will agree to have them around in most situatins. But even the most understanding patient may not want students of any sort in certain situations. And that is their right. And that doesn't mean there's something wrong with the patient. And I'd like to know how the patients choice not to have medical students oculd be "unfeasible" in other than life and death situations.

At Thursday, October 24, 2013 7:38:00 AM, Anonymous Anonymous said...

"The patient should be encouraged to participate in the teaching process to contribute her fair share to the development of a new generation of health care providers."

What other industry expects consumers to commit personal resources for free to train a new generation of anything?

Just another example of paternalistic medicine that's long overdue change!

If you want me to assist in your training, you will compensate me for the use of my body. In the absence of that, the answer is an unequivocal no!

Only when patients say no and stand their ground will paternalistic medicine die.


At Thursday, October 24, 2013 10:25:00 AM, Anonymous Anonymous said...

Thank you Maurice.

It's time that doctors recognize that patients are more than the sum of their parts and that mental health is really the most important part of that person. It boggles my mind that this isn't taught in medical school.

It is well known that a person with a healthy attitude and a healthy mind will heal faster.

Doesn't it make sense that treating people without dignity and respect would have a negative impact on mental health?

So, why is this issue so resistive for the medical community? They know better and yet, choose to damage patients, inflict emotional damage, ptsd for some, and yet they continue those psycho social aspects of care that are so detrimental to mental health.

At Thursday, October 24, 2013 11:23:00 AM, Anonymous Anonymous said...

I had thoughts similar to Ed on that section, who has made this decision that I owe this, and exactly who decides what is my fair share. I agree at times I think the medical community is a little full of themselves. We are not there for the student, we are there for ourselves and we pay dearly for that. I think there are many people, myself included who would be willing to let students partcipate if asked. Some would be ok with intimate exams some would not. I have had people shadow my dermotologist several times and my PCP once. Both however got my consent and in the case of my PCP I told them when it came to a specific part of my exam they would have to step out. That I think is the problem the medical communities thought that we owe this rather than seeing it as a favor from us. That we should rather than asking if they can......don

At Thursday, October 24, 2013 6:51:00 PM, Anonymous Anonymous said...

When I read these posts, I continue to be bothered by institutions not allowing any alteration to the portions of consent forms that require a patient to allow students and learners to participate in their care, only for the benefit of the learner. Obviously, a teaching institution that relies heavily on residents for the provision of care cannot realistically agree to having no residents participate in the care at all, especially in the case of emergency. But when those people who are participating are students and whose participation is ONLY for the benefit of the student and the participation confers no medical benefit to the patient, it is absolutely the patient's right to say those people may not participate. In order for consent to be valid, it must be VOLUNTARY. When consent is coerced, such as being told we won't do your life or health saving surgery unless you allow medical students to observe and participate, solely for their benefit, the consent is essentially invalid. When I read these posts I am even more firm in my belief that I will never voluntarily set foot in a teaching institution, no matter what that cost to me. Having to communicate my wishes, stand my ground, advocate for myself over and over to multiple people who see it as a nuisance, suffer the possibility of retribution by medical staff for being non-compliant with their policies and in the end be told that I have to sign it or go without is simply not worth it. As long as institutions have these policies, patients will suffer. I had a GYN procedure at a large teaching hospital many years ago. I had an almost entirely male OR staff, despite having stated emphatically I wanted females, the surgery was performed by a male resident, despite having a female private attending physician and, much to my horror, I later learned I underwent a pelvic exam by students while under anesthesia. My wishes were made clear and unequivocal. They were ignored. As a result, I will never undergo general anesthesia again and I will never to go a teaching hospital again. Period. I have learned my lesson that medical personnel cannot be trusted to respect my wishes and act in my best interest. I will never so naïve and trusting again.
Anonymous Patient Refusing Care

At Thursday, October 24, 2013 7:52:00 PM, Blogger Maurice Bernstein, M.D. said...

APRC from 6:51 pm today, I "hear" you and I also "hear" all the others over the years writing to this thread who have proclaimed the same decisions as you have. But what I just can't understand is how you and the others can explain a decision which literally, under a number of different circumstance, could mean the difference between staying alive or dying (one or the other) just to maintain the personal decisions regarding physical modesty and healthcare provider gender selection. Are those who want to make this decision consider themselves, if they die, martyrs? But is the cause, even if only a personal and individual cause, really worth the consequences? Just as I, who can understand modesty and gender selection as an important issue in medical care, I and I am sure most physicians would never understand how preserving this issue is worth not preserving one's own life.

APRC or some other visitor here, please explain to me the rationale to such a personal decision. ..Maurice.

At Thursday, October 24, 2013 8:02:00 PM, Anonymous Anonymous said...


I wouldn't go as far as saying this thread
helps anyone, rather prepares patients on how to
manage their next experience. This thread in my
view is a teaching tool as well as a medium to
spread blame and there is a lot of blame to go
around. Obviously there are many who can't
handle the truth.


At Thursday, October 24, 2013 8:38:00 PM, Anonymous Anonymous said...


Thank you for your response and for "hearing" me. I can only speak for myself and say that decision to refuse care in the future is not about the issue of modesty itself or martyrdom or even an overzealous commitment to the cause of modesty. My position is not, "Give me modesty or give me death!!!" Frankly, the courage of my conviction is not that strong. It is the paralyzing fear, lack of autonomy, having our wishes and desires belittled, scoffed at and bulldozed right over. It is the knowing, based on experience, we will not be heard or listened to, not wanting to suffer the same shame, humiliation and trauma AFTER THE FACT. It is the fact that those experiences bleed over into other parts of our lives and leave us damaged. It has little to do with anything that transpires in that moment, as awful as it may be. The way I feel now, all these years later, is much much worse than how I felt in that moment. It is the reliving it at every medical encounter, the hyper sensitivity to medical personnel and the sick feeling that washes over me every time I am reminded of what happened. If I have to choose between carrying the pain, degradation and shame of any more moments like that and simply going without care, I choose the latter. In a cost/benefit analysis, the cost of going without care, no matter how grave, is still less than the psychological toll of being violated in such a significant way. We are simply choosing the lesser of two evils. We do not want to bear the psychological burden that comes with being disregarded and humiliated in a medical setting any more than we already do.
The question posed in your post brings out what I think is the most important point in the modesty issue. It is the lack of understanding of the ripple effect providers have. A traumatic experience today as a patient will color that person's perception of all future providers. No matter how hard I try, I now regard all providers with suspicion. It is not fair to them or me. They have had to pick up the tab for the bad acts of others in the past. It makes their already hard job, much much more difficult. It also takes up extra time and energy they should be devoting to MEDICAL CARE and not trying to maneuver around my own baggage. It is also not fair to their other patients because they arrive at those encounters more emotionally fatigued and exhausted after dealing with me. Those few bad acts, all those years ago have affected me, my spouse, my current health, every provider who has seen me from that day to this and possibly other patients who have been on the receiving end of a less patient and more frazzled provider.
Thank you again for this post and for being so devoted to hearing patients.

Anonymous Patient Refusing Care

At Friday, October 25, 2013 7:00:00 AM, Anonymous Anonymous said...


Unless one has been in a situation that was so horrendous that they wished death to escape, and has to revisit the cruel, degrading, unnecessary treatment over and over again, and like anonymous had those sick feelings (that I was able to work through and no longer have being totally empowered by the word NO).

Once someone has been there, it's easy to understand why that person wouldn't under any circumstances want to revisit that situation.

I know you will think this is harsh, but my experience would be considered torture in another setting. How would a survivor about going into the same situation again and again with the threat of cruel and degrading care, with the threat of losing your autonomy, your dignity all against your will?

Maurice, I would encourage you to speak to a psychologist about the extensive damage that is or is similar to the extensive damage from gang rape. It's not about the penetration.

And...if you're in there for a procedure and there is little worry about dying,then the trauma doesn't focus on dying, it focuses on humiliation and that's where it stops.

Here's a simple example. Two people are trapped in a burning building. One has a child with her, the other does not. They both escape but the person without the child suffers no psychological trauma because her brain was focused on getting the child out of the building. The other was focused on being in the burning building.

What further complicates this is that we think we're in a trusted place, with trusting people. Once abused, because we need healthcare, where is the trust and like anonymous, I would refuse treatment if not on my terms.

Interestingly, the tools I bring with me when I go to a hospital, ties their hands, but gives me the strength to keep pushing the system.
It keeps working for me.

My book has all these tools to help manage and work through the system in a way where they really can't refuse if you state your need in the proper way, let them know you understand the law. If your procedure is important enough, and you are prepared with the proper documentation of what you need, unless it's an outright emergency they will bend heaven and earth to help you.

If anonymous would like to talk to me without benefit of financial profit to me, Maurice, please give her my e mail.

At Friday, October 25, 2013 7:58:00 AM, Anonymous Anonymous said...

All I can say to APRC is AMEN and I'm in the same boat with you!!

At Friday, October 25, 2013 8:35:00 AM, Blogger Maurice Bernstein, M.D. said...

APRC and Anonymous 7:58am in the "same boat"? I only hope if your boat is sinking that you don't deny the help by another ship to rescue you both simply because you both are embarrassed to disclose your personal skills as sailors or you don't like the color or national origin of the rescue ship.

Pardon this analogy which is grossly unappreciative of the seriousness of your concerns but I had to throw in my own rather graphic characterization of such a decision. ..Maurice.

At Friday, October 25, 2013 8:42:00 AM, Blogger Maurice Bernstein, M.D. said...

And continuing with the above analogy with Belinda:
... warning the rescue ship "We will only accept rescue by following our specific orders otherwise we will just wait for another ship to come along who will follow them!" ..Maurice.

At Friday, October 25, 2013 10:36:00 AM, Blogger Doug Capra said...

APRC writes: "When I read these posts, I continue to be bothered by institutions not allowing any alteration to the portions of consent forms that require a patient to allow students and learners to participate in their care, only for the benefit of the learner."
Here's the situation as I see it. Many of these forms (not all) do say in small print that the patient may refuse treatment by medical students. You'll also find this in may patient rights documents. BUT -- most patients don't read that small print and just sign the form, and may be unaware they have a choice. But then comes the PRACTICE. How is this situation handled. In most cases, there is no specific policy telling caregivers how the process should work.
So -- You'll get everything from the good, the bad and the ugly.
The Good -- The provider alone with the patient asks the patient if he or she will allow medical students to participate in his/her treatment and, if the patient agrees, even introduces the students. Full informed consent and dignified. No surprises, no ambushes.
The Bad -- The provider brings the students into the exam room while and suddenly confronts the patient. It's like a child grabbing a donut, taking a bite and then asking the parent "Can I eat this?" Perhaps the patient is gowned or already in the OR -- or already being examined by a doctor when the students march in. Some of this is just obtuse behavior. Some is conscious intimidation, knowing that if you ambush the patient he/she will agree.
The Ugly -- See the Bad scenarios above and add this: The provider says something like: "My medical students will be participating in your care today" or the provider says nothing and just brings the medical students in and goes about his/her business because the provider assumes that by signing the consent form the patient has agreed. In this scenario -- if the patient puts up any kind of resistance, the provider then chastises the patient with something like "Well, this is a teaching hospital...etc." Most of this kind of behavior is conscious intimidation, knowing that an ambush like this will almost always result in forced agreement.
Some of the Bad and Ugly techniques are actually "taught" in the hidden curriculum. Rarely do they say "Do it this way," but by observing this kind of behavior, medical students learn that this is the way to do it to get what you want.
What I'm saying is this. Many hospitals give patients choice in the consent forms -- BUT, there is literally no oversight as to how individual providers carry this out. Mission statements and policies are useless unless they are consciously integrated into the ground floor, individual, daily practices. In my opinion, they are most often not integrated enough.

At Friday, October 25, 2013 11:21:00 AM, Anonymous Anonymous said...


It seems to me the medical profession is just now starting to see that keeping someone alive, but with poor quality of life, isn't in the best interest of the patient. Quality of life includes mental health. We know a LOT about trauma and the brain now, and that knowledge needs to become a part of every doctor's education so the trauma can be prevented, identified when it happens, accommodated as necessary, and treated.

I completely understand APRC and I know how, if I were a doctor and she my patient, we could negotiate getting her necessary care without traumatizing her further. But that knowledge isn't routinely taught.

I want to be able to judge my own risk and make my own decisions about my health care. Some people prefer to have a doctor make the best decisions for them. For my mental health, I need to be in as much control as possible, and right now the system is set up to take control away from patients.

You want surgery? Sign this form giving the doctor permission to do whatever they feel is best - and hope that they only do what was discussed. That's a risk I'm not willing to take. I have no way of sorting the good doctors from the bad. Having a doctor performing a procedure on me against my will would make me suicidal. I know that. So the risk is death either way. That's how I evaluate the risk.


At Friday, October 25, 2013 11:22:00 AM, Blogger Maurice Bernstein, M.D. said...

I wrote the following to the medical school teacher's listserv. ..Maurice.

I am confused and concerned about a few of points in this section of the ACOG policy:

Although patients are given the opportunity to consent to or refuse treatment by learners, the obligations of the profession, the institution, and patients should be uniform and explicit. Professional obligations include disclosure of the risks and benefits inherent in the teaching setting and provision of adequate supervision at all levels of training. The patient should be encouraged to participate in the teaching process to contribute her fair share to the development of a new generation of health care providers. A situation may arise in which a patient refuses, for whatever reason, to have a learner involved in her health care. For example, a patient may express concerns about receiving care from an inexperienced learner or a learner of a particular gender or even cultural background. Such refusals should initiate discussion and counseling and should be handled with compassion and respect. Respect for patient autonomy requires that patients be allowed to choose not to be cared for or treated by learners when this is feasible

"The patient should be encouraged to participate in the teaching process to contribute her fair share to the development of a new generation of health care providers". What does "fair share" literally mean and why particularly when the woman is, at the time, in the status of a patient requiring surgery for which she has the responsibility to pay both the surgeons and the teaching hospital the monetary costs. Wouldn't it be more ethical not to require further contribution at this stage of her personal medical concerns?

Then after full disclosure of "risks and benefits inherent in the teaching setting and provision of adequate supervision at all levels of training" and then the then the informed patient refuses why does she then have to be "counseled" and for what?

And finally, "respect for the patient autonomy requires that patients be allowed to choose not to be cared for or treated by learners,when this is feasible"
Hopefully, "feasibility" will be the primary information provided to the patient under the initial "full disclosure" and not left till after patient gives consent for the procedure..

As physician teachers working both with "learners" and patients, to which group must we provide our ultimate professional attention if we are unable to give that attention to both? In my view, it should always be the patient. Any argument to that? ..Maurice.

At Friday, October 25, 2013 11:49:00 AM, Anonymous Anonymous said...

Maurice wrote:
"I only hope if your boat is sinking that you don't deny the help by another ship to rescue you both simply because you both are embarrassed to disclose your personal skills as sailors or you don't like the color or national origin of the rescue ship."

I am not denying rescue from that ship because there is something I don't like about the ship. The national origin or color of the ship are immaterial to me. I am instead choosing to stay on my own sinking boat in order to avoid the treatment I will suffer once I board the rescue ship. I am, again, simply choosing the lesser of two evils. It's what happens on that rescue ship and all of its indignities that I want to avoid. I would really really like to get on that rescue ship, but can't. I know what happens on that rescue ship and I don't want anything to do with it, so instead I will just go down on my own boat b/c that is easier and safer.

At Friday, October 25, 2013 12:01:00 PM, Anonymous Anonymous said...

To further illustrate RJ's point about blanket informed consent authorization:

A Kentucky man who claims his penis was removed without his consent during what was supposed to be a circumcision has sued the doctor who performed the surgery.

Two urologists testified for and against the plaintiff:

"I couldn't identify any emergency situation that dictated an amputation," Dr. David Benson, a 25-year urologist called as a witness for the plaintiffs, said on the second day of the trial in Shelby County Circuit Court. Benson said that when Patterson found a cancerous lesion on Seaton's penis during routine circumcision surgery, he should have taken a biopsy and discussed options with the family before taking further action. He said removing a man's penis is the "most psychologically debilitating" procedure and patients need to be evaluated to see if they can cope.

But Dr. David Paulson, the former head of Duke Medical Center's urology program, testified for the defense that Patterson had followed the proper standard of care in a life-threatening situation. Paulson said it would have been medically risky for Patterson to interrupt the surgery to consult Seaton's wife, citing Phillip Seaton's sleep apnea as a concern.

A cancerous penis is life threatening? The urologist couldn't be bothered to take a day or so to consult with the patient and his wife; BULL!@#&.

Or the recent Bloomberg article titled "Prostate Cancer Radiation Therapy Rises as Doctors Profit."

For years the science behind PSA testing has been questionable at best, the USPSTF finally recommends against, and the last major physician specialty to climb onboard are Urologists. This should surprise no one. Whatever happened to "First, do no harm" as the bedrock of medical ethics? And the medical profession wonders why we no longer trust them.


At Friday, October 25, 2013 1:33:00 PM, Anonymous Anonymous said...

That was a very well worded post. One of the best that I have read on this blog. Very elegant and I agree 100 percent with everything you said. Now for the sinking ship analogy. What if that rescue ship was a ship full of Somali pirates. Armed and looking for prey. Would you be so quick to jump aboard ? Why does a person have to give up their modesty to receive care that they are paying for ? It appears it's ok to lie to people to get them to comply. If any other business treated people this way they would soon be out of business. AL

At Friday, October 25, 2013 3:14:00 PM, Blogger Maurice Bernstein, M.D. said...

AL, continuing on with the sinking ship analogy, I might not expect that APRC and Anonymous would know in advance of getting aboard the "rescue" ship that there were criminals looking for another crime to commit, just as they should not expect the doctors and nurses about to attend to their critical illnesses are bent on causing them physical and mental harm. And Belinda, now also aboard their sinking ship has been on a sinking ship before caused by an attack by armed pirates would call out to the "rescue" ship a series of orders in an attempt to clarify the nature of the rescue and to ease her mind but then, in response, the ship simply glides by. How is this analogy doing? ..Maurice.

At Friday, October 25, 2013 5:13:00 PM, Anonymous Anonymous said...

I think it is very hard for people who work in health care to accept when a patient refuses care, no matter what the reason. After all, you have devoted many years of study, hard work and personal sacrifice to this endeavor, only to be met with obstinance and refusal. I am sure it must boggle the mind of every health care worker out there and cast patients as little more than petulant children.
However, it is the duty of the health care worker to try to see things from the patient's perspective, and not the other way around. YOU are the fiduciary and I am the entrustor. As such, you have the duty to act in my best interest and I have the right to expect you to do so. You have chosen the role of provider, but I have not chosen the role of patient. [perhaps aside from a handful of purely elective medical matters]. I do not believe health care workers are bent on causing me or any other patient harm. Experience has taught me quite the opposite. I am not on their mind at all. The fact that I have any emotions about what is going on never even crosses their mind, or at least it did not that fateful day all those years ago. My emotions are a petty annoyance that represent an unwelcome detour from the task at hand. Lies and anesthesia are just the quickest way around them. Providers do not think about me past the medical issue in front of them. They just plug along and do their job as usual with little thought as to how those actions might affect me and how I differ from the patient before me or after me. Their only concern was for their own agenda and personal convenience. I simply did not matter at all. This is likely why providers make statements such as "I see it every day" or "We're all professionals here" to patients who express modesty concerns. Those providers are seeing things from their perspective. However, it's really not about you. It's about me. I am the patient and my feelings matter more than yours. That's just the way it is. My experience is more important and my emotional presence in the operating room is not some sort of extraneous distraction. It's bigger than you.
In keeping the with the Somali pirate analogy, I would submit that if a Somali pirate ship sailed up alongside my ailing vessel, I would recognize them for what they are and refuse to climb aboard. Unfortunately for me, the ship that sailed up all those years ago had a full crew of white coats aboard which gave me a false sense of security and caused me to place too much trust in them. At least with pirates, you know where you stand.
Dr. Bernstein, thank you again for this blog. Nothing in my comments is directed at anyone on this blog or any person in particular [aside from those who have personally done me harm]. My comments are just the most honest version of what I have to say and meant to foster a robust discussion. Thank you for this blog and your dedication to it over so many years.

At Friday, October 25, 2013 7:12:00 PM, Anonymous Medical Patient Modesty said...


I am so sorry about the terrible experience you had a number of years ago. You are not the only one who had this horrible experience. I am not sure if you read the case of Maggie from Utah who made it clear that she wanted an all-female team for her hysterectomy.

I certainly do not blame you for refusing to go to a teaching hospital. Patients under anesthesia are very vulnerable because many medical professionals feel that once you are under anesthesia that it does not matter who participates in your surgery since you are out and you cannot speak up.

This is exactly why Medical Patient Modesty strongly recommends that every patient demands that a personal advocate (spouse, family member, or friend) not employed by the medical facility be present for all surgeries to ensure that the patient’s wishes are not ignored. I personally encourage patients to leave a medical facility if they are not willing to allow a personal advocate be present for surgeries. Also, all medical professionals should be required to sign a form agreeing to honor your wishes about same gender team. One husband who was present for his wife’s C-Section told a male technician who tried to come in to leave and he complied.

I wanted you to know that I support you. Feel free to contact me through Medical Patient Modesty.

One of Medical Patient Modesty’s goals is to educate people about how to protect themselves in medical settings and to prevent bad experiences like yours. Many patients do not know the truth about what can happen to them once they are under anesthesia. We are taught to always trust medical professionals. Many patients have been stripped naked unnecessarily for surgeries such as hand, knee, etc. There is no reason for patients to have their underwear removed for many surgeries that do not involve genitals. All hospitals that have policies requiring patients to remove their underwear for any surgeries need to end this ridiculous policy.

I hope to reach out to many people to stand up for their rights to modesty in medical settings before they have bad experiences that will do emotional damage.

You are right. Patients’ feelings are more important than medical professionals’ feelings.


At Friday, October 25, 2013 7:31:00 PM, Blogger Maurice Bernstein, M.D. said...

Just as those of us physicians whose job is to find the etiology (cause) of the patient's disease, I think it has been very valuable to engage into a discussion of the etiology of the significant emotional concerns of patients regarding their relationship and interaction with healthcare providers. Sometimes we do have to also investigate analogous behaviors and situations to find not only the etiology but the pathophysiology (how the cause leads to the final symptoms). To do that, it might be wise to look at other professions and see whether similar conflicts, attitudes, behaviors and reactions occur between those practicing the professions and their clients.

Take as a beginning to this analysis--the law profession. I have had hardly any experience dealing with the law profession either as a physician (fortunately!!) or as a simple client so I look to my visitors here for help on this one. While competence and trust are important and necessary components of the legal profession as they are in medicine, do situations develop in the experience of lay persons with lawyers in which the emotional trauma are similar to that described here in the medical profession relationships? How are these emotional reactions, if present, handled by the client and lawyer or law profession system? Ia that profession handling their issues better? Any comments on this?

With regard to other professions we can also consider the ministry and the Church. Also the teaching profession but let's start with law. ..Maurice.

At Friday, October 25, 2013 7:52:00 PM, Anonymous Anonymous said...

While I understand why someone intentionally avoiding life saving medical care would be hard to understand, I think the more common scenerio is someone delays getting something checked because of medical concerns. I think the number of people who would choose death over exposure if it were that simple would be small. The number who would delay, convince themselves it wasn't serious, and wait until it was to late would be significantly larger. I am in the second group, fortunately for me the issues did end up being non life threatening but could have been.
Now I will ask you one Dr. Bernstein. I find it hard to believe that a profession that claims to put the patient first, who doesn't understand how patients would put themselves at risk for modesty, can justify REQUIRING patients sign an agreement to let medical students partcipate in their care as a condiction for care. How is that more acceptable than the patients actions? Is denying a patient care unless they partcipate in the education of students any more understandable? This shouldn't be who is worse discussion, but perhaps it may shed a little light on the lack of understanding present at both sides. And before it is tossed out there, giving the impression of denying care is just as wrong as actually doing it.
As to the ship scenerio, if you were on a sinking ship 2-3 times and each time pirates picked you up, and you talked so several friends and they had been picked up by pirates when their ship would be very leery when your ship started sinking of the approaching ship. The odds of a pirate picking you up pretty small, the odds of your modesty being compromised in a medical setting much much higher....don

At Friday, October 25, 2013 8:37:00 PM, Anonymous Anonymous said...

I think I have just been outed as a lawyer. Is it that obvious? Old habits die hard.

With respect to hot button ethical issues in the course of the representation of a client, lawyers have it pounded into their [errr our] heads since the first day of law school. This is facilitated through the use of a unique form of torture known as the socratic method. This consists of a professor posing an original question with varying hypotheticals over and over and over until the hypothetical becomes so impossible you simply crack and say something ridiculous. The example of unauthorized pelvic exams under anesthesia comes to mind as one such hypothetical. That is a gimme law school exam question any first year law student could easily maneuver through as violating the scope of the consent. Basic principles such as the elements of valid consent, implied consent, revocation of consent, duties of confidentiality, and other matters are the bedrock of the atty client relationship. The duty of communication, duty of competence and the fact that all core decisions belong to the client are repeated over and over ad nauseum. All core decisions, such as whether to accept or reject settlement, whether or not to testify in a criminal case, whether or not to accept or reject a plea deal in a criminal case are under the absolute complete and total control of the client. Attorneys can counsel, urge and even try to withdraw from the representation when a conflict arises, but the decision made by the client is the final decision. Attorneys also CANNOT act without authority. You represent the client. He does not represent you. It's his divorce, not yours so if he is not interested in requesting a DNA test regarding those kids that are so obviously not his, well you had better start doing the child support calculations. If your criminal defendant won't take the deal, no matter how many times you tell him how good it is, you had better start your pre-trial motions and tell his wife she is going to need a job to support herself after he gets convicted. You cannot accept any deal, offer etc. without the authority of your client. Now whether or not individual attorneys do this in their every day practice is not something I can attest to. I can only say that this is a CRUCIAL element of training and you cannot become an attorney without passing an ethics test on all of these issues. The attorney client relationship can be an ethical minefield and there are model rules of professional conduct promulgated by the ABA as well as state by state rules. Knowing them is one thing, doing them another. Obviously, this level of detail is not something doctors should be tortured with. They practice medicine and are therefore spared this drudgery, but I think a basic run down on the elements of valid consent, the scope of consent and a basic consensus in the medical community about what the patient gets to decide and what the doctor gets to decide does not seem to be out of order.

And also, if one of our clients requests a female attorney, she gets one, no questions asked. Period. I don't even ask why. I just do it. I assume she has her reasons and if she wants to share them with me, I welcome her confidence, but she is the client and I am the lawyer and it is my duty to represent her, not the other way around. If a male client expresses the desire not to have me as his attorney, I simply accept this and take no offense. He is in the best position to determine if I can serve his needs and if he feels I cannot, he is right.

Disclaimer: The contents of my posts do not constitute legal advice and do not necessarily reflect the opinions of any firm or any of its attorneys or clients. They are not intended to be legal advice and should not be interpreted as such. Nothing in the posts should be construed to establish an attorney client relationship and no duties, either express or implied, are established.

I am posting here as a patient, not an attorney. Sorry, as I said, old habits die hard.

At Friday, October 25, 2013 8:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Don, I can't answer your question about ACOG statement "The patient should be encouraged to participate in the teaching process to contribute her fair share to the development of a new generation of health care providers" In my comment to the medical school teacher listserv, I argued against that participation. I really don't know, so far, the true philosophy behind these kind of statements since I am not participating in the third and fourth year teaching program or involved in administrative policies. I do know, as I have already written here, that all of my first and second year students do no history taking or physical exam on patients without identifying themselves to the patient, stating their role (first or second year medical student) and what they need to accomplish with the visit and requests the patient's consent. If the patient say "No"..that's it. Perhaps not even asking for an explanation, though usually the patient gives it spontaneously (too tired, recently interviewed by a student, awaiting being taken for an X-ray or even "awaiting discharge") I have never heard from a student that a gender issue was being offered. ..Maurice.

At Friday, October 25, 2013 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

APRC, of course you write well but I had no idea about your profession. I thank you for writing to us about the official guidelines for practicing law.
I now await the view of the client with regard to their experiences with lawyers in terms of behavior, trust and emotional outcomes associated with those experiences.

Yes, professional ethics is taught to medical students but I fear that it is diluted and contaminated by the "hidden curriculum" presented to them in their later school and resident years by their supervisors and by the sheer amount of work and time at work that they experience. Ethics, I am afraid, is secondary to accomplishing the task of diagnosis, treatment and ending up with a healthy patient. ..Maurice.

p.s.- As for your disclaimer, I have one too on the right side column near the top of the page. As a anonymous lawyer, I wouldn't mind your evaluation of the wording of that disclaimer.

At Saturday, October 26, 2013 5:06:00 AM, Anonymous Anonymous said...


Your example of the rescue ship lacks the degree of personal intervention that would arise in a medical situation. While the sailor may feel humiliated that his lack of skills have been exposed, it doesn't contain the same punch that sexual battery (any sexual act including stripping against a patient's will) does.

There are several reasons why people develop PTSD. It comes from he unexpected and includes natural disasters, accidents and sexual assault. Of these three groups, the sexual assault victims have the lowest rate of recovery.

People develop PTSD after an experience and many times unless faced with the triggers, or lack of knowledge of the symptoms, don't realize they have a problem.

PTSD is a normal reaction or abnormal events. Everyone is different so not everyone will be traumatized by the same event, but if you took ten people and exposed them to their triggers, they would all develop PTSD if they were normal.

One of the most obvious symptoms is avoidance of things that remind you of the trauma. You might not even realize you're avoiding certain things. Once realized, it's up to the patient, most of whom find the situation so overwhelming that they go to drugs or drink to cope.

There is a difference between feeling embarrassed, humiliated and being traumatized.

So..I pose this question. The knowledge of the relationship PTSD and the unexpected being the foundation of what causes the condition, why does the medical community do everything to hide what they can from the patient and not disclose the most important part of procedures/surgeries, that involve our dignity, our autonomy and everything that makes us human?

This I find as the ultimate medical disgrace to humanity. Fix the body and break the mind.

Until every medical school and physician understands the deep emotional aspects of medical care that are detrimental to mental health, one will never understand the words spoken on this blog and it is the medical community that doesn't know what they're doing, and the patients who do, but we find out too late. We find out after the damage is done.

There is something morally and ethically wrong with this and most physicians either don't see it, can't see it, or don't want to see it.

At Saturday, October 26, 2013 5:52:00 AM, Anonymous Anonymous said...

It just occurred to me that it seems that you think and expect patients to give up their dignity for healthcare?

You cannot deny that there is a problem, especially when you acknowledge the gender/neutral position of the medical community shouldn't be.

Am I reading this wrong?

At Saturday, October 26, 2013 12:02:00 PM, Blogger Doug Capra said...

Maurice wrote: "Ethics, I am afraid, is secondary to accomplishing the task of diagnosis, treatment and ending up with a healthy patient..."

I would have to disagree with part of this statement, Maurice. Diagnosis and treatment, yes. But ending up with a "health patient?" Too often, esp. in larger institutions, it's move'm and and move'm out. As long as the protocols are followed, and right tests given to make sure they don't get sued later, all the correct paperwork is filled out -- as long as the processes are followed -- too often the real outcome is an afterthought, i.e. how will all this affect the patient's daily life? Will it be improved? That's one of the good things Medicare has done. It's forced providers to focus on those "never events" and the outcome. Doctors in private practice with reasonable numbers and a personal relationship with their patients, can often better focus on weather the treatment will really make the patient's life better. Doctors in large for-profit institutions run by non-medical administrators are often faced with move'n and and move'n out.
A few weeks back, the New Yorker ran a cartoon that showed a patient sitting in a doctor's office. The doctor was saying: "I'd like you to start thinking less about a cure and more about the kind of treatment you can afford."

At Saturday, October 26, 2013 2:37:00 PM, Anonymous Anonymous said...

Maurice wrote, "Yes, professional ethics is taught to medical students but I fear that it is diluted and contaminated by the "hidden curriculum" presented to them in their later school and resident years by their supervisors and by the sheer amount of work and time at work that they experience. Ethics, I am afraid, is secondary to accomplishing the task of diagnosis, treatment and ending up with a healthy patient."

I certainly understand the difference between the high minded morals of academia and the harsh realities of practice in real life. If you ask any first year law student what they want to be when they grow up, they will all say things like "oh, I want to be a prosecutor so I can help crime victims", or "I want to be a civil rights lawyer and work on constitutional issues". No law student in the history of the legal profession has ever said, "I want to go to work for an insurance defense firm and defend big tobacco and companies who dump toxic waste into ground water while having an inhumane billable hours quota hanging over my head like the sword of damoclese"! Sounds fun!!!

I think Maurice's statement clarifies the general consensus in the medical community that what they are really doing is curing disease and restoring health and while ethics provide a general guideline for that, when it really comes down to it they are doctors and not ivory tower academics, so "let's just fix the patient's problem and restore him to health. If we do that, we have done our job". A doctor is busy trying to treat cancer, which is really the priority so if an unwelcome medical student tags along and views the patient in a state of undress, it's obviously not as important as dealing with his cancer!" In this era of dwindling reimbursements, higher patient loads and managed care, who can blame them? They are really just people after all.

However, ethics are not meant to sit on the sidelines, consulted and considered when convenient. They are the supreme moral compass by which all decisions should be made. Ethics are not something to apply when it's easy to do so, and brush aside when the circumstances are more dire because you just need to get the job done. Ethics are actually less important the lower the stakes and the more routine the matter at hand. The more complicated the case, the more serious the disease and the more sensitive the patient, the greater the need for ethics. Not the other way around. Ethics are not there to guide you when it's easy, you can figure that one out on your own. They exist to advise of the correct principal when things are tough. It would be like saying someone could have their first amendment rights. . .as long as you agree with what they say. Or, "Yeah, we'll make sure the cops get a warrant, unless you're probably guilty, in which case we will bust into your house at 4 in the morning and drag you out of bed in your underwear no questions asked". That is not the way it works. The first amendment exists not to protect the things we agree with. It’s there to protect the things we do not like or want to hear, no matter how much they offend our sensibilities. Without it, blogs like this might not exist. The bigger the issue, the MORE important ethics are. They are matters of public policy and the needs of that one doctor in that one impatient, stressed out and high stakes moment are outweighed by the greater good for the patient and all patients in general. It’s fundamental. Ethics are bigger than you. They are bigger than all of us.

At Saturday, October 26, 2013 5:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Doug, maybe I should have written ""Ethics, I am afraid, is secondary to accomplishing the task of diagnosis, treatment and ending up with a healthier patient..." in place of "healthy patient". That is the physician's goal notwithstanding the challenges in making a diagnosis, multiple limitations in treatments and yes, the demands of hospital administrators and an ongoing curriculum set by the above factors which may not always meet everyone's (including every patient's) criteria of what should and should not be expected in meeting all of a patient's characterization of how a doctor should behave. ..Maurice.

At Sunday, October 27, 2013 11:45:00 AM, Blogger Maurice Bernstein, M.D. said...



Post a Comment

<< Home