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Patient Dignity (Formerly: Patient Modesty): Volume 93
This graphic is my repeat presentation to this thread. It first appeared here 5 years ago as the graphic on Volume 56 of "Patient Modesty". (Photograph from U.C.L.A. library website obtained through Google Images. )
Now that we are focusing on patient dignity, it would be of interest to compare dignity vs modesty as applied to a patient fully asleep under anesthesia within the operating room.
Might I suggest that modesty is no longer a matter of ethical concern when the patients body is uncovered but the issue becomes the preservation of dignity. Modesty requires awareness . Anyone want to discuss this conclusion related to the unconscious but exposed patient? ..Maurice.
AS OF JANUARY 6 2019 VOLUME 93 WILL BE CLOSE FOR FURTHER COMMENTS. GO TO https://bioethicsdiscussion.blogspot.com/2019/01/patient-dignity-formerly-patient.html FOR MAKING COMMENTS.
175 Comments:
Good Afternoon:
Patient Modesty in Healthcare
There’s an illness that’s moving like wildfire through our medical community.
This illness effects everyone from the CEO down through the rank and file workers. We’ve seen illnesses like this before and they are very very strong however, there is a cure for it.
We have an antibiotic strong enough to kill it in its tracks but because the virus has spread so quickly throughout the medical community, the only way it will be effectively stopped, is if the entire medical community not just here and there to get inoculated.
The illness is bad. Currently, the virus is showing up more everyday within the hallowed walls of our medical institutions. It rears its ugly head more often when dealing with male patients than female patients but it happens to both genders.
The illness I’m talking about is the complete lack of respect of a patient’s dignity (aka modesty), and privacy the medical community has for human beings that present at medical facilities with modesty issues. The two go hand in hand.
The antibiotic we have for the cure of this illness is called Humanity.
If the entire medical community were to take a full dose of the humanity antibiotic, they’d begin to see patients as people first. They wouldn’t be so fast to judgement when they come across a patient wanting to protect their dignity. Patients in turn would not be so defensive when they go for medical attention. Their minds would be more at ease as they wouldn’t have to worry about medical ambushing which currently is rampant within medical institutions. The patient/provider relationship would be allowed to grow rather than fester like an open wound.
So how does the antibiotic work.
In the short-term.
Patients would be greeted with a smile. Workers would introduce themselves and explain what their purpose is and why they are there and ask permission before they do anything.
When patients need attention, the attendant would introduce themselves then escort the person back to a bay or room. Next, they would be respectfully asked to remove all their clothes and put on a johnny gown which would then be handed to them. The attendant would ask if they have any questions. If so, they would answer them to the best of their ability within facility rules. If no questions, the attendant would make sure the area was secured so the patient has privacy for changing then leave the area. When ready to come back & speak with patient, staff would announce themselves and wait for patient to reply saying its okay to enter their space.
Other ways the antibiotic works in the short term are;
Medical institutions would begin to retrain employees by making everyone take a course in patient respect with a required refresher course each year.
Medical and nursing schools would add patient respect courses as a requirement for graduation.
To alleviate male patient embarrassment and humiliation, give men and boys the choice of a male hospitalist when male related intimate issues are at play.
In the long-term.
Medical institutions would ramp up recruitment of men to go to nursing school, graduate, then enter areas in need of male personnel like urology, radiology, oncology, and diagnostic sonography or ultrasonography to name a few.
The booster in the antibiotic is to help the community to find ways (like using male hospitals instead of female personnel), to take care of male related intimate issues if the patient wants same gender care.
Whether one’s personal preference is for either same-gender or opposite-gender medical care, their choice should not only be respected by everyone, but also accommodated by all healthcare providers and their affiliates without question.
The shot of humanity is something our healthcare system is in desperate need of right now so I hope, they will be wise enough to take the antibiotic and cure this sickness once and for all.
Regards,
NTT
Quote from the referenced article [https://jamanetwork.com/journals/jama/fullarticle/2715597]:
"and the medical community at large do not value trainees enough to stop this harassment."
Is this a clue to cause?
Does the medical community extend dignity and respect to patients - being polite is sufficient. Did these men say their inappropriate comments politely?
Maybe these men learned the culture from their visits to medical institutions and responded accordingly. How is it that sexual expressions to future doctors are bad, but unnecessary sexual exposure of a patient is tolerated without administration action [words only] against it.
How about a follow-up of these men to see what other environments where they found it acceptable to make these comments? It might be interesting.
If the medical community reflected a high-minded environment to the people they serve, patients would respond in kind. Physician, heal thyself.
BJTNT
How about the healthcare industry make an assurance, guarantee that you as a male patient won’t be judged, gossiped about, sexualized about nor have a cell phone pic of your genitals taken by a female nurse by the name of Kristen Johnson in upstate New York hospital.
How about the healthcare industry make an assurance, guarantee that during your colonoscopy that the female anesthiologists won’t make comments that “ she wanted to man you up” , make false statements to staff that you have an STD and enter a false diagnosis in your medical chart as was done by Dr. Tiffany Ingram.
How about the healthcare industry make an assurance, guarantee that you as a male patient won’t have a ton of employees in your operating room uninvited taking cell phone pics of your genital injury that occurred at UPMC.
How about the healthcare industry make an assurance, guarantee that you as a male patient won’t be groped and assaulted by an ent physician named Dr Twana Sparks while the entire female operating room staff laughs.
How about the healthcare industry make an assurance that you as a male patient will have privacy, Peace and respectful care after you have died lying in your body bag without 5 nurses peeking at your genitals at a Denver Colorado hospital.
In regards to NTT’s previous post, don’t you think this goes way beyond “ alleviate male patient embarrassment and humiliation.” Better yet how about the healthcare industry make a better attempt at getting nurses to wash their hands. That would save about 100,000 lives each year, don’t you think.
PT
Thanks for introducing this Volume with a description of pathology and approaches to treatment. Good. However, I wonder what my visitors think about the entry statement I made hoping to clarify one "operative" distinction between "dignity" from "modesty" terms which has been changed in this thread title.
My concept is that "modesty" represents a conscious "awake" awareness of, in our discussion, "our private anatomy" and requires the modest individual to be awake and aware of others who are paying attention to their modesty requirements or defying them. A patient's "dignity" does not require awareness at the moment of "undress" but is a human property that should be assumed as always, permanently, present unless disclosed otherwise by the individual who is the subject of what is occurring at the time.
All healthcare providers must at all times assume that every patient has their own concerns about their bodily appearance to others and this concern is the expression of the "dignity" inherent in every and all patients.
So am I wrong in excluding "modesty" as an issue in an unconscious patient but emphasizing the importance of attention to the patient's human "dignity"? ..Maurice.
By the way, if visualization of the patient's body can be controversial in terms of "modesty". How about "touching"? Here is a link to a thread started in 2008 with visitor comments titled "A Doctor's Touch" describing the clinical value of touching the patient which may be of interest as we continue "Patient Dignity". ..Maurice.
While it is correct that patients cannot have modesty concerns while they are anesthetized, they similarly can't have dignity concerns during that period either. However before being anesthetized and after, such concerns can come into play because the patient knows they were naked on the table and that they had no control over whether their exposure was appropriately minimized (what, how long, to who) nor how the staff behaved as concerns the patient's exposure. The unknown in this regard serves to heighten concerns compared to exposure while conscious. Many people don't feel that way but some of us do.
As an aside on the patient misbehavior discussion, at our Thanksgiving gathering yesterday a newly minted 21 year old RN working on a med-surg floor at a local hospital commented on an old man having said something inappropriate to her. She's pretty laid back and wasn't bothered by it but this being her 1st job it was notable to her.
On the touch issue, I'm fine with handshakes, touching my shoulder, or similar normal social interaction type stuff, but I do want healthcare staff to tell me or ask me as appropriate before they touch me for medical exam purposes.
Biker, elements of human dignity are present and should be aware to the medical staff whether or not the patient is fully under general anesthesia.
I can present here an example of professional behavior which I actually observed in the operating room which supports my above statement.
As I recall, it was a 20 year old male who was undergoing a repeat aortic valve replacement. He was already unconscious. His groins were exposed for femoral artery access but immediately after exposure the genitalia were covered. Why was this action promptly carried out? It surely was because the staff was aware of all patients' human dignity even when the human was asleep.
My definition of human dignity is that it is present at all times, awake or asleep. ..Maurice.
The concept of modesty seems to be a subset of dignity. One has dignity or worth because of his/ her participation in the human race. This human dignity has many components. We have the dignity to make individual choices regarding our associations, our careers, our aspirations, etc. We also have the dignity to choose the way we display our bodies or have them touched by others. This displaying or touching is the modesty component of dignity. Furthermore, our modesty may be conditioned or regulated by our society or culture. What’s considered modest in one society may not be considered modest in another. There’s also the possibility that our views of modesty may not conform to societal views. Additionally, subcultures within our culture may view modesty differently. Ultimately, however, in our current culture in the US, one’s individual view of modesty is pre-eminent. Aside from “decency laws” there is no higher authority than the individual. If the above is true, I, the individual, determine my modesty – how my body will be displayed or touched. My modesty is violated by anyone who acts against my individual modesty determinations. (Admittedly, sometimes these “violations” may occur because others are unaware of my modesty concerns.) Just as I do not lose my individuality when I am asleep, unconscious or anesthetized, I do not lose my modesty concerns in these states. Awake or asleep I still possess those views of how I want to display my body or to have it touched. Isn’t the reason for an Advanced Medical Directive so that I may DIRECT the way in which my body is treated when I am in an altered state of rationality or consciousness? To say that my modesty isn’t violated, if I’m unaware of it, is preposterous. Drugged date rape is a crime because it is a violation of one’s body, one’s modesty and one’s free will WHILE UNCONSCIOUS. The state of consciousness is irrelevant to the crime. The medical community refuses to admit the possibility of modesty violations. The prevailing sentiment seems to be that if the patient is unconscious, his/ her modesty is not violated. This is absurd. No. Just as in the example above, one’s modesty has been violated. Although the “scars” of this violation may not occur due to anesthesia, the violation has still occurred – one’s individual determination of modesty has been transgressed. Assembly-line medicine cannot countenance this individual determination of modesty. It slows down the process. Instead, the subject is ignored. “Leave your modesty at the hospital door”, is the mantra. Ignore modesty and it will go away. Unfortunately, much of society has subscribed to this view. I refuse to embrace this denial.
Reginald
It’s very interesting that Dr. Bernstein’s blog, Doctor’s Touch has a picture of a male doctor kneeling to examine private parts of a woman without looking at them. This was the “compromise” position that introduced men to do first gynecological procedures on women. Before that time, only midwives examined women intimately. I have this very picture on an article I wrote about History of Modern Gynecology.
Misty
Misty
On your site regarding your illustration “ what to expect during a pelvic exam”, it would be beneficial to readers that female patients can additionally request drapes to cover their inner and outer thighs for more privacy. Many more proactive facilitiesare doing just this to enhance the patient experience.
Again, thank you for presenting center stage the dilemma men face on KevinMD. Regarding the comment section, of course going in there we knew a few cages would get rattled, it’s always expected. Thank you for advocating on this subject and quite soon I will call on you to present some ideas I have to present this to a much bigger audience.
PT
Actually, Misty, from my point of view as a physician who has over the years performed many many pelvic exams and teach, teamed with gynecologists, second year students how the procedure is carried out, doctors can learn further about female genital pathology by visual inspection than by palpation (touch) alone. Beyond that, what is missing in the picture is visual contact with the head (expression) of the patient. Such periodic, repetitive visual contact, beyond verbal communication is important in the awake patient. I teach students repeatedly to be looking at the face of the patient when palpating any part of the body since often patients will grimace rather than express the discomfort verbally. ..Maurice.
Dr. Bernstein,
My point is that before 1800s male doctors were not allowed to touch or see private parts of women. Before modern medicine was invented, modesty was much more important. Opposite sex intimate medical care did not exist before.
Female midwives before modern medicine was established saw and touched women’s private parts and it was not a problem because they were females.
Look at how this medical student talked about the historic progression of pelvic exams at Male physicians treating Female patients: Issues, Controversies and Gynecology.
Also, check out Shameful Exposure | Early Modern Medicine. This article talks some about male patient modesty.
Modern medicine is gender neutral and has worked to indoctrinate many people to accept that the gender of a medical personnel does not matter and that we should focus on the skills of the doctor/nurse instead of gender.
Misty
Good Morning:
Dr. Bernstein in reference your example of the 20 year old patient getting an aortic valve replacement.
If the valve replacement were done today, patient exposure could have been totally avoided had the institution allowed the patient to wear a CovrMedical bilateral medical garment or something similar from another company. The garment gives full access to the femoral arteries in the groin area without exposing the patient's genitalia.
I believe hospitals could directly effect a patients outcome in a positive way by using these types of garments throughout their institutions.
Plus, the institutions that use them would get some good pr out of it via word of mouth from the patients.
So in the end, you have a win win situation. Good for everyone.
Yes the garments cost money but that would be offset by the increase in patient volume.
Regards,
NTT
Maurice
I assume you were referring to that 20 year old as undergoing a “ Transcather aortic valve replacement “. My question is, do you think their behavior ( staff) was attributable to your presence? For every one example you refer to as “ professional behavior “ there are 10,000 examples where it is not professional behavior. I’ve found that when staff are NOT under the microscope they tend NOT to care about the patient in regards to the patient’s dignity.
PT
In the observation I had in the operating room with the 20 year old male, the general genital covering appeared routine, I was at a distance from the table and individual doing the covering never looked at me and appeared to be acting in a routine fashion. Also none of the 2nd year medical student observers my duty to monitor were at the time in the room.
Again, since I never have been a member of an operating room team or frequent observer, I cannot speak for "malpractice" in that environment. Hopefully PT, your ratio of one "good" vs 10,000 "bad behavior" is an over-estimate. Does anyone have an idea of "good" vs "bad" ratios in other occupations or professions including religions? ..Maurice.
Re the idea of building an internet site such as Organization for Dignified Patient Care - it’s a great idea. Those who are facing needed medical care, but especially men, need a site where they can access information about their care that they would be hard pressed to find elsewhere, ESPECIALLY INFORMATION REGARDING THE CORRUPT NURSING CULTURE AND THE MAJORITY OF PHYSICIANS WHO IGNORE, I.E., WHO SUPPORT IT BY HAVING ALL FEMALE STAFF! As one contributor said: “They've gotten away with looking for so long they don't want rule changes that might take away their viewing pleasure.” Forcing male customers to accept female hags and others is SO MUCH MORE THAN ABOUT SAVING THEIR OVERPRICED SALARIES! IT IS ABOUT THEIR SEXUAL VIEWING PLEASURE! These hags are hypocrites to the end!
My idea was to create a site where male customers who have been discriminated against by staff, who have been victims of sexual impropriety/sexual abuse can come for ADVICE ON HOW TO REPORT VIOLATIONS. Let’s make it easy for men who have fallen victim to nursing hags (and yes this “skirt” will continue to call an animal an animal – hags and voyeurs apply to a majority of female nurses, techs, aides, etc.). I’m with PT on this – the makemsick hags paint all male customers who desire same gender care as weak or silly, I paint them back appropriately with the same “broad brush” which is the least they deserve! Consider having different sections on the site: one such section can detail how a male customer can issue formal complaints all the way up the food chain. Of course, as states differ, each state would have a separate listing that supplies the path to take to complain, that lists ALL the organizations that one can complain to, the best order to do so in, and might even supply sample letters. Let’s make it easy for men who have been victimized by the voyeuristic skirts to take back their power, and get these hags out of what now passes for “healthcare.”
Of course some will disagree with me when I state unequivocally that another section (or a link to a different site) could be rather a Hall of Shame, where hags such as the Denver 5 and Twana Sparks are publicly exposed, and here men that have followed the advice in the Patient Care site could describe how they were violated, how they succeeded in having nursing hags reprimanded or hopefully having a permanent revocation of nursing license, and LIST THE NAMES OF THE PERPETRATORS. I’m not sure how I ended up on it, but one of my email accounts sends warnings of registered pedophiles who recently have moved into my area. I regularly read the Sheriff’s Calls for info about criminal activity in my rural area.
The site should also detail what discrimination is for male customers, and inform them of how to INSIST ON THEIR RIGHTS TO SAME GENDER CARE – NO EXCUSES BY NURSING HAGS AND SO FORTH, whether in a hospital or clinic environment.
Now, the reason I bring up vaccines is not only because a youngster in my family was ruined by them , and I have some experience trying to teach ELA to such youngsters – OUR SCHOOLS ARE OVERFLOWING WITH THEM - but MANDATORY VACCINATIONS ARE AT THE HEART OF THE BRAVE NEW WORLD WE SEEM TO BE ENTERING IN. The worst, like the youngster I mentioned above, can’t make it in school; they are kept at home or placed in facilities until they are basically thrown to the streets at a certain age, depending on the state or county’s rules. A friend of mine who once worked at such a facility was attacked and almost killed by one such inmate. I recall her gathering some warm coats and blankets several winters back as she had found a few young men released from such a residential facility homeless, living in a desert wash and begging at the side of the road for food.
EO cont.
I keep bringing up vaccines because mandatory vaccination for schooling and certain employment IS FASCISM, and those who don’t recognize the wolf at the door will sooner or later be on their hit list. Let’s make it clear – the primary motive of Big Pharma, supported by a coterie of what I can only describe as brain washed morons, i.e., physicians and makemsick workers, is to eventually roll out a schedule of mandatory vaccinations for everyone, child or adult. THE MAJORITY OF A PEDIATRICIANS’ REVENUE – SOME 60-80%, IS DERIVED FROM VACCINATIONS. That is, a majority of their revenue is derived from destroying the immune systems of infants/children. For the uninformed or skeptical, try joining a few groups whose children have been killed/severely harmed by vaccines – these parents will open your eyes! Always more infants dying after their “shots” or children developing severe behavioral and/or physical illnesses after the vaccinations. Try reading the now hundreds of studies coming from anywhere but the USA that details the DECEPTION THAT IS VACCINATION, AND THE MEDICAL OPS THAT SUPPORT SUCH FASCISM. OF COURSE BIG PHARMA LOVES VACCINATIONS – THEY CREATE HUNDREDS OF MILLIONS OF NEW CUSTOMERS WHO HAVE NO IDEA THE MAKEMSICK INDUSTRY HAS DESTROYED THEIR HEALTH. Do you really think you are free here? Try being a physician that orders a medical exemption – these rationally thinking and courageous physicians are hounded and smeared publicly and legally for doing what they should do – protecting the health of children. Now, it probably doesn’t have a snowball’s chance in hell, or male customer’s expectation of having his modesty/dignity respected, but if passed, the bill to remove protection against liability for vaccine death/injury would end most pediatricians’ practices! You should hear what parents of vaccine damaged/killed children call pediatricians!!!
And, for those who haven’t a clue as to what’s really going on with the fascism that passes for “healthcare,” here’s just one example out of thousands that show what the deep state is capable of doing when faced with the truth and this truth of course threatens their ill gotten gains: https://explainlife.com/scientist-jailed-after-discovering-deadly-viruses-are-delivered-through-vaccines-2841/?fbclid=IwAR1exqpN9xfx1zvmt3NTnHcxjuGljwwrw3QI0sIoE7IWD-BJ2cRYRmRxmyw.
EO
Maurice
To put everything into a more presentable perspective and taking into account all the hospitals and surgery centers you will have 10,000 surgeries in one state in a single day. I’m just referring to surgeries, discounting all the intensive care units, physician offices, rehab centers, level 1 trauma centers and nursing homes. Surgeries at major hospitals run 24/7 and at outpatient surgery centers are typically 7am till 8 or 9 pm. Major hospitals will have 24 surgical suites that can be booked all day and night, do you really think the staff are going to be nice and treat everyone respectable when it’s just cattle, slabs of meat moving in and out.
PT
I want everyone here to notice a marked change in the content of views expressed on this blog thread since the title was changed from "Patient Modesty" to "Patient Dignity".
For example, I would have formerly considered EO's presentation of her views of the vaccination issue totally inappropriate to the primary issues involved in modesty concerns of patients and so would not have published it. However, expanding the area of our conversations to the dignity of patients, it makes this thread open to presentation and discussion about these other concerns as "said" to be observed and practiced within the medical profession.
Now, I want all my visitors to know that this entire blog with over 1000 presentations was developed to "discuss" the matter of "bioethics", including the many aspects I considered of possible interest to others.
My question to my visitors and commentators is whether "Patient Dignity" as expanded away from the pure "modesty" (actually specifically "physical modesty") is what is wanted here. Consider that patient dignity can involve many other areas of discussion beyond matters of modesty.
I ask Banterings, who, as I recall, initiated this change in title here, but also I ask the others here, is this now expanded areas of discussion to many other issues is what is wanted for discussion here. The vaccination issue and expanded also to pharmaceutical drug promotion and patient pressuring certainly is appropriately up for discussion and dissection. But is that what our visitors want here.. or should we concentrate on and consider changing medical system behavior on but one issue? Any comments? ..Maurice.
Dr. Bernstein, please do not allow this discussion to include vaccines, big pharma, or anything else along those lines. They have nothing to do with patient physical modesty and privacy and the basic human dignity that entails. There are plenty of other places that EO can rant about that. I would also suggest that allowing posters to call all nurses hags or anything else like that is not helpful to the cause. It can only serve to have our legitimate complaints and concerns not be taken seriously by those anonymous readers who might otherwise be sympathetic to the cause. EO can think it all she wants but please don't provide a public platform for it.
Dignity can be a very big topic but let's keep the focus narrowed to the modesty and physical privacy aspects of it.
Right now I’m at a loss. Could it be that EO hates female medical staff more than I do? How is that even possible? To begin with, many people suffer from the “ I just can’t fathom that “ syndrome. Until people started seeing video clips of extreme unnecessary police force people assumed that you got what you deserved, but thanks to cell phone technology the truth is finally coming out.
The little dust collector with the three monkeys “ see, hear,speak no evil “. That’s attributable to the “ I just can’t fathom that syndrome”. In many people’s mind that just can’t comprehend, disseminate information and come with an open mind to events they can’t handle, fact is many just can’t handle the truth. The second falsehood is fake information, such as nursing is the most trusted profession. The fake adds that make false promises that you the patient will be treated with the utmost respect.
When are people going to see through the smokescreen Bullshit! To see, admit to yourself is the first step. I’ll give you an example, in the 40’s and 50’s blacks suffered from the same dilemma. Is this a society that is prejudiced against us or this just the way things are supposed to be. There is a Urology clinic in a county called Jeffersonville county Indiana of which is one of many I have been researching lately. It’s interesting but, there are 6 male urologists associated with this clinic and 12 female nurse practitioners, why? You can find the clinic as well as look online and see their pictures along with their bio.
I have read that typically most Urology clinics see about 75% of their patients as male, yet this clinic for reasons beyond me need 12 female nurse quacktitioners. You can accurately assume their medical assistant staff will be all female as well. Let’s flip the roles here. Can you imagine if there were an OB-GYN clinic that had 6 female OB-GYN physicians and 12 male nurse Quacktitioners. Never!
PT
Maurice
The main narrative is physical privacy and that has been the primary focus in these discussions yet, I believe to illustrate how deviate the medical community can be other examples have been enlisted just to show how low people stoop in medicine to Fu&k over other hominids.
Medicine is the last industry on the planet to admit this, their mistakes. They come up with stupid oxymoron phrases like “ best practice “ and there are others to stupid to list. It is industry corrupt with greed, unethical behavior and unprofessional conduct with no end in sight. It’s just sickening!
If you notice I reference Hipaa violations along my comments but believe me I could go on and on with examples that would illustrate an absolute disservice to people when they are at their lowest, when illness strikes. I’ll admit it’s a real challenge for me to adhire to the discussions and I’m only doing so because this is the topic and it deserves utmost attention.
When I find a blog that discusses fraud, deciet and corruption in healthcare, billing practices to Medicare, poor medical care to our veterans, violations of the Stark laws, kickback schemes, you can rest assured I have commented on them and will continue to do so.
PT
Biker
I don’t know the gender of EO, nor do I care. Personally, I give much credence to posters on this blog who seem to know the just how evil those in healthcare can be. I don’t care how they acquired this knowledge, be it from a combination of patient experiences and/ or working in healthcare. I do give extra credit when they are colorful about it and in this regard I give EO an A.
The definition of HAG by Merrimack-Webster ..an ugly, evil looking woman, a female demon, a hobgoblin.
My question to you Biker is have you ever received care from a female nurse who was evil. Have you ever received what you thought was care from an evil female nurse who tried to harm you? If you have not then you really don’t know what evil is. I don’t really care about those who read this blog and or remain anonymous. To me they are not engaged for whatever reason. If nurses read this blog and don’t learn anything from it or walk away unenlightened they it’s true they are a HAG. I think EO is being rather nice by definition cause there are a number of choice words I could use to describe them.
PT
But PT et al, what should be the theme of further discussion on this thread? Again, dignity as the named topic opens this thread to a host of issues regarding the interaction between the medical system and the patients. (Please scan through this "Illuminative Evaluation of Dignity in Care" 2012 Thesis by an author from England-- great detailed definition and approaches to resolution of problems.)
And it is my opinion that "moaning and groaning" to each other and the silent visitors does nothing constructive to remedy situations which need to be remedied.
Rather than calling issues "names", shouldn't there be discussions but leading to actions to remedy the situations?
The question should be what and how should further commentary be carried out on this bioethics blog thread? This is important so, as moderator, I know what and how to moderate! ..Maurice.
PT, having had 2 bladder cancer surgeries, a year's worth of treatments via the penis, 13 years worth of follow-up cystoscopies (every 3 months to start then slowly working its way down to annual ones now), a testicular ultrasound, and vasectomy, and every nurse involved in that care being female except for my most recent two cystoscopies, I have far more experience with female nurses and techs for intimate care than most people. I would not use the word evil or hag to describe any of them, including the two I consider to have been either inappropriate or unprofessional. All of the others did the job they were assigned to do in a professional manner, not doing anything to add to my discomfort or embarrassment. That I still felt uncomfortable or embarrassed and would have preferred male staff is on the system itself and those who make the staffing decisions, not those individual nurses. They didn't do anything wrong.
Anonymous readers do matter in that they can be influenced to change their approach to patient care or conversely to speak up as a patient without their having to jump into the conversation itself. Most of us have been influenced on any number of topics by what we have read without discussing the issues directly with the authors.
In my comprehensive experience in corporate settings and as an appointed and elected small town official (where you have to solve the problems yourself w/o staff), those who can clearly and calmly present the actual problem they are trying to solve are the ones taken more seriously, as are their proposed or requested solutions.
Biker
The internet is filling over and flooded with articles referring to nurse bullying, violence and incivility. So much so that the Joint Commission as well as other nursing organizations have tried to get involved. When you read these articles they tend to say that patient care is at risk but they really don’t say how. They don’t want to come out and say yes, nurses bully their patients on the internet for if they did that might just compromise their so called standing as the most trusted profession. Anyone that discriminates is evil be it an individual or a group and if an entire organization discriminates then that organization is evil.
You want to be nice to people who discriminate against you? Ask black and Jewish people if nice worked for them when they were discriminated against. Ask them how that is working? Do you think anonymous readers here are going to be engaged, obviously Maurice know the visitors and I don’t think they are looking at this blog from an educational standpoint. I’m not sure how you are going to present problems to people when you don’t have staff. There is a big difference with people in a small town versus 4000 people who work at a major medical center in a large city, it’s comparing apples to oranges.
There is not one of us here who can judge anyone or what they have experienced. We don’t know nor have we walked in the shoes of EO or anyone for that matter. I don’t know what EO has been through and maybe I don’t want to know but obviously it was not good. For all we know maybe EO was at one point nice to providers and found that it did not work. There is a big difference between providers who are not professional towards a patient regarding physical privacy and a provider who not only was not professional but evil and attempted to harm you. You want to know evil, I’ve experienced that.
PT
Whether the writers here are statistical outlier or NOT, I believe there is a real gender medical care problem (disease) at least in the United States (hopefully we will hear from other countries who are coming to this thread)... and the goal I see for this thread is to begin some process to attend to the initiation and augmentation of approaches which will begin and lead to a CURE of this systemic disease.
We read here about the symptoms and course and pathologic basis-- now is time to work towards that cure.
I am sure that all our commentators know lawyers and physicians. A first step is to make an effort to notify them what is being discussed here and have them join this thread with their views and perhaps their professional suggestions of how to proceed.
..Maurice.
PT, thanks for your support. It is much appreciated, and contributes to healing. Yes, I myself and several family members, as well as a friend, have been both physically and emotionally wounded by the makemsick industry. In addition to grave physical harms, many of us bear quite dreadful, lifelong emotional scars that don’t ever really heal… And I am 100% with you in calling this industry evil. Yes, you are correct that most people cannot begin to comprehend the monster that the medical industry has become. Sure, there are some good providers out there, but, in my experience both personally and professionally, most are the opposite – arrogant, greedy, and reckless – reckless with our very lives!
Now, Biker, as this blog has been running some, what, 12-13 years, did using “nice” language change ANYTHING? ABSOLUTELY NADA! The nursing culture is just as corrupt today, if not more so, as it was 12 years ago. They continue to discriminate across the board against male customers. They continue to practice sexual voyeurism as well as endangering/taking lives with their reckless, selfish behavior and low intelligence. And yes, I am being polite using the term hag, as others terms are much more suitable, but not to this site. One man’s ceiling is another’s man’s floor – what you term a rant is simply one of the ways I write as professional creative writer, and I have over 45 years experience with creative as well as academic writing/editing. One has only to read ProPublica to savor the widespread corruption of all parties in “health” care.
Now, one of my Masters Degrees is in English, and some might think that a “soft” degree. I can assure it is the opposite. Our foundational training is to enable us to discern the truth from falsehood, and this endeavor is one of the most difficult. I have endeavored to show the false narratives – no, let’s call the animal what it is – outright lying by the makemsick industry. They lie about caring about customers, they lie about cancer screenings, they present false statistics, ad infinitum. They lie for profit.
Before you shut down the convo re vaccines, EDUCATE yourself. IT’S ALL ABOUT THE MONEY! Follow the money, as journalists say. Probably everything you think you know about vaccines is just another lie by a greedy, evil industry. Like PT, I use this term deliberately, for it is accurate. Have you had to bury a child after “unavoidably safe” vaccines? I think not. Ernest Fenollosa has given us much truth in this one sentence: “Logic has abused the language which they left to her mercy.” So it is seen in the lies and deceptions put forth by the makemsick industry. Simple jargons for simple sheeple minds is about all that is needed to rule the herd. And as I like to say, an educated sheeple is a dangerous sheeple! For these kinds of sheeples, such as pediatricians, lead the blue collar sheeples down the path of deceit and destruction.
EO cont.
Now that the gig is just about up, i.e., that many people the world over are seeing the terrible deception, harms – evil - that is the vaccine cartel, the deep state is becoming more aggressive and oppressive. Nothing must stop in their acquisition of yet more profit. Globally Big Pharma has now topped a trillion dollars annually, of which 45% is US business. Note that John Hopkins just put out a statement that they would not treat children or adolescents that are not fully vaccinated. That’s right, if you didn’t allow 70-80 vaccines to be put in your children’s bodies, you are no longer allowed to USE THEIR FACILITIES OF WHICH WE THE TAXPAYERS PAY 100% OF – facilities, personnel, and so forth. So, while I take the discrimination of male customers as a HUGE problem, as a significant evil, I must present it as just one facet of an evil industry. The poisoning of our children surely must rate as the greatest of evils. I’ll repeat just one more time- most contagious diseases were no longer lethal well before the advent of vaccines. Instead, we now have over half of our children with lifelong diseases caused by vaccines! The Orwellian nature of this surely must awaken some of the herd – an authoritarian medical regime that permits no freedom of thought, or of body. Ironic, is it not, that many of the diseases that John Hopkins attempts to treat are from the childhood vaccination schedule, such as, yes, cancer! Autism rates are 1 in 35 in the US, with boys’ rates being 1 in 28. Big Pharma no longer attempts to discover and manufacture useful drugs, instead they have become huge marketing machines who have nearly unlimited control over the main media, medical research (we’ve discussed how a majority of research is false), education, and the makemsick industry. I take something back - the wolf is already in the door. Both educated and uneducated sheeples let it in, and it’s gonna be hell to take back our freedom. Our freedom of body and mind is not only recognized nationally, but internationally, But here, in these fascist states of America, there is no longer any true informed consent.
Bear in mind that our society has already entered the second phase of fascism, and medical ops is their willing servant in pursuit of control and profit. I know evil when I smell it, and the rank odor emanating from the makemsick industry stinks to high heaven of it! Recall, first they came for the gypsies, then the Jews, who’s next? Perhaps tear gassing starving children at our borders? Oh, that’s happening today! Now for those who deem that control of their own body is their inherent right, I say – the makemsick industry is the primary thug of the global medical cartel, and I approach with eyes wide open.
Thank you Maurice, for having an open mind. It a rare thing indeed in today’s makemsick industry.
EO
EO, so do think the real solution to the "makemsick industry" behavior is behavioral control through change in the political system in the United States for devising laws and the legal system for seeing that the laws are followed?
Are we (USA) alone on the planet in this whole medical system misbehavior or worse? My concern is exactly why I want to encourage the visitors here from other countries to voice their experiences within where they live.
Banterings.. where are you in this patient dignity? I miss your postings. You have not written as yet to our Volume 93. I hope you are in good health and not facing the medical system issues that are being discussed here. ..Maurice.
EO wrote: Now, Biker, as this blog has been running some, what, 12-13 years, did using “nice” language change ANYTHING? ABSOLUTELY NADA!
In my case I only began speaking up a 2-3 years ago as a result of finding my voice here on this forum. Prior to that I was the typical guy that simply "manned up" and made believe it didn't bother me. Since then speaking calmly and clearly has been very effective.
I have been assigned male staff upon request and w/o being hassled by the female schedulers for my last 2 cystoscopies, 4 times now for 3 different types of procedures where sedation is deemed mandatory I have had those procedures w/o sedation, I was allowed to keep my pants and underwear on for an upper endoscopy and a T.E.E., both procedures for which having nothing on but a gown is standard protocol, and when I had a little dust up with Dermatology over not wanting a female scribe and LPN in the room for my exam, Patient Relations went to bat for me and effected a policy change in large part because of the manner in which I presented my complaint. I overheard the Patient Relations person essentially portraying me as credible, rational, and reasonable in my expectations of no female observers during my full skin exam.
So, yes, being nice has proven to be a very effective way to cause change in the delivery of my healthcare. In the corporate world and in the public sector where for 40 years I was the one in charge those who came to me ranting and calling people names have gotten nothing more than a smile, nod of my head, and an opportunity to vent. Rarely did I take their complaints seriously because they came across as people for whom no solution would be acceptable. Those who came to me in a calm rational manner got my attention and I'd do my best to find a win-win solution.
For broad changes that everyone might benefit from we need laws passed or a major court case. Until such point I will continue doing as I have done and yielding the benefits of more respectful and dignified healthcare such as I have achieved these past few years. In the case of dermatology, the policy change I caused to happen benefits other men who may also express concern over female observers. In urology my requests are giving them positive feedback that hiring a couple male nurses was a good move on their part. That perhaps will help other men. Having procedures done w/o sedation or any ill effects occurring has surely also taught the staff involved that maybe sedation shouldn't be quite as mandatory as it is. These things have ripple effects.
Good Evening My Friends
We’re here on this blog for those men and women that have had their dignity stripped away from them by a healthcare system that has lost its humanity to show them they are not alone.
We that have had dealings with the system have diagnosed the problem and are now seeking a cure for the virus.
Its going to take everybody working together towards the end goal of pushing this issue out into a public forum where the healthcare community can neither hide from the issue or bury it anymore.
As bad as they are and as angry as we get at them, we cannot let our guard down. If we want to be taken seriously by the medical community, we will have to play the nice game or, they will just look at us and say they’re a bunch of outliers that we can ignore.
Like Biker, I believe its going to take a lawsuit or congressional intervention to make the kind of changes we are looking for.
But that’s not going to happen until we get this issue out into the public’s eye where they like us, can see there is a problem that needs to be addressed. Once people really know what’s going on, they will call for change.
You can’t tell me that we have the know how to send a probe 54 million miles to another planet and make a spot on landing, but we don’t have the know how to fix problems here at home.
We have the know-how. We just have to find the will to use it.
As far as, are we the only country with healthcare issues, I would say no. The difference between our system and other country's from what I've been reading is other countries are working on the issues to correct what's wrong for the sake of their patients.
We here in America are just letting BIG BUSINESS make the rules instead of "the people".
For instance, I read in a journal the other day about a study done on urodynamics for prostate surgery.
They actually took the time to ask the patients their views and they got personal.
What they found out was men had apprehension, discomfort, and embarrassment. and, were not happy with the inadequate amount of information given about what would happen during and after the test. Many were embarrassed during the test due to lack of info.
Better privacy was another issue. Too many people in the room and just like here nobody introduced themselves to the patient and said why they were there.
So you see, we aren't alone.
Difference is, based on what the guys said, changes are to be made system wide to make the testing more tolerable.
You wouldn't see that here without a congressional mandate or court order.
So, chins up, chests out as we march on for a cure.
Regards,
NTT
Let's get started: How about my visitors writing about this medical system misbehavior, amply described in these Volumes, to their US senator or congressperson and posting their response to be read by the visitors here. There has been much political concern disseminated in the media from politicians about financially protecting patients with established diagnoses. Now, how about views from the legislators regarding gender mistreatment by the medical system as described here? ..Maurice.
Maurice et al,
Forgive me as I have some issues with family and work are taking up all my time.
As to the issue of vaccination, I believe the vaccination issue is relevant. Forced vaccinations are a violation of one's bodily integrity just as modesty issues. Even if this thread was titled (only) "Patient Modesty" the vaccination issue has relevance.
I believe that other issues (such as criminal activities) furthers the lack of concern for the humanity of patients that infects healthcare. These issues are sociopathic and systematic.
I hope to be back to more in-depth posting soon.
-- Banterings
Since this thread has been expanded to Patient Dignity and with the issue of vaccination being started as a matter of personal autonomy, part of ones dignity.. how about quarantine for communicable diseases, most commonly tuberculosis?
First read the AMA Code of Medical Ethics regarding "Ethical Use of Quarantine and Isolation".
Like vaccination for infectious disease can one argue that quarantine for infectious disease is also a "violation of one's bodily integrity"? Can personal human dignity of any person be violated for a "common social good"?
If so, can anyone see a "common social good" in the way patient modesty is handled throughout the medical profession? For example, would there be less opportunity for obtaining "the best management and cure of disease for all patients" if the medical system was compelled to follow many of the "gender equality" requests brought to this thread?
Like "anti-vaccination" or "anti-quarantine" for maintaining the individual's dignity, could an "anti-gender" attitude by patients have a societal harm?
..Maurice.
Modesty based physical privacy is in a class of its own with no commonality with the vaccine controversy or any other extension of what some might want to place under the dignity heading. Can an argument be made that these other things are dignity issues? Sure, but all it does is divert attention from the specific issue of gender equity in the delivery of healthcare. It just serves to water down the discussion.
My wanting the same bodily privacy dignity considerations routinely provided to women has nothing to do with vaccines or hospital billing practices or the medical profession's self-governance, nor the newest addition to the list, quarantines. When I am asking for a male nurse or sonographer I really don't care about the rest of those issues. If gender based physical modesty/privacy weren't an issue all to itself it wouldn't have been singled out under B.F.O.Q.
Please let's not water this down.
My husband had a heart attack in August. The 1st hospital didn't record him telling them he experienced bad side effects w/ painkillers. On transfer by helicopter, unknown to him they gave him 100mcg Fentanyl in addition to the 4mg of morphine given at hospital. He said he felt he was having an out of body experience. When he arrived at the hosp. that could handle heart patients, they immediately stripped him, put his things in a pink trash bag, and left him exposed to all including the registration woman. he is a prostate cancer survivor and wears pads and he was thoroughly humiliated but so drugged he couldn't voice it. He was exposed for a good 30 minutes. He was shivering uncontrollably. He was in a room w/ 4 females. His blood pressure dropped from the cold and the drugs (this is what he had told the other hosp.). After the procedure, there is no note of where he was but again he was left exposed and when they wheeled him out his gown was around his neck. Upon transfer to his room, (they wouldn't let me in there) they again left him exposed. The incompetent nurse could not get the equipment hooked up so the room was full of other people. Again, she left him exposed in front of them and made him use the urinal in front of them. This would not have happen if he was a female. The doctor who removed the sheaths also did not cover him up the next morning. A total lack of respect. He is very leery about more medical intervention because of this total lack of respect. Although exposure is sometimes needed, it should be done in a limited basis w/ only those necessary to the procedure.
I think that periodically all medical staff should have to be practiced upon so they know how it feels. If nudity is no problem, then they should have no problem for their co-workers to practice on them. My husband feels violated. Also, it took them over 2 hours for me to see him and then only because my son finally stopped one coming out of a door. We found out she had just come out of my husband's room and was laughing hysterically and couldn't speak for laughing. His memory is spotty and he doesn't know what was going on but we both are very upset about this. What was going on that 2 females nurses alone w/ a drugged man that would cause such hysterical laughter? He no longer wants females involved with his care if he is to have it. JR
Welcome JR with your disturbing story.
I hear Banterings and I hear Biker.
I want the visitors here to know that I am not against the idea of resuming the thread dealing with strictly patient physical modesty as has been the main topic throughout all these 93 Volumes--but there is no reason why I can't start a continuing thread on patient dignity which can cover issues more broadly than physical modesty. It is true that I have had separate thread titles in the past years dealing with some specific aspects of patient dignity and these are still being read but generally not written to.
There obviously appears to be multiple areas within the medical system's activities which patients have considered as infringement on what property they own--their individual dignity. And these concerns are worthy of discussing in a thread name separate from patient modesty.
I would tend to agree with Biker that we shouldn't get off track but instead we should set aside the patient modesty matter as a separate topic which has been the main concern of participants over these past 13 years of postings. The goal with regard to patient modesty is to provide specific changes in the medical system and behavior.
Yes, personally unwanted vaccination pressuring or demands and many other examples of possible dignity infringement by government or the medical system itself is worthy of discussion but within a separately titled thread.
Banterings (who initiated the modesty title change) and all the other readers and participants what do you think about resuming "Patient Modesty" Volume 94 and beginning "Patient Dignity" as the simple single title, Volume 3?
Why am I writing all this? It is because I see in the 13 years of the writings primarily on patient modesty and the misbehavior or worse in this regard a topic that now needs active approaches to change the system and not diluted with other aspects of human dignity which may need other approaches for change. Does anyone agree with my suggestions regarding the threads? ..Maurice.
Good Afternoon:
USA Today & the Milwaukee Journal Sentinel have done an nice story on how doctors surrender their license in one state rather than suspension or worse then move to another state abd pick up where they left off.
He removed the wrong body parts twice. And he's still a doctor.
https://eu.jsonline.com/story/news/investigations/2018/11/30/doctor-good-record-might-have-troubled-history-given-up-medical-license-elsewhere/2048657002/
Regards,
NTT
Maurice,
We have discussed such things as supporting that medicine "does not know any better." I do not think that such topics become the focus of the thread, but are allowed to support that modesty violations simply occur because medicine "does not know any better."
As moderator and (we) as posters must focus on the modesty aspect. Supporting material (such as vaccines and quarantine) may be presented, AND (as when the thread was only titled "Patient Modesty") a seperate thread may be spun off if that topic so warrants it.
-- Banterings
NTT, "ugh!"
This documentation piece shows the intrinsic deficiency within a system to keep control of the medical system. Discouraging for those of us who want to improve the medical system.
This is an example of a physician's actions to maintain self-dignity is destroying the dignity of the medical board of another state. As repeatedly noted in previous Volumes, we must include changes in the state and federal agencies if we want to make changes in the medical system below them. Again, "ugh!" ..Maurice.
I wanna write to my senator about our topic. It's Marc Rubio but I couldn't pull up his mailing address from Google. I don't have a good attention span. I might ask one of my nurses to get it for me or a coworker but first I thought maybe somebody here might know it.
Otherwise I wanted you all to know that the Adventist Health system is in violation of the Seventh Day Adventist Church but very possibly they are unaware of the fact.
I was a member of the Adventist church for 14 years before I learned what Ellen White said about the opposite gender intimidate care issue.
I'd like to mention that our church has been accused of making Ellen White into a god. We don't but we acknowledge her as " more than a prophet" In chapter 6 of Daughters of God Mrs. White wrote It is not the will of God that men attend to the delicate needs of women and lady physicians should utterly refuse to look upon the secret parts of men. Very much evil has resulted from the practice of men treating women and women treating men. It is a practice according to human devising and not according to Gods plan. Ellen White also said that if men attended to men and women attended to women, a door that Satan desires to enter is closed to him. All this was written like in 1911 and thereabouts. And one reason a lot of Adventists don't know is because Ellen White wrote more than 40 books,5000 articles and 50,000 manuscript pages.
In response to JR, help your husband regain some control by filing complaints appropriately. The Hospital your husband was mistreated at is licensed by the State, is certified by CMS, and has nurses who must follow nursing regs as well as state and federal regs.
You could complain to the State hospital licensing agency - found at the Dept. of Health Services in your state. Here is an example of regs in my state, Washington, about treating patients with respect and not abusing them (of which your husband was a victim on both counts).
WAC 246-320-141
Patient rights and organizational ethics.
The purpose of this section is to improve patient care and outcomes by respecting every patient and maintaining ethical relationships with the public.
Hospitals must:
(1) Adopt and implement policies and procedures that define each patient's right to:
(a) Be treated and cared for with dignity and respect;
(b) Confidentiality, privacy, security, complaint resolution, spiritual care, and communication. If communication restrictions are necessary for patient care and safety, the hospital must document and explain the restrictions to the patient and family;
(c) Be protected from abuse and neglect;
(d) Access protective services;
(e) Complain about their care and treatment without fear of retribution or denial of care;
But worse, here are portions of my states regs on SEXUAL MISCONDUCT (every State has similar regs). There was ZERO reason to leave your husbands genitals exposed (he wasn’t given a foley catheter it sounds like so ZERO reason to uncover his genitals, even to access the femoral arteries). That is either very poor training for those nurses or intentional actions by them. Regardless, complaints about sexual misconduct should be filed with your State’s Board of Nursing, the Hospital, and the Licensing agency. Tell them the story you posted here. Until men start complaining about sexual misconduct these behaviors won’t change.
WAC 246-840-740
Sexual misconduct prohibited.
Sexual misconduct. A nurse or nursing technician shall not engage, or attempt to engage, in sexual misconduct with a current patient, client, or key party, inside or outside the health care setting. Sexual misconduct shall constitute grounds for disciplinary action. Sexual misconduct includes, but is not limited to:
…
(b) Touching the breasts, genitals, anus, or any sexualized body part except as consistent with accepted standards of practice for examination, diagnosis, and treatment and within the nurse or nursing technician's scope of practice;
…
(f) Not allowing a patient or client privacy to dress or undress except as may be necessary in emergencies or custodial situations;
(g) Not providing the patient or client a gown or draping except as may be necessary in emergencies;
…
(i) Removing patient or client's clothing or gown or draping without consent, emergent medical necessity or being in a custodial setting;
…
(q) Making statements regarding the patient, client, or key party's body, appearance, sexual history, or sexual orientation for other than legitimate health care purposes;
(r) Any behavior including any verbal or physical contact which may reasonably be interpreted as sexually demeaning, humiliating, embarrassing, threatening, or harming a patient, client or key party;
(s) Photographing or filming the body or any body part or pose of a patient, client, or key party, for other than legitimate health care purposes or at the request of and for the benefit of, the patient, client, or key party; …
-AB in NW.
I don’t think everyone should get their panties in a knot for worrying over issues that are not physical related privacy posted on this blog. You know the medical community certainly won’t and they will even look for an excuse to diminish their behavior and their pathetic horrible mistakes as they routinely screw over the lives of other people.
Case in point. A nurse killed a patient by giving them the wrong medication, vecuronium instead of versed. The news report listed vecuronium as a drug that is used in lethal injections. The posts on Allnurses were of the position that it was wrong by the news agencies to note that this compound is used in lethal injections. Never mind the idiotic mistake made by the nurse, never mind this happened to a patient the day after Christmas, never mind what the family went through, never mind the unfortunate death the patient experienced.
Just blame the news agency for letting the public know that this drug is used in lethal injections. Have I ever mentioned how much I despise the medical community, have I mentioned how much I hate nurses. Would you like to know how many fatal mistakes nurses make each year administering medicines to patients.
PT
Let’s talk more about this issue of dignity and physical privacy. Which is worse, being treated in an undignified fashion in the hospital, being given vercuronium by mistake and dying in an undignified fashion or simply refusing to seek care like many men do and then dying from the disease process. I’m a little confused why a physician would prescribe versed for claustrophobia regarding this patient, Ativan is the first appropriate choice since Ativan is used to treat anexiety. Versed seems like overkill for a patient verbalizing that they has claustrophobia.
Nurses spend a lot of time on their cell phones, facebook and chatting at the nurses station about patients and their families. They get upset when they have to get up from the chair their buttocks have been glued to for the last hour and give a patient medication. They want to complete the task as fast as they can so they can return to their chair while the glue is still warm. Such is the sisterhood of nursing, ever complaining about their assignments, the number of patients they have etc. The perpetual bullying, violence towards their coworkers, patients and physicians.
Men avoid healthcare for many many reasons, one of them is to stay away from evil hags for fear of incompetence. Mistreating patients in regards to respectful care and physical privacy is not just unprofessional behavior, it’s not just sexual impropriety, it’s not just discrimination, call it what it is additionally, incompetence.
PT
AB in NW, does the extensive state regs which you described in Washington State and hopefully in all states apply only to hospitals or also in every physician's office? How are the institutions actively monitored to verify compliance? Or do the states simply await complaints from patients, family or other observers? I suspect the answer is "the latter". ..Maurice.
You know, I was thinking a bit further with regard to my last posting. I once experienced a "new patient" enter my office simply asking me to prescribe a narcotic without providing any further history or to have a physical exam. When I explained my "no" response to his request, he got up and left my office. I then instantly assumed he was from the State screening me for my behavior regarding a narcotic request. There was nothing in this "patient's" appearance or behavior to suggest any other possibility.
In this regard, then, why can't the state arrange to have "pseudo-patients" randomly enter hospitals to provide a limited monitoring of the state regulations you describe? The airlines carry "pseudo-passengers" to maintain safety, why not "pseudo-patients" in hospitals? ..Maurice.
Good Morning Friends:
JF, Rubio has a senate webpage that has a link to send him email. Everybody in congress has one as I've been using the links to send letters to many of them. So far with just canned responses.
Here's the link to Rubio's page.
https://www.rubio.senate.gov/public/
Regards,
NTT
Dr. Bernstein,
The sexual misconduct regs I posted apply to all licensed nurses and nursing techs practicing (licensed) in the State of WA. That is, whether it’s a hospital, assisted living facility, clinic, ambulatory surgery center, diagnostic imaging center, etc. These are statutes under the “nursing” section of the Administrative Codes. Every state I’ve looked at has similar that would apply to nurses, wherever they practice. That is, nurses and their aides have a responsibility to treat each patient with dignity, maintain their bodily privacy, and not abuse and demean patients. Leaving patients exposed endlessly for no urgent/proper medical reason violates these laws.
These regs apply to ALL genders, not just for protecting females. Unfortunately there seems to be a pervasive medical myth, not evidence based, that one doesn’t need to provide proper draping and bodily privacy for male patients, nor similar “modesty” accommodations to male patients that are provided to female patients. Such discrimination is inconsistent with state and federal laws. - AB in NW
Dr. Bernstein, pseudo-patients could work for checking on inappropriate dispensing of drugs, but how do you do this with exams or procedures requiring intimate exposure? Certainly there would be people willing to subject themselves to that; no different really than people being willing to be patient actors in medical schools. The issue is how does a pseudo-patient present so as to get their clothes forcibly removed in an ER or get a catheter or be scheduled for a testicular ultrasound or some other intimate procedure?
I still think we'd see healthcare staff (all levels, physician down to medical asst) be much more respectful of patient modesty/privacy/dignity if before they were allowed to work in a healthcare setting they had to have an intimate exam by opposite gender staff, and with extra staff in the room. Then and only then would they understand what it is like to be a patient in the way we discuss here. Most 20 something young women entering the healthcare workforce have never been a patient in that manner. Most never will and as a result will never understand the difference between being polite and being respectful nor the difference between convenience and necessity.
Biker, I offered the suggestion of "limited monitoring" of staff behavior by the State. There are many less dramatic repetitive staff-patient communication and behaviors of the staff to patients that could be signals of the potential for worse actions or ignorance. Yes, staff preparing a patient in the ER for a physician examination or how the nurse behaves in applying a bed-pan to a patient or closing curtains surrounding the hospital bed. There are many other possible actions or procedures which could provide insight to the investigator "pseudo-patient" about a staff's ignorance or defiance of rules. ..Maurice.
AB in NW
Those regs you posted do not apply to medical assistants and who exclusively employs medical assistants, physicians offices. State boards of nursing regulate nurses that are nurse practitioners, registered nurses, licensed practical nurses and certified nursing assistants. It’s always seemed redundant to me why state nursing boards do not regulate medical assistants. There are many medical assistants who practice outside the scope of their license and who present themselves as nurses which in some states is a crime.
Secret shoppers or pseudo-patients would be worthless in evaluating the services of any medical facility due to the liability and what would the point of it be anyway? Medical facilities across the country pay millions of dollars for Press Ganey to survey YOU the patient when they want to and the complaints are not acted upon regardless. The money paid to Press Ganey by the way comes out of you medical bill. I’m going to say with absolute certainty that about 98% of all nurses have no idea about the regulations you posted, nor can they recite 2 regulations from the nurse practice act.
As far as female staff making derogatory sexual comments about their male patients, I’ve heard just about all you can imagine. They have to verbalize it to other staff. If the nursing industry is so professional and the most trusted profession then why would you need those regs in the first place. Don’t you think the choice of a career would be to advocate for the ill and that it would be a calling, that at some point during coursework ethics training you have to have a presence of mind.
WAC 246-840-740 q) Making statements regarding the patient,client,or key party’s body,appearance ,sexual history,or sexual orientation for other than legitimate health care reasons. This one is probably abused the most.
PT
I believe that any medical staff member should not be allowed to carry a cell phone on their person that is capable of taking photos/video. The old and the drugged are especially vulnerable to misconduct by medical staff. The cath lab is not exactly sterile as they allowed in the helicopter crew and did the "shave" on the table so there is no reason that an advocate for the patient such as a wife or husband cannot be present to make sure there is no misconduct or abuse. I am mature enough to know to stay out of their way. My husband was present during my emergency C-section where my guts were laid on top of me and I was fine and he didn't interfere. The secret atmosphere that we allow medical procedures to have is the biggest part of the problem. If everything was transparent then I think many of the issues would resolve themselves. The idea that they used Versed is to me, unethical. If you are given painkillers and a general numbing agent then why is Versed necessary to wipe out the pain of the procedure? It is used in my opinion to wipe out your memory of their actions for their convenience. I don't feel it is anyone's decision to decide what memories I keep and what memories are erased. That sounds like a war crime to me. If Versed is consent to then the person should have a right to have an advocate of their choice present. If they are indeed doing no harm then why not? In most ORs there is an observation room behind glass so why can't your advocate be in there? Transparency solves many issues. Why can't a family member be present when they transfer someone from recovery to their room? What is the big secret? Most adults especially if they are told to keep out of the way will respect it. Medical staff are human and many times people forget that and make them demigods. They are sexual beings too and don't necessarily leave that at the door. Having an advocate present is just sense. JR
JR, I am convinced that versed and the other amnesiacs used are primarily a convenience tool for the staff and a billing mechanism for the hospital.
First on the billing, on one of my procedures that I refused versed for a T.E.E.(transesophageal echocardiogram), they billed $600 for use of the recovery room. I had to go round after round with them to remove that charge from the bill being I never went to a recovery room because I had nothing to recover from. I imagine many hospitals also bill separately for administering the versed as well.
More importantly if a T.E.E. and upper endoscopy which I also had w/o sedation are simply a tad awkward but not in the least painful and if colonoscopies are neither awkward nor painful, I cannot see what medical benefit the patient receives from being sedated with an amnesiac. It my case it makes me ill which is a big negative instead. This is why I am convinced its purpose is simply staff convenience.
Part of that staff convenience is not going through extra steps to keep the patient covered when its easier to leave them exposed. For the T.E.E. and upper endoscopy I kept my pants on vs wearing only a gown. For the colonoscopies (did it twice this way), not being sedated meant I was assured of being kept covered 100% of the time.
I would add that the secrecy aspect you note extends to the verbal and/or written instructions and literature patients receive or can find on the internet themselves. They invariably gloss over privacy and exposure issues if they get mentioned at all. The dermatology office doesn't tell the patient scheduling their 1st full skin exam that a scribe and asst will be there observing. The Cath Lab doesn't tell the patient who will shave them (if they even get told they'll be shaved) and whether or not they'll be exposed at any point in time. Urodynamics testing is grossly privacy-invasive but male patients are not told that it'll be 2 women doing the test, similar to men being sent for testicular ultrasounds without being told it'll be a woman doing the procedure. This not informing the patient is pervasive throughout.
JR, the public, has no clue that many benzodiazepine sedatives like midazolam (aka versed amongst other names) & non-benzodiazepine sedatives like zolpidem cause anterograde amnesia. These drugs are the doctors & nurse’s best friends because it allows them to do what they want & not get caught because without an advocate there for your protection, you’ll never know what they did & who was there when they did it.
There is hard evidence that the amnesiac effects of the drugs can & do last far longer than they anyone predicted. Especially in older adults. Some people’s memories are screwed up for the rest of their lives.
I agree with Biker that it’s a convenience for the medical staff so they keep it at the ready & freely use it without regard to the patient.
As part of any healthcare reform, better patient laws must be enacted for the following.
Whenever gender specific intimate care of any type comes into play regardless of gender, the patient must be asked beforehand if they prefer same gender care givers. If they do, the facility must (with the exception of emergency care), provide them before proceeding with the task at hand. Violation of this basic human right, will result in immediate termination of employment of all offenders involved.
Take the cell phones with cameras out of the hands of all healthcare workers during working hours. Hospitals should provide communications to keep in contact with staff during working hours.
Anyone caught with a camera phone on their person during their shift gets an automatic one-week suspension without pay regardless of title. Get caught a second time, its automatic termination.
Next is the use of benzodiazepines. Due to the effects of the drugs on people’s memories, if the hospital insists on using them, then patients must have a patient advocate of their choice with them at all times the drugs are in use on the patient. With their advocate with them the provider will inform the patient & their advocate that the drugs are being used & what effect they will have on them. The advocate cannot be a hospital employee.
When a patient is asked to get an exam, test, or, procedure, the healthcare provider asking will provide their patient with a full & accurate account of what it is that they are asking their patient to go through. Too many patients are being blindsided by the industry which leads to poor patient/provider relationships.
Ladies & gentlemen, the American healthcare system has had things their way far too long & we the patient are the ones paying the price. For example, the article in USA Today shows how their system protects the doctors at the patient’s expense by allowing them to surrender their license in one state then just go to another state & pick up where they left off. Nurses that violate patients do the same thing & get away with it.
The inmates are running the institutions. We don’t need nor do we want these kinds of individuals taking care of our citizens. Its time to purge the system of the pervs, voyeurs, & all the others that do wrong by the patient.
In any patient centered healthcare system, it’s the needs of the patient, not what’s convenient for the healthcare worker or institution that takes center stage.
Let’s remove their veil of secrecy once & for all.
Of the people. By the people. For the people. That is what a reformed American healthcare system must be about. Not give me your money & leave any ideas of dignity, pride, & respect at the door or just stay away.
Only after the patient’s rights are secured will we take a look at what can be done to lighten the burden on medical staff. Not before.
If these are the kind of things you want to see from your healthcare system then ladies & gentlemen its time to put that iced tea &/or beer down, get off that couch, & contact your state & federal representatives, family, & friends & let them know “YOU MEAN BUSINESS”. Things must change.
SPEAK NOW. LOUD AND CLEAR. Or forever hold your peace.
Regards,
NTT
Biker,
I agree. Versed is used for their convenience. My husband was not told about it. The stuff you found on the Internet glosses over what really happens in a cath. lab. He went through hypnosis to regain some of his memories. At the end of the session when he came out of it, he was emotionally upset. It was a terrible experience. The hospital he was transferred from noted that he had a "husband". We have to wonder that since he was transferred to a large Catholic hospital that they might have been less considerate of him for this reason? By the way, his spouse is female. This same hospital treated me horribly by not letting me see him before the procedure even I was there. I also was not able to see him for 3 hours after the procedure except a glance in the hallway. I was supposed to have able to see him within 30 minutes but it took 3 hours.
You're right. The cath. lab doesn't tell who shaves them. He remembers being told they were shaving him. In his drugged state, he remembers thinking why but was unable to voice it. The OR reports of the past listed more details but they have secrets down to a science now. He really didn't need to be shaved. The cath. lab is really not sterile as they let in the air ambulance crew and did the shave on the table. They didn't allow him to undress either although he was able to do so. I wasn't shaved for my C-section and nothing bad happened. I think this is just a routine they use to create submission and power.
They say the pain med and Versed are for the patient's good. However, after the procedure he remembers them telling him they were stitching devices to him and it would hurt. Hurt it did. At that time, they didn't care about the pain so their story of how they do this for patients not to feel pain is not true. They didn't even numb the area.
He had told the other hospital that he didn't want painkillers due to sensitivity but they failed to note that and by the time he was at the other hospital, he was drugged out of his mind.
In his health directive, he has listed what he will allow and what he won't. There is an app. you can put on your phone so it is always w/ you. I mostly go everywhere w/ him so I can once again turn into a tigress if needed. I have come out of retirement to protect him from this medical system that discriminates against men. They would never do to women what they do to men. I was once told by an urologist that he didn't like women like me. I told him to get used to it because women knew how to stand up against doctors and it was my hope that men too would learn how to stand up for their rights. I was defending my husband at the time. JR
Another aspect of the provider-patient gender relationship, which I don't recall being specifically discussed here is about the LGBTQ status of the patient (and even that of the healthcare provider).
Does anyone consider it insulting for a for a physician or nurse, male or female, to ask their patient their sexual orientation as part of history taking? Shouldn't that history information be pertinent and essential for managing certain aspects of medical treatment and nursing for that patient? For example a transgender male who has residual female breast tissue be cautioned to maintain breast screening for cancer? How about prostate cancer in a transgender female who may still have an intact prostate?. Here is the link for a presentation of the overall management of a transgender's health: "Transgender Health"
This all begins with worthy communication between parties. And what about the personal gender of the provider (physician, nurse, tech, etc.) Would you say that also should be part of the initial conversation between provider and patient? But, do you see this "gender disclosure" of both parties a necessary part of a "honest" and "beneficial" part of the provider-patient relationship? ..Maurice.
Dr. Bernstein, as you note there are legitimate reasons for some physicians or other staff to be aware that a patient is transgender, but rather than ask all patients, I suggest transgenders be the one to communicate that info to their providers when it is pertinent to the care being received. Transgenders are such a small % of the population that it would be overkill to ask every patient this question.
Concerning lesbians and gays, I say it is none of the physician's business unless the patient chooses to share it. Same goes for lesbian or gay healthcare staff. It is none of the patient's business. As a patient I really don't care whether they are or aren't.
Biker, Maybe YOU don't care, but some patients do. Especially when it comes to intimate care.
Biker et al, we DO teach first year medical students to include a Sexual History in their detailing of the Past History as in sub-category PERSONAL HISTORY:
H- Home, living situation and relationships
E- Education, employment
A- Activities, typical day, exercise, hobbies, sleep habits
D-Drugs (illicit, tobacco, alcohol)
S-Sexual history
S-suicidal or depressed (current or past)
S-spiritual history
Is any of the categories SO PERSONAL and SO UNNECESSARY TO ASK that these sub-categories of the patient's life as to warrant omission?
The patient is not threatened by the student to respond to any of the categories but will explain to the patient why the answers are important as a physician develops a complete medical history.
..Maurice.
Last year Press Ganey earned between $100-500 million and yet their worthless efforts have defined just how worthless your opinions are to the hospital where you received care. Notice they tell all their patients “you might get a survey” but that not all do. Probability tells you that the more statistical data you recieve the more accurate the evaluation. How many times have you heard each year how nursing is the most trusted profession and that we are expected to place our full trust in them.
Why do we need to know all the regs that AB in nw posted, answer is we don’t. How would you the patient know those even exist, most all nurses don’t. Why do we have State nursing boards and why is it that every 3 months they post pages and pages of nurses that have been reprimanded. Is it that they have to be transparent, to show that those who work for the boards are doing their job, but to what end. Who does it benefit? In many states the nursing board will not show the general public what nurses are reprimanded, why? Is it an embarrassment to the nursing industry or to the board itself?
AB in nw posted those regs to demonstrate that you the patient should be treated with dignity and respect by showing you those regs.Yet don’t you think it’s the hospitals, medical facilities responsibility to let you know those regs exist. If they let you know those regs exist that would cast doubt that you could trust anyone in the nursing industry. So, knowing what the regs are, how is that supposed to help you the consumer patient? Those regs are about as worthless as core values in that very very few know they exist. The same can be said of the nurse practice act, who can recite any of it.
It just seems to me that there is very little information provided to the consumer patients to make good informed consent when there is much information out there that says how little you can trust the medical facilities. One way I like to point out healthcare’s dysfunction is by comparing it to other industries. Now, not only have physicians been told to do no harm, but now they are being told to do no financial harm. No, you should blame all the nurse quacktitioners and physician actors for not having the required clinical skills and just ordering very expensive tests.
PT
Folks
I have seen many patients of the LGBTQ community treated very badly once it’s known by staff. It’s sickening! Furthermore, patients who suffer from hermaphroditism are treated worse and they don’t even fall into the LGBTQ community.Figure that one out, they are treated like circus freaks. Finally, if you are a male patient presenting to the emergency room with an object lodged in your rectum I assure you the entire hospital staff will be aware of you in short order.
PT
PT, I would think that would be a HIPPA violation. I know it's probably true though. Where I come from a doctor had to go to a hospital because his wife superglued his genitalia together while he slept. He wouldn't go to the hospital where he worked but he still didn't go far enough. It was known by everybody and their brother in no time.
I do not follow this website every day so
I am late in finding out about JR's allegations when her husband was in the hospital. Reading her various posts though I did not get the impression that either she or her husband complained. They definitely should and it seems almost a guarantee that if they did at least something would be done about this. In their case there were numerous witnesses to back up the story whereas I was out all by my lonesome. I still think that somebody associated with this site should write a book about all of this.
PA
Dr. Bernstein, all of those questions may be pertinent to the physician for purposes of their better understanding the whole person. I get that part, and agree it could be a good thing if it helps the physician see the patient as a real person.
For some patients however the fear of being judged and receiving lesser care is real. Others who may trust their physician may be concerned about confidentiality, especially on sexual orientation or history matters or concerning mental health. No longer can patients tell their doctor anything in confidence. It goes in the electronic record and it'll be there in perpetuity for the myriad of healthcare staff who don't need that info but who the system gives it to anyway. It'll also be there increasingly for govt. entities with non-healthcare agendas for whom weaponizing health records is a means to achieve their ends.
The system itself is working against the interests of all concerned.
This LGBT issue reminds me of a question I've thought of a few times in the past but never posed. Are there regional differences in the US concerning the issues we discuss? The US is far from being a monolithic culture. I've been places down South and in the Southwest that are so culturally different than New England that it doesn't even feel like I'm in the same country.
The LGBT issue that prompted me finally asking the question is just one example, but gays have lived in the open here for so long that it is not a big deal. The culture of Northern New England is live and let live and most people don't care about such things. If the LGBT community is being abused in the healthcare system here based on their orientation it is not anything I've ever heard about from the gays & lesbians I've known. We just had a transgender woman run as the Democrat candidate for governor and neither she nor the general public made that an issue in the campaign. It only seemed to be an issue for people in other parts of the country. She lost to a popular Republican incumbent in this otherwise Bernie-friendly State, and nobody pointed to her transgender status as a reason for her loss.
Coming back to the general topic of modesty/privacy/dignity, is it possible that there are regional differences? Or differences between urban/suburban areas and rural/small town areas?
PT is right. Staff, nurses, etc. have VERY LITTLE knowledge of the regs and their own responsibilities under their licenses. They receive little to zero training on much of this material. Sadly they rely on word of mouth and "urban myths". I think that makes it all the MORE valuable to complain about violations you experience from these folks.
On a related matter, for those of you that access medical care at HOSPITAL based physician offices, hospital based clinics, hospital based imaging centers and the hospital itself there are federal regulations that must be met by these entities and those regs apply to EVERY patient (not just Medicare & Medicaid patients). Each hospital, to receive federal payments, must be certified as meeting these requirements. Many hospitals use the Joint Commission to achieve this certification. Certification involves an unannounced inspection periodically. Some have a direct survey by the government (which is always done by the State licensing agency under arrangement with the Centers for Medicare and Medicaid Services, CMS). These certification surveys happen on average every three years. Failure to be certified means NO PAYMENT for Medicare and Medicaid patients and ultimately the closure of the hospital/medical center.
Attached is a link where you can see the list of regs that are required (they are called the Hospital Conditions of Participation and they have associated Interpretive Guidelines that outline their intent and how they will be surveyed).
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf
Some relevant standards from that document:
§482.13 Condition of Participation: Patient's Rights
“A hospital must protect and promote each patient’s rights.”
§482.13(c)(1) - The patient has the right to personal privacy.
“The right to personal privacy” includes at a minimum, that patients have PHYSICAL PRIVACY to the extent consistent with their care needs during personal hygiene activities (e.g., toileting, bathing, dressing), during MEDICAL/NURSING treatments, and when requested as appropriate.
People not involved in the care of the patient should not be present without his/her consent while he/she is being examined or treated. If an individual requires assistance during toileting, bathing, and other personal hygiene activities, staff should assist, giving utmost attention to the individual’s need for privacy. Privacy should be afforded when the MD/DO or other staff visits the patient to discuss clinical care issues or conduct any examination or treatment.”
§482.13(c)(2) - The patient has the right to receive care in a safe setting.
“The intention of this requirement is to specify that each patient receives care in an environment that a reasonable person would consider to be safe. For example, hospital staff should follow current standards of practice for patient environmental safety, infection control, and security. The hospital must protect vulnerable patients, including newborns and children. Additionally, this standard is intended to provide protection for the patient’s EMOTIONAL HEALTH and safety as well as his/her physical safety. RESPECT, DIGNITY and COMFORT would also be components of an emotionally safe environment. “
§482.13(c)(3) - The patient has the right to be free from all forms of ABUSE or HARASSMENT.
So, for example, those patients that are intentionally left naked/exposed for no justifiable medical reason, not given the decency of draping nor physical privacy, are being abused and violating the federal standards above. This is why I’ve stated complaints to the licensing agency, Boards, and, if the Joint Commission is the certifying entity, to the JC, should include the words like “abuse”, “sexual abuse”, “felt threatened, uncomfortable”, “unnecessary exposure”, "intimidating", etc.
If you don’t complain the behavior continues. Complain. AB in NW
PA, I am not sure that the book written by a participant here would be as effective in the short run. I do agree with AB in NW that formal complaints to the Joint Commission has the potential of being more effective. However, I also believe based, on previous postings that PT would promptly, disagree with my advice regarding the JC.
Biker, I fully agree that the electronic record which I never had available (not concocted or required) so thus not part of my past active medical practice and currently my participation in a "free clinic" for the poor and those patients who are not eligible for governmental support..hooray--all notes are written by hand! (the only handicap is being able to read all other physician's handwritten notes.)
Finally, acceptability of a patient for the doctor to ask and write responses about any personal details of the patient's history is strictly related to relationship and understanding with the patient's physician and specifically whether the patient understands the value of such documentation as part of the beneficial professional action to cure. "To cure": isn't that the ideal goal of all patient-doctor interactions. ..Maurice.
Thanks AB in NW, I didn't realize there were standards that clear and specific. That is encouraging and helpful. To what extent do the regulatory agencies expect patients to have first pursued their complaints directly with the hospitals?
Dr. Bernstein, if for example a patient is meeting with a physician for the 1st time for a routine physical, I suspect that it is not clear to the patient how the physician knowing the patient's sexual orientation or history is pertinent to the physical they are about to receive. The other thing is that it isn't the doctor taking the history but rather a Medical Asst. At least that's been my experience in recent years. When the doctor comes in they may ask some follow-up questions to probe deeper on an issue and they will ask additional questions as they perform the physical, but all of the lifestyle questions, meds being taken, past medical issues & surgeries etc is covered by the MA beforehand, the MA of course just following a script and keying in whatever the answers are.
Maurice
Twice I have made complaints to the Joint Commission regarding my care at a hospital and twice after making the complaints online I have received some ridiculous number that is best described in scientific notation. Never recieved a follow up from the Joint Commission, responses Nada. Having worked in management at hospitals I have on many occasions escorted the Joint Commission through hospitals from department to department as they looked for infractions. Most of these people are clueless and could not inspect their way out of a cardboard box.
What benefit is there to make a complaint to such an organization when you don’t get a response to your complaint. Hospitals are inspected once every third year and I assure you it’s never the same people that visit. The Joint Commission is not the venue for patients to bring complaints to, a) the Joint Commission does not have the manpower. They don’t have a base in every state, their field inspectors are flown out to inspect the facilities. b) The Joint Commission only insects hospitals for their processes, fire drills, fire exits, fire extinguishers, evacuation plans, you get my drift. c) if you want to score well with the Joint Commission on the day of the visit supply them with lots of coffee and donuts.d) The Joint Commission does not have regulatory power, they cannot shut down a hospital.
d) Passing their inspections is like getting the seal of good housekeeping. e) They are a for profit organization, hospitals pay them a sizable sum to inspect their facilities. f) Hospitals are not required to have their facility inspected by the Joint Commission, it’s a voluntary program. g) You will never see a physicians office volunteer for Joint Commission inspections. The Joint Commission is a line that sounds important dosen’t it, well it’s not. It’s just a name.
A patient at a hospital in Tennessee was given a fatal dose of vecuronium instead of versed. The mixup occurred when the nurse typed in the letters VE in the Pyxis and when the Pyxis opened the drawer that’s what she got and gave the patient. While in the pet scanner the patient died, a horrible death I will say, unmonitored. This facility was Joint Commission approved recently, before this incidence, Whoops, ill say their process is broken big time, HUH. You would think the Joint Commission would ask “ why is Vecuronium, a compound used in lethal injection stored in a Pyxis! In patient care areas?
One would think only Anesthiologists would have direct access to a drug like this. Did the Joint Commission fly their inspectors out to this facility, that’s a big NO. But I’ll say that the last Joint Commission inspectors who inspected this facility should have their Ass/Asses in a sling. You can’t brib CMS and the state with donuts!
PT
Maurice
Did I mention that the cost of the Joint Commission as well the cost of Press Ganey is figured into every patient’s hospital bill. I have mentioned that not all patients will recieve a survey from Press Ganey, that decision is made based on the hospitals decision to send you one. Why would the hospital allow you a dissatisfied patient to recieve a survey, a survey that could reflect negatively on the hospitals HCAP scores which could affect Medicare reimbursement.
If the Joint Commission is such a regulatory agency which it is not, wouldn’t you think they would be transparent and share, post, investigate, corroborate and/or allow CMS to review complaints from patients. CMS knows how flawed and corrupt Press Ganey is, just review online the 7 things you didn’t know about Press Ganey. But, don’t let all the medical complainers distract you from the real truth, medical staff hate the idea, concept that they are being evaluated, but yet, they know it’s a big scam.
PT
Yes, we have complained. However, the hospital said that nothing wrong had been done and that is the end of it. So we are taking legal action. We have filed HIPAA complaints, submitted complaints to the attorney general, and to the nursing board. All are still under review. We recently had to have his insurance company get involved because they have charge for a private room that he was never in on the first night. We had tried for months to get a response from the hospital but none until the insurance got involved. My husband was afraid to complain while he was in the hospital. All he wanted to do is to get all. At that time, he thought he had lost his mind because we did not know about the drugs. Once he was out and safely at home, we made the complaints. This is a religious hospital and basically their customer service rep sent a letter saying, "Too bad for you." Once we got a copy of his medical records, we were able to see many more things that were done that shouldn't have been. I am glad we did not complain before we got the records because that might have allowed them to change them.
On another matter, this same hospital asked my husband 3 times what sexuality he thought of himself as being. They also would ask what gender he preferred to have sex with. I told him he should have ask them because their private preferences also should be known too. However, he would be too chicken to but I would. They also asked him if he was sexually or verbally abused at 3a when he was just out of the procedure room. I think we should be able to ask or test for drugs and alcohol before they are allowed to give care. Some of the actions of one nurse could perhaps be explained. JR
Maurice,
Here is an excellent Medscape November, 2018 article titled: Why Do Patients Withhold Information?
The problem is that medicine has granted itself too much power.
-- It is OK for us to have patients undressed (and remain exposed) at our whim.
-- Paternalism.
-- It is an emergency, consent does not matter.
-- We need to know your complete history, if not to diagnose what is wrong with you, but for anticipatory guidance.
-- etc...
It is time to do away with the term patient. We are healthcare clients (just like the way of the financial industry). It is time for the patient to decide what level of service they want to receive.
It is also time for providers to do their jobs and begin practicing a little customer service.
Companies that practice customer service have better working conditions. Starbucks Coffee has tuition reimbursement and Amazon raised their minimum (starting) wage for all U.S. employees to $15 per hour. Read about 12 companies wWith the most luxurious employee perks.
Note that these companies have strong commitments to customer service and the "customer experience."
As I said before, the job of medicine will not get better unless medicine hands over power to the patient.
-- Banterings
I wrote the following to a bioethics listserv to which I subscribe:
Here is a topic brought up on my bioethics blog which I don't recall having been discussed here. In these days now where paternalism is "gone" and autonomy is going "full throttle" (or is it?), shouldn't we now be called and treated as "clients" or should we persist in being called "patients"??
I will summarize here the responses, if any, of the ethicists (physicians and lawyers and philosophers) who participate on the listserv. ..Maurice.
An ethicist suggested using the term "customers" for "clients". Another non-physician ethicist wrote the following:
There are plenty of healthcare settings in which I have wished that patients got even a fraction of the respect they get at the local Costco.
A "Customer" is someone with the power of the purse - - which patients rarely have, except within their deductible/cost-sharing. But even that deductible brings limited freedom, since the insurer or employer decides which providers are "preferred," and changes that list every year. A Customer not only chooses what to buy (which patients sometimes can, sometimes cannot do), but is able to hold the seller accountable (eg, return the product for a refund), which patients can't often do w/o the help of a lawyer.
So "patient" is not necessarily an honorific term. And "customer" is not necessarily derogatory.
A physician-ethicist followed with the following:
Patients, not customers or clients. The difference is in degree of autonomy. If autonomy in medical practice is going "full throttle" then it's time to apply the brakes and get back to shared decision-making.
As healthcare providers our first responsibility is to our patients but our job also includes being responsible stewards of medical resources ("distributive justice" in ethics-speak). I help my patients choose among reasonable options. It's my decision what those options are. Customers and clients are not restricted in that way.
Finally, another physician-ethicist agreed with the last comment:
“clients” suggests service provision on demand. Definitely understand the push-pull, but > 50% of a doctor’s duty is always to elements beyond any one given patient’s preference: guided by voluminous ethics & law, available evidence, resource management, and broader societal concerns. There is actually quite frequently some misalignment, however slight, between a particular patient’s preference and all the other factors. The physician has to navigate the space in between using her independent judgment. That’s unlike any client/customer relationship.
And so what would your agreement or rebuttal be for the above views? ..Maurice.
Good Evening All:
If this story about a doctor at New York-Presbyterian Hospital pans out to be true, just more reason for public oversight of every hospital in this country.
Hospital won’t name doc who allegedly molested 17-year-old female teen.
https://nypost.com/2018/12/07/hospital-wont-name-doc-who-allegedly-molested-teen-suit/
Hospital many yet again be trying to protect one of their own and bury this story.
Why else would they not tell the teens mom who the doc was or that it was someone impersonating a doc and they don't know who it was.
It's about TRANSPARENCY.
No mention of law enforcement involvement either.
Regards,
NTT
If physicians and the medical profession would accept the concept of the individual who comes to them, one way or another, should be considered "as a client" and not simply "a patient", there might be less of the behaviors (misbehaviors) of the profession which has been amply described on this blog thread.
One reason, the subjects of the medical system are not "clients" is because the sick individuals are subjected to the limitations of primarily "others paying for the services needed: health insurance, private organizational or governmental". This lack of self-responsibility for payment appears to be in stark contrast with what is the situation for those needing or requesting dental care from the dental profession. Payment often comes directly from the individual needing the dental care and so that individual has by this financial autonomy greater voice in what and how things are done by the professional. They are dental clients setting their role and power before and perhaps while they become a dental patient.
A brief article on this viewpoint can be found at this dental practice education website: http://www.speareducation.com/spear-review/2012/09/the-difference-between-a-client-and-a-patient
How do my visitors here compare the two professions and their behavior based on the concept of "client" vs "non-client--only a patient." ..Maurice.
Dr. Bernstein, I am a customer when I am buying standardized goods and services be it at the grocery store, a new vehicle at a dealership, my phone service, or the guy changing the oil on my car.
I am a client when I am buying a specialized service or unique goods in which, with my input as to what I want, that person or business uses their expertise to perform that service or create those goods. This is the guy that tends my flower beds, the realtor or lawyer handling a transaction for me, or the woman that I'm hiring to do a painting of my property.
I am a patient anytime I am in the medical system. There are both standardized and specialized aspects to healthcare but being a patient is not the same as being a customer or client in the sense that I describe above. I can't quite come up with the words here but being a patient is literally presenting my body for examination or some procedure to be performed on it deemed necessary for the maintenance of my health or even the preservation of my life. Being a patient is far more personal and one is far more vulnerable than when we are a customer or client.
There are of course many fine points that could be argued and exceptions to the rule found but generally speaking I see no need to change the terminology.
Hello
I am a longtime follower and have contributed both positive and negative experiences here. I have one of each to contribute.
My primary physician has recently modernized the office. I have to admit I see the benefit of him having the comprehensive digital records for my care and medications at his fingertips. The downside is that they send in a female staff member to update and dictate all the new information and findings. I was not 100% comfortable with her being there but I could see the benefit of recording all the data. Being there for the exam would be another matter. My Dr follows the same procedure every time. When he reached the part of the exam requiring exposure I was about to say something. Before I could the assistant packed up and left before the exam began. I felt very respected that she left on her own before the exam without having to say a word. I was pleased with the experience and told the office health management organization so.
Fast forward to my vasectomy a week ago, different doctor/office. The urologist did the whole prep and procedure on his own, no unnecessary office staff (all female of course) in the room, which was good. Midway through the procedure some random female staff member just comes barging in. I somewhat stunned by it look at her and ask "What the hell?" She just looks at me for a moment and says "Don't mind me, I just need to get a few supplies." and proceeds to rummage through the cabinets. I was incensed but at the same time not surprised. How ^%$# disrespectful can you possibly get? I find it hard to believe that this room had the only source of whatever she needed and that it was so critical that she could not *&^% wait until I was done. I am still fuming and the management body for this office will hear about it as well. One good thing is that most offices now want patient surveys and there is at least one avenue to be heard.
Mike
Mike, my guess is that female staff member saw you earlier in the waiting room or in transit to the procedure room and pegged you for a closer look when she knew you'd be exposed during that procedure. When you complain she'll act all innocent and say she didn't know you were in there, but her reaction having not been one of shock that you were there exposed and immediate apology indicates it was a contrived entry into the room. Sometimes people think they are not as obvious as they are.
This is from the oath of Hippocrates, dated around 2,400 years ago.
I will respect the privacy of my patients. It is the earliest expression of medical ethics in the western world. It is in fact still used today by the AMA code of ethics. First do no harm was coined in the 17th century. Here we are some 2,400 years later, no we are not carving these promises on stone tablets but rather these are solemn promises made supposedly by countless providers who can’t make up their minds.
Should we call these people clients, no customers, let’s call them patients and back and forth. It dosen’t matter what they call us, today healthcare in this country is well over $4 Trillion dollars and next year it will be $5 Trillion, that you can count on. Nursing supposedly has their own code of ethics but it’s ok, they don’t know what it is. They can’t even recite two regs from the nurse practice act. What do they call their patients, honey, sweetly, dearie, darling. That’s because they are too stupid and too lazy to look at your arm band to see what your name is.
Florence Nightingale has been dead for 108 years but it dosen’t matter, only 50 years after her death female nurses saw it ok to assault their male patients with a steel spoon if they had an erection, 250 years after “first do no harm was coined” and mentioned countlessly in nursing schools in this country. The moral of the story is that it dosen’t matter who the figures were that helped shape modern medicine nor does it matter how long ago they died. They might as well be fictional characters in a storybook, the term patient, client, customer just refers to an ever growing price tag.
PT
Good Morning Everyone:
Biker I agree with you, Mike was marked by the staff to "be checked out".
Looks like we have to hold their hands yet again.
Time for medical facilities and doctor's offices be required to post A sign on the door.
WITH PATIENT
DO NOT DISTURB
DO NOT! ENTER
Unless the doctor calls an emergency if anyone violates the room when the sign is hanging or lit, they should be fired on the spot for violating the patient's right to privacy.
After a few voyeurs are fired, word will spread and it should slow down the perverts then stop.
If doc doesn't fire employee include that tidbit in your complaint to state officials.
As AB in NW says, you want change, you gotta complain. It's the ONLY way this crap with end.
Regards,
NTT
Mike,
Call and speak to the physician directly. Tell him how you were traumatized and assaulted by the female nurse entering uninvited and unannounced. Tell him about the nightmares that you are having along with the flashbacks. All classic symptoms of PTSD.
Let us also NOT forget that despite signing a consent form, this may rise to the legal definition (both civilly and criminally).
You can also say that the facility would also that you would hope that the facility would also be the one reporting the incident to law enforcement because you would hate to see the charge of conspiracy added.
NOTE: Conspiracy is one of the most nebulous areas of American law. Rather than punishing individuals for the actual crimes they have committed, conspiracy laws incriminate individuals for the agreed upon intent to commit a crime.
I would also tell him that you would feel less victimized if the facility investigated the incident, shared with you the corrective actions and disciplinary actions against the offending employee.
This is extremely important, let the physician know that he treated you with nothing but dignity and respect, but it was this singular female that caused you the mental trauma. You can also tell him that you know that he will afford you the same respect and dignity in dealing with this incident.
If you really want to shake things up, ask if they are an employee or an independent contractor and if they are covered by their own liability/malpractice insurance or that of the facility.
This is how we take back our dignity.
--Banterings
Maurice et al,
Now I will speak to the issue of client-customer-patient.
Medicine can take a cue from other professions that have clients. The first is the financial industry. We use to have stockbrokers and investors, now we have financial advisors and clients. Read: Do Financial Advisors Work With Customers Or Clients?
Based on this article,"The key distinction is that when engaging with customers, the value isn’t actually the advisor (or the salesperson in general); the value is in the product. Good customer service may create repeat customers, but if you eliminated the product from the equation, the business would vanish. "
Does a physician sell a product?
The next arguments that Maurice posted was the issue of the payor and sometimes clients come to them without the luxury of being able to shop around; think the emergency department. We can compare another profession that is often compared to and works hand-in-hand with medicine: the legal profession.
First there is NO QUESTION that lawyers have clients. What about public defenders? Someone else (society) foots the bill. The lawyers also comes in an emergency, when the client has no choice. Yet, the lawyers still have clients.
Like physicians, lawyers and financial advisors have fiduciary duty to the client (patient). The fact that physicians legally have a fiduciary duty further cement the correct term is client.
Patient as an adjective means able to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious
As a noun, it means a person receiving or registered to receive medical treatment, from the Latin pati, meaning to suffer.
In the era of patient autonomy, patients refuse to suffer AND refuse to accept or tolerate delays, problems, or suffering without becoming annoyed or anxious.
Therefore, the term patient no longer applies.
I see that I am going to have further make my point on patient/client like I did on the modesty/dignity issue.
-- Banterings
Mike
For a moment let’s forget about Hippocrates and Florence Nightengale, it seems they don’t matter in this day and age. I can rent a cheap room for the night at best Western or the Motel 6 for around $50 bucks. Housekeeping will always knock and say “ housekeeping” before they enter but they usually know that the guests have checked out.
Now, when I see my primary care physician my co-pay is $15 bucks but I am fairly sure my health insurance picks up the other $150-175 which I believe is the cost of the office visit. In that time I’m in the exam room I am paying (renting) the room, paying the physician as well as paying for the electricity and all the other overhead. In the short amount of time that I’m in the exam room privacy is an expectation.
PT
PT
You make a good point, housekeeping in a motel tends to be more respectful than "professionals" expected to function at a much higher level and cost. It is interesting that you use this example, as I made the same comparison when I complained to the management organization stating that I had never received such disrespect during any other type of service (such as an oil change in my car). I related another story on this forum some time ago where two "professionals" entrusted for my care in recovery decided to have a bit of fun with me. As a joke they had me walk down to the public restroom for the day surgery center in my underwear to "show off that body", thinking I was still too out of it to remember. My body has always come out of anesthesia faster than my brain. I remember asking them multiple times to dress me first but lacked the capacity to resist their pushing me to do it. I cant even remember who/how many people saw me. Hours later when my head cleared completely I recalled the whole incident and was furious. I asked my wife (at the time) if the incident occurred as I believed it to and she confirmed, siding with the nurses that it was just a "harmless joke". Not to turn this into the battle of the sexes but the pattern is that it is the female care givers that are the most guilty. I complained to my insurance company and they were responsive, but I doubt there was any real follow through with the hospital. I just cant believe that these medical people think they can pull this crap with people they are tasked to care for and get away with it.
Maybe its because they always do.
Mike
Following up on Bantering's comments, I recently had to go through the admissions process at a Baylor Scott and White Hospital. When I was handed a General Consent Form to sign, I was told that I didn't really need to read it and just sign the yellow highlighted area at the bottom. Well, I did read it and proceeded to amend the areas regarding who could be in the room for treatment and also, the area regarding photography. The desk person literally freaked out and told me that I couldn't amend the form in any way.
Now in the past, this wasn't a problem as long as I initialed and dated the changes. There was nothing on the form that indicated that it could not be changed, so it was not officially a "Contract of Adhesion" according to the law. (My lawyer filled me in on this one.) She gave me another form to submit my changes on. I filled out the form, signed and dated it. She then handed me a fresh copy of the General Consent Form to sign. I put notation marks by the two clauses noted on the second form and wrote, "see attached form". She freaked out again and said that I couldn't do that and to just sign the form. Logic told me that the two forms needed to be tied together with something other that a staple because if the second form was lost, discarded or destroyed it would appear that I had just signed the general consent form.
Being in a hurry and seeing that this was for a minor procedure that would not require exposure, I signed a "fresh" Consent Form, witnessed the second form stapled to it after receiving copies of both.
A bit of a stacked deck, don't you think? What recourse does a patient have but to speak up and read before you sign? As a side note, the rest of her office seemed amused at her loss of composure.
Ed T.
Ed T,
Any form can be altered. You can sign "see attachment" where you sign your name and say that is part of your signature. It is the same way an illiterate person signs an "X".
The attached form will have your signature.
You ask, "What recourse does a patient have but to speak up and read before you sign?"
Read my response to Mike above...
-- Banterings
And to confirm some of the suggestions previously noted here about medical staff behavior with respect to patient dignity, here is a British study with conclusions which I think you will agree with. Here is the Conclusion:
Conclusion
Individual staff behaviour has a major impact on whether threats to patients’ dignity, such as aspects of the hospital environment and patients’ impaired health, actually lead to a loss of dignity. The hospital environment could be highly conducive to dignity but the behaviour of individual staff with individual patients will still strongly influence these patients’ experiences of dignity. Staff behaviour has a particularly strong influence over whether patients lose dignity or not during intimate care. While provision of privacy is important for patients’ dignity, therapeutic communication is also essential. For patients to feel that their dignity is promoted, staff should communicate in a way that helps patients to feel comfortable, in control and valued.
Recommendations and implications for practice
All practice staff should behave towards patients in a way that promotes dignity during each and every interaction.
• Staff must provide privacy within the environment, by closing curtains fully, not intruding without warning and consent, and minimising bodily exposure.
• Staff should use interactions that make patients feel comfortable (humour, reassurance, friendliness and professionalism); in control (explanations and information giving, offering choices, gaining consent and promoting independence) and valued (helpfulness, consideration, showing concern for patients as individuals and courteousness).
• Staff should not use interactions that are curt or authoritarian nor breach patients’ privacy.
• Experienced staff should role model behaviour that promotes dignity to more junior staff.
• Staff should take appropriate action if they consider a patient’s dignity is at risk due to the environment or staff behaviour.
• Staff should be extra vigilant in situations where a loss of dignity is more likely, for example, during intimate procedures and when patients are unable to take steps to promote their own dignity.
..Maurice.
In the British study re: dignity, is it propaganda the way it would be in the US? In other words, just words on paper or directions for staff actions? For example, are the staff trained to the "Recommendations and implications for practice"? Also, is there any enforcement? If the British have administrators in the medical community as we do in the US, rather than managers, these "conclusions" are just for laughs by the staff, assuming they are even aware of them.
BJTNT
Hello,
I tried altering the Consent Form, as Mike did, prior to getting pre-op tests at the hospital. I was also told that this was inadmissible. After a supervisor reaffirmed that I couldn't be admitted, until I signed an unaltered form, I proceeded to walk out of the hospital. Before I was able to drive home, I received a call from the surgeon's staff asking me to call them. (Apparently, hospital and staff don't want to lose a paying customer. Amazingly, there was also not the usual communication gap between hospital & dr.) I immediately called CMS to determine if the hospital could require that this form be unaltered. The response was that since it was a privately-owned hospital(not state- or federally-affiliated one), the hospital could set this rule. After being assured by the surgeon that no pictures would be taken (nor students, etc. present), I returned to the hospital the following week to sign the form. (I thought that the least I could do was to give them a week to sweat. Actually, I was probably the only one concerned.) I was told by the hospital that, before pictures were taken, I would have an opportunity to give consent at that time. (No mention was made whether "that time" meant when I was drugged senseless.) I asked why I couldn't just refuse on the form and avoid future inquiries; however, that proposal was unacceptable. Needless, to say, I felt powerless. It seems that "informed consent" does not admit to negotiation. For me, "informed consent" meant "the hospital's way or, the highway". Unfortunately, it seems that once you're in the hospital's "care", you'll be treated according to their rules and definitions (of dignity, privacy, etc.).
Reginald
Reginald,
One can easily (after the registration process) hand them a document that says something to the effect that this document supersedes all previously consent forms signed, that you have changed your mind and refuse photo/video, student participation, etc.
Simply tell them this is to be a part of your medical record and they MUST include it.
-- Banterings
Good Evening:
If the recommendations in the British report from 11 years ago were implemented and not just done for propaganda as BJTNT stated, then that just goes to show how far behind the rest of the world the US Healthcare system really is.
From a technological standpoint, our healthcare system is right up there with the best of them.
From a human standpoint, we're no better than a third world country. We're in the dark ages.
The Brits saw this as a problem 11 years ago and sought out ways to correct the problem.
When we see problems with the human element side we just spin our wheels and tell the public its not a real issue.
Sad.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”
― Margaret Mead
Regards,
NTT
Hello Redruth, Cornwall, United Kingdom.. I see from my statistics counter that you have been visiting here numerous times. Of course I don't know your name or gender but since I put up the link to a medical dignity study and summary from United Kingdom which was followed here by commentary by a couple of my visitors, we would certainly appreciate if you could enter the conversation with your objective and subjective description of how medical dignity is or is not practiced by the medical system in your country. It is important to clarify differences, if any, between national cultures as it applies to how patients are treated in the medical system. ..Maurice.
I haven't been able to get on this blog for a week but I have a response about Mike's vasectomy that I wanted to voice.
Mostly I just wanted to say that I disagree with Banterings that Mike's doctor respected him.
It seemed at first like Mike's doctor respected him until SHE showed up. But she did show up and so far as we could tell nothing was said to her, for her to leave by that doctor. Unless that woman somehow out ranked the doctors, he had the ability to ask/tell her to leave and shut the door behind her. ( hopefully there was a curtain blocking the veiw )
The doctor could have put a sign on the door since locking the door isn't allowed.
The female staffer entered because the doctor allows his staff to do so.
Good Evening Everyone:
WB JF.
If Mike's procedure was done in an office setting like many procedures are going nowadays, most rooms are NOT setup with patient privacy in mind.
I went once for a procedure. Rooms are small, there's no privacy. Walk in the door & there's the chair with the stirrups attached but lowered to allow patient to sit. No curtain for privacy.
When I saw the setup, I cancelled on the spot and walked out.
Doctor should be help responsible for the actions of his staff.
They need to use signs on the doors
PROCEDURE UNDERWAY
DO NOT ENTER
PATIENT AWAKE - QUIET PLEASE
Unless doctor calls an emergency, entering room with sign on the door should result in immediate termination.
Remember, we can't sit back and hope healthcare fixes dignity and patient respect.
WE have to take this fight to them if WE want CHANGE.
It's the ONLY way it will happen. Speak loud and clear until you have no more voice and write until your fingers are cramped.
“Nothing is impossible, the word itself says 'I'm possible'!”
Regards,
NTT
I just wanted to post an update on my vasectomy experience that we have been discussing.
After I sent in my seething complaint about the disrespectful treatment from the staff, I got a timely response from the doctor. He seemed sincere and said that he appreciated my direct feedback and that they would take measures to ensure that such things never happen in the office again. Whether or not his words are worth anything, who can say? I for one don't plan to revisit that office to find out.
There were no curtains in my procedure room either, but there was a door and one would think that was enough. If disrespectful staff blow through doors why wouldn't they throw back curtains as well?
JF makes a good point and makes me think about something I had not considered. "The female staffer entered because the doctor allows his staff to do so." This is absolutely true, and now that I think about it the doctor never said a word about it. Now I feel like he is as much to blame as she was.
Mike
Mike, the good news is your speaking up had effected a change at that practice. For sure you were not the 1st male patient targeted in the manner you were but hopefully you were the last. Most men that may have objected to such intrusions wouldn't speak up, including those who realize it was intentional. We've been socialized since childhood to not complain about indignities we suffer. The female staff know this and as occurred to you, use it to their advantage.
This example is a reminder that the issue isn't just female staff being inappropriate. Their male bosses and co-workers are enablers to the extent they see it happening and do nothing.
Mike,
I had a lipoma removed from the side of my head a few years back. My plastic surgeon, one of only 3 physicians that I trust, had the curtains in front of the exam room door drawn for the whole procedure even though I did NOT remove ANY piece of clothing. Also, staff knocked and talked from outside the curtain unless invited in.
My friend up North told me that since exam room doors have no locks, that if ever exposed, he would place one of the chairs available in the exam room against the door to keep out unwanted visitors OR bring a door jam bar to the appointment.
At the very least, it will start a discussion about unwanted visitors.
MOST IMPORTANTLY:
-- Ask the physician to document the discussion in the medical notes.
-- Explain to the physician how such intrusions or the presence of VOYEURS would be traumatic to your mental well being.
NOTE: Do NOT let the physician try to correct you and force you to use the term "chaperone," "assistant," etc. Explain that the term VOYEURS provides CONTEX to your feelings about additional people in the exam room. By asking you to use a different term, the physician is IGNORING your feelings about interlopers and DISMISSING the potential PSYCHOLOGICAL HARM (side effects) that this may cause you.
What you have effectively done is protected yourself by creating a situation where the physician, the practice, the facility, and the corporation would be LIABLE for INJURIES under MALPRACTICE as a result of ADVERSE PREVENTABLE SIDE EFFECTS.
You can also negotiate the terms under which additional people would be allowed in the room IF ABSOLUTELY necessary. One of them is a favorite punishment that the nuns in Catholic school used; that is the voyeur stand with one's "nose to the wall".
The pain, anguish, and (psychological) trauma of voyeurism is well documented as well as the sexuality of voyeurism:
Janay Rice and the Problem with Trauma Voyeurism
Victims tell of long-term trauma from voyeurism of Wellington theater director
Peeping Toms' Voyeurism Scars Victims' Psyches
Voyeurism in HEALTHCARE is even considered traumatic.
THIS IS HOW WE TAKE BACK OUR DIGNITY IN HEALTHCARE!!!
-- Banterings
Actually when I mentioned curtains blocking the veiw , I wasn't referring to her veiw. She accomplished her goal and saw what she wanted to see.
It's sometimes emphasized that medical staff close doors behind them as they come and go from the room but a door doesn't have to be left open to show a naked patient to random patients or staff. The door can be opened when people are at the wrong place at the wrong time ( and then the door shuts. )
You can always depend on medical facilities to kick you when you are down, after all, they have had a lot of practice doing it. A nurse bully is almost never absent in a nursing workplace. In fact, a nursing professor ( do you believe that there is such a stupid thing) coined the term in 1986, but it’s actually been going on for a very long time. Now , according to the AAMA ( American Association of Medical Assistants) if you can believe that there is such a stupid thing, medical assistants are supposed to act as a patient liaison by making the patient feel at ease in the physician’s office. Medical assistants are supposed to be essential members of the patient-centered team if you can believe that.
Medical assistants who claim or call themselves a nurse is considered a crime and any medical assistant who uses the title as a medical assistant who is not working under the supervision of a physician, physician assistant or nurse practitioner is guilty of a class 3 misdemeanor and any physician, physician assistant or nurse practitioner who refers to their medical assistants as nurses should be reported to the respective state medical board.
According to the Joint Commission and OSHA on workplace violence in healthcare bullying is a workplace violence that takes on the form intimidating or humiliating behavior non-verbal and these are the exact words they use.according, they say that bullying does not include discrimination. I find it disturbing that an organization like OSHA and the Joint Commission does not enforce behaviors by investigating and/ or holding facilities accountable, simply because they are not regulatory agencies.
PT
Good Morning ladies & Gentlemen:
Interoperability: Informed Consent for the real-world physician.
http://www.medicaleconomics.com/business/interoperability-informed-consent-real-world-physician?elq_cid=121070&elq_mid=4752&rememberme=1
Some doc says they should re-write the informed consent (IC) we sign because the patient who is at a doctor’s visit has not signed a consent for the release of RWD.
Newer terminology, in clinical research, is real-world data (RWD) and real-world evidence (RWE).
The way things are now, clinical research doesn't have access to data from your office visits and they want it so they are recommending a re-write of the IC.
They want to draft a new IC Draft with the goals of the clinical practice and clinical research.
They say a simple first step is to inform and educate patients with information on RWD through patient information booklets.
Their way of educating patients is tell as little as possible and just say everything will be just fine. Sign here please.
Best regards to all,
NTT
To Banterings
I read your last post. That is how my husband feels. He has nightmares about how they disrespected his personal dignity. He also has nightmares because they stole many of his memories and he is very afraid of the parts that he doesn't remember based on the horrible parts he does remember. Not only did they steal his dignity but also his memories. For me, I had a "warden" who wouldn't go away and invaded my private space. I could not deal with my emotions since he wouldn't leave. He received information that I didn't want him to receive and heard information that neither my husband or I wanted him to have. It was an invasion of privacy both mentally and physically. I have often said I felt "raped" as rape is using a method to gain control over the victim. That is how I felt. It was a rape of the soul. Some say use violation instead of rape as rape is what a man does to a woman. I think it has more than one meaning and I am not belittling it.
As for signing the forms, you should not say ask me later if I will amend it as you will most likely be drugged and will agree to anything as they give you drugs to make you cooperative and to obey their commands. My husband signed numerous forms when drugged that ordinarily he wouldn't have signed. He remembers one form he was told to sign was for the insurance payment but upon receipt of his medical records was actually a consent form giving permission for photos, observers, students, etc. He wouldn't have signed it in his right mind.
We both have post hospital stress syndrome. My husband never wants me to leave his side if he has medical treatment. He wants protection from them. They seem to think we are objects placed for their manipulating purposes. There needs to be information out there what really happens during a pci and STEMI. The heart attack is the least scary part. JR
PT,
OSHA is ONLY concerned when the bullying is directed at other employees, even if by patients.
-- Banterings
A. Banterings
OSHA is just another wanna be think they are a regulatory agency like the Joint Commission. The only thing these two agencies are experts are are consuming Donuts and lots of them.
PT
Good Morning One and All:
There is a website called Patient.
https://patient.info/
They have groups in their community area that cover everything under the sun.
Under Men's Health/Prostate Problems a BobbyT started a discussion called
BPH patients and male modesty during exams.
If the guy is for real, he says he works in the medical training industry where we provide live simulated patients to train medical students and advanced nursing students on how to be respectful and courteous while performing sensitive personal exams on patients. I am also a BPH patient myself and have endured invasive physical exams myself.
He was asking men in that group for what their medical providers said or did (or did not do) to make you feel comfortable and help you keep your dignity. What did they get right and what they got wrong. What upset you most? How much privacy did you receive? Did the gender of the urologist or nurse practitioner matter? Were other personnel present during your exams either to assist or act as a chaperone?
If you could give any advice to a future doctor or nurse practitioner on how to make such exams more comfortable for the patient what would it be?
Here's the direct like to the discussion. He's has 10 replies so far.
https://patient.info/forums/discuss/bph-patients-and-male-modesty-during-exams--688937
This might be another avenue for us to get the word out if he's for real.
FYI Moderators over there are very careful so watch what is said of they'll block ya.
Otherwise, lets not scare him to much. LOL
Have a great day everyone.
Best regards to all,
NTT
I think that cell phones w/ cameras should not be allowed to be carried by medical personnel while they are on duty. It is too easy for them to snap pictures of people when they are in compromising situations such as drugged. Only cell phones without pic/video capability should be allowed. Medical personnel are not above taking pictures as newspaper headlines have verified this perverted behavior. I have read from some medical boards about OR staff using cell phones during an operation. I can't begin to say all that is wrong with this!
As far as having unwanted staff intrusions when a person is exposed, hospitals are particularly bad about not respecting privacy. Social workers, techs, and admissions clerks are routinely in a "patient's" room when they are exposed. Never should anyone be exposed unless it is medically necessary in that area and only to those who need to be involved. An admission clerk does not need to see your private areas. If privacy doesn't matter, then why bother with clothes at all?
I also think that medical staff should be screened before shifts for alcohol and drug usage. They should also be screened for viruses, etc. as needed. They should also have to tell their gender identification and sexual preference as that is now routine for "patients." How do you know how to address them if you do not know their gender identification? I also think it should be illegal to get information from a severely drugged individual and especially having someone sign consent forms when drugged. That needs to stop. There is a lot of abuse of power going on in the medical world and it is time we the consumers speak up and get it stopped! JR
Hi JR:
I've been advocating for years that they take any type of device with picture taking capability out of the hands of all healthcare workers during working hours.
If you're caught with one during your shift, automatic 2-week suspension without pay.
Get caught a 2nd time, automatic termination.
There has to be a consequence in place with teeth that will make them think, before they act.
If healthcare employers want their people to have communications, they should at the facilities expense equip their people with small two-way radios.
It's the only way to take the enticement out of the hands of any would-be perverts.
Regards,
NTT
My son works for a very large defense contractor. Phones with photography capabilities are not allowed on the premises. The people that work there manage to survive the workday without their cell phones. I imagine healthcare workers could too.
Here is a modest proposal;
Since the Hippocratic oath includes training the next generation, legally only a physician can train another physician, and ethically it is the responsibility of the profession (guild) to train the next generation of "craftsmen," then as part of their licensing, nurses, physicians, NPs, PAs, and anyone who can do a physical exam (on THEMSELVES), should be required to annually demonstrate that they can train and evaluate students.
There should be 2 students (for each year of renewal); one male and one female (to demonstrate proficiency in physical knowledge of each gender). Nurses would have the added burden of training of urinary catheterization. Physicians with certain specialities would have the added burden of instructing students of their speciality.
Lower level licensed professionals (often referred to as technicians) would have to train 2 students (for each year of renewal) in their speciality.
They do not have to train from scratch, they can be a "practice patients" where the licensed individual examines them and the provider seeking licensing evaluates their performance while helping them become more skilled at their art.
This use to be done by students on each other (peer physical exams). My example spares the students until they are graduated and licensed.
-- Banterings
I don’t think anyone here on this blog can fully appreciate how pervasive the use of cell phones by staff in patient care areas. You can’t even imagine the extent they are used in in surgery, for example by the circulating nurse surfing the web during major surgery. The fact that it happens so often speaks volumes as to how poorly staff are managed. Despite the fact that I’ve known a number of people terminated by taking cell phone pics of patients did little to curb the behavior of others.
It was 10 years ago that a chief resident at a prominent well known hospital took a cell phone pic of a patient’s penis and sent it to other residents. The chief resident was terminated and reprimanded by the state medical board. The concern of the facility was that it was leaked to the news media and an investigation ensued for weeks as to who reported it. The patient was ultimately awarded $250,000 after threatening a lawsuit. I know the case very well as I had family members working there at the time. Cell phones in medical facilities is one thing, but staff with their cell phones out in patient care areas especially surgery is another.
PT
Good Morning:
Cell phone issue I have found is a double-edged sword.
Patients don't want them used by staff in any patient care areas and on the flip-side staff are increasingly not liking being recorded by patients and their families.
One solution would be to limit everyone (staff and the public), with a phone with picture capability to common areas like waiting rooms, cafeterias, and the main lobby. Common areas doesn't mean nursing stations or break rooms either.
Staff violation still gets an automatic 2-week suspension without pay.
Get caught a 2nd time, gets ya an automatic termination.
Public violation causes security to take the violators phone until they leave the building or they leave immediately with their phone.
There are ways to resolve this and other issues. Healthcare and the public need to find a way to work together and find a common ground to start the process rolling.
The system is the way it is today because we allowed it to get that way.
The system can be fixed. All sides just have to find the will to want to fix it. And therein lies the real problem.
Have a great day all.
Best regards,
NTT
As we are about to enter a New Year (2019), we should look back to December 15 2007 when the "Volume 2" of Patient Modesty was started .
Anyone want to describe here a comparison of what was written then as to what is being written now in Volume 93? What has been better described and understood now as compared to then? What has been accomplished for our readers and for any earlier set goals as evaluated in this comparison? Or do you see everything written here now as similar to the past and can be described as personal ventilation or indeed "hyperventilation"?
Or do you see that there is evidence of a constructive "march to a goal" rather than a place to ventilate? After 93 Volumes on this topic what has been accomplished? It is important to evaluate, as we do in medical therapy, whether what we are doing is performing what is intended. ..Maurice.
I would have to disagree that the public shouldn't be able to record medical staff. Reason one being that it is a memo of the event. Many times information being given isn't absorbed at the time and it serves as a way for the individual or the family to hear all information that is given in the manner that it was given. Reason two is that the medical staff shouldn't be saying or doing anything that they don't want to be a permanent record. Maybe if they knew it, they would be more careful in their actions. Having said that, the public should never record private information on another individual unless it is a life threatening incident. In the same hospital of horrors my husband was at, an older lady just out of surgery was calling for help. The nurses ignored her. She managed to get up and fell. My niece heard the nurses come running and saying that she needed a CT scan as she had busted her head open. Too bad there was not evidence of their neglect as I am sure their "thorough" records won't reflect this. Hopefully, the older lady will be okay. By the way, this was in the same cardiac unit my husband was in. I do see value in the public being able to record a memo of events. At school besides knowing how I should and how I should not deal with kids, I always knew that I could be recorded. Never say or do anything that could be the next early news headline. Medical people need to live by this motto too. Of course just like in education, there are those who never learn.
Some doctor's offices are now using a commercial transcribing service for "patient" encounters. This means their is a lay person included when the doctor sees a "patient". This is a new invasion of privacy. I wonder if they have been educated that what they see and hear in the encounter is private. Also, I think if I encountered such a person, I would tell them not ask that they must turn towards a corner and not look during a private exam. I don't really think anyone but the doctor needs to see my privates including the nurse\chaperone unless she/he is medically necessary. JR
JR,
I would suggest that the scribe and their laptop also be covered with some sort of "bag" (about the size of a garbage bag) that allows them to hear and breath, but NOT see).
-- Banterings
JR,
As a male, I always compliment the MD when he/she doesn't have a female scribe. With one MD it was a good opportunity to establish rapport by discussing taking typing [keyboarding for you youngsters] in high school. Another MD uses a hand recorder. I compliment him every time for no female scribe. Granted the person that types the transcription has access to my medical information, but let's not fool ourselves that our data is protected. Read HIPAA for what it says and not what you want it to state.
I picked an MD because he had a male scribe and quit seeing this MD when he replaced the male with a female scribe. I always made such a point of his having a male scribe that he commented on my compliment.
BJTNT
JR , You hit the nail on the head.
Is everybody else having having to take all these different steps to get on this blog now?
JF, one goes "nowhere" without taking "steps". Simply "complaining" without putting ones complaint into action is purely "ventilation". That may be "therapeutic for the complainer" but it doesn't facilitate reaching a "goal" of resolution which is felt to be essential for "all". ..Maurice.
That's not what I was talking about Dr B. A bunch of pictures appeared on my phone and I have to go through a process to be able to post. Otherwise what you say about"speaking out? Point taken.
And moving on with "patient dignity", how about a few words about the interface or interaction between "patient dignity" and "professional dignity", the latter exemplified by an article and comments in a KevinMD presentation, specifically about work attire in the medical profession.
For example, how would a male patient feel if he was able to clearly see the female physician's anatomy by her dressing without long coat fully covering her body.
Dignity, dignity, dignity in medicine may be applied in both directions. ..Maurice.
I thought you’d be interested in reading this article.
Look at how only the chest between the breast bones are exposed for this surgery. Of course, it does not matter if the chest of this man is exposed since he is a man. I wonder if this can be done for a woman. This surgery took place in India. They are less likely to expose your private body parts for surgery if you are awake.
Misty
Maurice
Yes, I read the article and yes for the most part I agree with the author and I have much to add about the long coat vs the short coat. There is much to be said about the way female physicians dress, short skirts with stilettos, really! What are they attempting to exemplify here, that they can dress like a high class Ho?
What about the scrubs that female nurses would seek out with all the lettering “ I’m a sexy nurse” with Betty Boop emblazoned all over the uniform. At what point does it not become a uniform? From another perspective, should all this sexual advertisement be projected at patients when they are ill or is it part of the plan to further sexually objectify their male patients? You tell me?
PT
I think the public should know about the usage of such drugs as Versed that allows the medical community to commit those breaches of personal dignity violations. They are described as conscious sedation that allows you to be awake. Not really. You may respond to verbal stimulation but your basic thought process and the ability to act on those thoughts are silenced. The main purpose of drugs like Versed is to erase your memory of what has happened so they can treat you however they want and you won't be able to stop them as it is happening or remember what happened afterward.
It is my opinion that drugs like Versed has done a lot to allow this culture of medical people not caring how they deal with people during procedures and that carries through even to when people are in just for routine exams without Versed being given. It is my opinion that every drug that is used as a standard cocktail for procedures should be fully outlined and consent should be expressly given for their usage. To me, these drugs are more like a war crime drug. No one has the right to purposely erase or steal someone's memories. Drugs like Versed are used in conjunction with pain killing drugs so their usage is questionable. What do they do that they don't want you to remember?
It has to be the way they leave you exposed and the comments they make about you. Many times the exposure is unnecessary like during a percutaneous coronary intervention. They should cover the genital area but it is easier for them and more entertaining to leave the area exposed. I think with males especially they are entertain by the shrinkage occurring when exposed to cold. Most of the medical staff involved are young female staff and if you read and are around some of them you will hear how disrespectful, immature, and vulgar many of them are outside of their hospital setting. It would be naïve to believe they are any different in the medical setting. JR
Good Evening:
JR, you are right the public has a right and should know the real effects (especially long term), versed and other benzodiazepine drugs the anesthesiologists are using on patients before they are used. Versed is only supposed to be effective for between one and six hours
The problem is the majority of society doesn’t want to know and that’s the way the medical community hopes it stays. If people start to question the side effects to the drugs they want to use, then the medical people will lose a huge ace in the hole they keep in their back pockets for covering up a surgical team mistake(s).
They’re just beginning to realizing that the effects versed has on wiping out memory can in some people last far longer than they initially realized. Instead of a day or maybe two, the memory lose effects are lasting weeks into months, sometimes years.
Patients in general, don’t want to know the ins and out as to how the surgery they need will be done. They just want to be knocked out until its over and not remember anything. Hence in steps the anesthesiologist with just what the doctor ordered. A load of benzodiazepines to make you forget from the time you get to pre-op until you wake up in PACU. If your lucky, your head will clear in a day or two and you’ll start making fresh new memories.
This is why is so important to have an advocate with you because you won’t remember the conversations you had with anyone in pre-op.
I’ve made it perfectly clear to my advocate who must get a copy of any signed informed consent for before I leave pre-op. That the document must say in it in plain English I do not under any circumstances consent at any time to the use of any drugs whatsoever that have the ability at any time during my stay at your facility to cause me to have anterograde amnesia in any form whatsoever.
The precise mechanism of storing memories in the human brain is not yet well understood but we’re going to give it to the patient anyway and hope for the best.
People experiencing amnesia as a side effect of versed and other benzodiazepines are generally unaware their memory is impaired, unless they had previously known it as a side effect.
Versed, is superior to diazepam (aka valium), in impairing memory of procedures like endoscopy & colonoscopy, but propofol is the gold-standard because it has a quicker recovery time and a better memory-impairing effects on patients. It is the most popular benzodiazepine in the intensive care unit (ICU)
So, to make sure your memory is really scrambled, they give ya a mixture of the painkiller fentanyl with the amnesia drug Propofol and you’ll never know what went on. That mix is used a lot in colonoscopies.
Sorry, but I’m not going to be your guinea pig.
So, JR unless the attitudes of people change, the medical community will be able to keep yet another one of their “dirty little secrets”. This one could be life altering and/or threatening to anyone they administer it to.
Patients that know about the drugs should whenever possible, push for a local or nerve block instead of a general.
Have a pleasant evening all and a Merry Xmas and healthy New Year.
Regards,
NTT
JR
I certainly would welcome twilight anesthesia for procedures that would a) facilitate my comfort b) enable me to be more cooperative, however, there is much more beyond these modesty, privacy issues that I have concerns about. It’s the IDIOTS that are administering them.
Medication errors are frequent in the healthcare workplace. It was found that medication errors account for billions of dollars in lost productivity, wages and medical expenses. Medication errors injure 1.5 million Americans each year and kill tens of thousands of Americans annually.
Is this study I just listed new? Why of course not. This study occurred 13 years ago and it’s getting worse! To me it seems ironic in a way that I’m concerned that medical staff most likely will not be respectful of my privacy during surgery or a procedure, that’s a given. There is a good probability as well that a medication error will be made. I don’t know how year after year these IDIOTS get the credit as the most trusted profession. Do a search, “ medication errors”.
PT
Good Afternoon:
I call this
Nightmare Before Christmas
It was the night before Christmas; and all through the ward
not a patient was complaining; and the nurses were board
They sat around; with nothing to do
I know someone said; let’s check out the hunk in 222
With a wink and a smile; they headed down the hall
as someone then said; I can’t wait to see his balls
When they got to his door; they took a look around
not a person was stirring; there was no sound
The target was laying; quietly in his bed
he was in a coma; from a bump to the head
They posted a guard; and the rest went in
as their eyes began to bulge; to match their grins
They gathered round; each side of the bed
oh, look at his bulge; one of the nurses then said
With a nurse on each side; they reached for the cover
in great anticipation; of what they would discover
In one swift motion; they pulled it down
only to discover; he was wearing a gown
They came this far; to get a good look
everyone knew; they’d do whatever it took
They pulled back his gown; to see their prize
as they saw they smiled; with wide open eyes
They looked and admired; as they pulled out their phones
snapping away; as someone began to moan
He was covered back up; when they were done
then out into the hallway; where it had all begun
Each nurse was grinning; ear to ear
as they knew there’d be more; in the upcoming year
Regards to all,
NTT
What has been discussed here for years perfectly and poetically written here by NTT.
Thanks. And to NTT and all, have pleasant current holidays and a healthy year ahead and free of "nightmares". ..Maurice.
Some of you may not be aware that we have an article about Versed on our web site. You can go to this link.
Misty
That poem belongs on a hospital review.
NTT
The poem you posted, accurate and insidious as it is occurs frequently but I don’t think any poem storyline etc. can fully depict the behavior displayed by the Denver 5. The nursing industry has been up in arms for years over nurses being displayed in sexist roles, porn and so forth, yet, we see nurses trying hard to portray themselves as sexy nurses as so stated by the inscription on their scrubs.
There are those that sit on agencies, American nurses association, ethics for nursing etc. that work hard to wipe up the mess, discredit and unprofessionalism that for years has been attributed by nurses themselves. There is much effort done to improve the image of nursing but nothing done to actually change the culture, just damage control.
There has never been any effort to improve the patient experience, just bogus surveys from Press Ganey that you pay for but often don’t get. There has not been any action by the ANA ( American nurses association) or any other nurses association to educate, get to the root cause and/or even bring it out in the open.
In the case of the Denver 5, those involved were Given 3 weeks of paid administrative leave, a bonus if you ask me. The State of Colorado nursing board took no action against them. This kind of warped Ghoul Munster movie shit they did would be off the chart even for any porn script. Who could even think that after you died they came back to open up the body bag to get another look at your junk!
PT
Good Afternoon:
PT you are correct. The Denver 5 is about as low as any human being can go.
Due to years of practice, the healthcare apparatus in this country has great damage controls in place.
Until a party they injure decides to go public for the better good rather than take the money in exchange for their silence, people will never know just how unsafe our healthcare system really is.
We need to find someone with influence to stand with us and start making changes to a broken system.
Until then we keep the pressure on any way we can.
Best regards to all,
NTT
PT, the nursing board in Colorado condoning what the Denver 5 did (by taking no action) comes as no surprise. This is why voyeur-type activity continues in the healthcare world. There are no consequences. Healthcare, like religious and educational institutions, has long prioritized hiding sexual abuse so as to protect their public image. Image is more important to them than the victims. That the nurses in Denver weren’t promptly fired affirms that the hospital also condones what they did despite their public statements to the contrary; and that was with a public outcry. Given offenses rarely make it into the public arena, I imagine the nurses at that hospital know there is little to no risk in sexualizing their male patients.
Twana Sparks and the lack of an acceptable response, that was telling also. The ratio of staff who spoke up for the patients? I think that it's probably the accurate ratio in general.
Her x lover's finally turning her in was in all likelihood because of her personal hatred towards Twana for personal reasons.
In a way that doesn't matter though because it shows that what the cowards fear is real. It really is unsafe to go against the flow.
We have written a health directive that addresses all of the issues that my husband experienced. Although health directives normally do not cover these, we both feel strongly that any contact with medical people in the future needs to happen in a much more controlled sitting. Everyone should make clear and expand health directives to encompass what they expect. Health directives should not just be for end of life or if you are incapable. He no longer wants females nurses alone with him as he is unsure what the last two found so entertaining when he laid drugged and exposed. He doesn't remember this but I encountered them laughing uncontrollably. The one cardiac critical care nurse said that she didn't know how to check the medical equipment without exposing him. It was such a violation! He was exposed for an hour or more in a room full of techs when she didn't know how to get the life saving equipment to work. She knew he was drugged and really didn't care about his personal dignity as she also performed bedpan duties while these techs were in there. So much for any compassion or nurturing from nurses in you are a male in their care. Because of the Versed and Fentanyl, my husband wasn't able to defend himself against their violations. These drugs are used to masked their horrible treatment and any mistakes in treatment. JR
More about personal dignity. I think that medical people being respectful of personal dignity (i.e. not leaving "patients" exposed, not making fun of them, etc.) goes hand and hand with quality care. If the medical are too lazy and uncaring to be respectful of personal dignity then it is reasonable to think that the overall level of care is just as sloppy or inferior. In my husband's case, they didn't respect his personal dignity and his level of care was indeed horrible.
It does make sense that if they don't respect a human being's right to personal dignity, then they don't respect that human at all. As a woman, I demand what I want. Many men are afraid of being ridiculed if they ask for personal dignity. I know I would not feel comfortable being let alone, naked with 2 male nurses if I was drugged out of my mind or even in my right mind. However, it is very common for a man to have multiple female care given to him. I find this practice to be discriminatory. I don't suppose anyone in the medical community would care to admit that women are just as capable of bad behavior as men are when left with vulnerable humans. Just read news headlines about women teachers having sex with underage male students. And just about all medical workers have a sex life too. They don't park their sexual thoughts at the door and pick them up after their shift. Be real! JR
Good Morning:
Hi JR.
Our medical community is not alone in that they can’t admit women are for the most part incapable of bad behavior.
Society in general has the same problem. Always quick to crucify the male but hold the horses and let’s take a look at that if a female is the violator.
The underage male student is a good example on how our society sees the issue. If a male teacher were to violate a student, they’d lose their license, be fired, and have to face prison time.
When a female teacher takes a male student, SOCIETY looks at it as if he had the time of his life. Except for Texas, judges and prosecutors feel that way or the woman would get prison instead of probation.
Very unequal.
If ANY healthcare worker ever tells you that their job has no sexual overtone to it, they are outright lying.
Before anything else we are all human beings first and foremost. Part of being human is being sexual. We all do it. Some people have a hard time controlling that emotion which leads to trouble sometimes.
Until enough people stand together and tell congress and state legislatures “we’ve had enough” the healthcare system will not change. They don’t have any reason to.
They are so entrenched in covering up the truth at any cost that not many know there is a real problem there.
The system must have local civilian oversight if its to grow and prosper. State boards such as nursing must have civilian males included on their board or they will continue to cover up female healthcare workers mistakes.
Medical boards need civilians so that doctors aren’t handing in their license in one state due to trouble then going elsewhere and picking up where they left off.
The rank & file won’t be pleased but it’s the only way to get transparency.
The system is broke. The only way it’s going to get fixed is if good people see what’s going on & tell their legislators to get busy, ignore the special interests, and fix the mess.
In all my letters to legislators I’ve always said I am ready & willing to sit down with anyone willing to come to the table with an open mind and willingness to do whatever it takes to re-build what we have into a world class healthcare system. I’ll do my part to make this work for future generations.
Regards,
NTT
NTT,
My brothers male teacher violated a male student. The guy didn't speak up until years later. It could be that female victims are listened to more but overwhelmingly victims keep mum about the abuse. There's just to many ghoulish people who take delight in other people's humiliation. So the victims pay the price and do what seems the most safe thing to them.
NTT: You are so right on. Thanks
It seems that only lawmakers can change the delivery of medicine. The medical community will never change from within. They won't even allow oversight by anyone outside the medical community.
What chance does a patient have against the medical community? Who wins when the health administrators get to pick the arbitrator in an arbitration? Who wins when the medical institutions can hire a handful of lawyers against your 1-2 lawyers if you can escape arbitration? Only lawmakers are going to change the system [an exception being the rare person who has the people skills of Biker]. Do MDs really think that changes by lawmaker will benefit them? Still, MDs keep their heads buried in the sand. "I only want to see patients". "I only want to see patients". "I only want to see patients". Mantras are OK, but only when they work.
The medical community's propaganda perpetrated on the public is effective only because it's such an easy sell. Who in the public doesn't want to believe that the medical community's purpose is to treat medical issues and even save a life? What an easy sell. It's another example of why managers are not needed in the medical community, anyone can do the job - ergo health administrators.
We patients are not going to win with the tame oversight agencies operating today.[lawmakers N.B.]. Take the CA Medical Board for instance. There are two civilians and two lawyers with the majority members being MDs. Why? Their answer. "Medicine is so complex that only fellow MDs can judge." If we were considering diagnosis and treatment, OK. But look at some of what's being considered:
a. Fraud - Only a MD can evaluate billing and other fraud committed by a MD? Huh!
b. Sexual Abuse - Only a MD can evaluate sexual abuse by fellow MDs? Don't we want community morality standards and not MD standards?
c. Drug Overuse - Only a MD can evaluate opioid overuse and DUI convictions by MDs?
d. Incompetence - Only a MD can evaluate medical incompetence in a fellow MD? Well maybe in some cases, so the Board calls in specialists as is done in civilian courts? Md Boards are courts since they decide and have penalty powers.
Medical boards composed mainly of fellow MDs that control the licenses of MDs are tame agencies. It's like a murder trial in which an alleged murderer demands that only murderers sit on the jury since only they can understand murder.
Social media is a great opportunity for us to change inaccurate public perception of the medical community. With growing momentum on social media, we can elect new lawmakers, not beholding to the donations made by the AMA. It wasn't that many years ago that the AMA was the largest entity [not industry, occupation, but single entity] contributing money to politicians.
BJTNT
I agree. Things have to change. I am dedicated to make the change happen. My husband didn't have a stress echo test done because they would not allow him to have an advocate in with him. What do they have to hide? He insisted and left without the test. We have found another place that said they have no problem with him having an advocate, me, in with him. Now all we have to have is the prescription from the doctor for this place not connected with his practice. Wonder if that will happen?
I have begun a blog site that will be telling his and my experience and I hope that others will add their experiences. It is important that we the people get our stories out there so others will know what has happened and what can happen.
I know some don't care but they really should as bad things do happen. As I said before, if your personal dignity is not respected than I feel they do not respect you are a person and are likely not to medically treat you as well as they should or to give you proper care. It seems like the older we get, the less they care about our dignity. You can verify this by visiting a nursing home.
In other aspects of our lives we demand respect. Why can't we demand and be given respect when we are at our most vulnerablest (I know not a word)? If medical workers can make up false info to put in a legal medical document than I can make up words.
I am gearing up for our lawsuit. I am also going to take what happened to our lawmakers. I want everyone to know what happened and that if nothing is done, it will keep happening and you never know when it could be you or your loved one who is violated, abused, and harmed. JR
It " SEEMS" that only lawmakers.... seems is the key word. Maybe a more effective way is targeting key people in an individual way.
Why did I get into this profession--a "cesspool" of uncaring unprofessionals?
Why am I teaching students to participate within this "unprofession".. to swim along with the others? There must be some "good" in my profession and there must be some "good" (a real benefit for their future patients) at the end of their formal education road when my students become physicians. Are we really tearing down an entire profession because some (but not all) of those who attend to human patients are misfits or worse in their work?
Looking at the "big picture", can't we congratulate the medical profession for the good and beneficial and dignified attention and care and cure that happens every day, every hour, every minute in medical practice throughout our country and the world? Can't we also drive out the misfits by speaking up before or at the time of the misbehavior or apparent crime,reporting to Boards and government and taking legal actions? However, there still must be some "good" for all patients in my profession and the profession I am advocating for my first and second year students. ..Maurice.
Dr B, There are good doctors and medical staff. My mom was pulled back from the brink of death and I feel very sure I was to. MANY people are saved and there conditions improved by hospital workers and doctors. Many doctors and nurses blend making it better for the patients and making it better for their own spouses and family.
It doesn't change the fact that there's lots of goons around, ready, willing and able to humilate other people. Lots of cowards around who look the other way.
You're one of the good guys. I feel sad that it seems like we're only saying negative things. But the one negative thing we keep harping at is a major concern and has the same damage and devastation that sexual abuse does.
BJTNT,
What will happen next will be people taking the law into their own hands.
It is not to that point yet.
Burnout and suicide are the byproduct of the attempts of the profession to stick to the failed religion of medicine: paternalism, gender neutral, being thorough. What were once held as gospel truths have been disproved. (Think reproductive cancer screenings.)
PEs are still routinely required for oral contraceptives.
The only recourse is to file lawsuits which may be without merit, yet they are a cry for justice from patients. Increased malpractice premiums have forced physicians to become employees of the only ones who can afford the premiums.
If medicine had handed control to the patient (reverse paternalism), then physicians would hold the highest status the profession has ever seen. Instead, patients expect them to be abusers and sexual predators that are a necessary evil.
-- Banterings
And the secretiveness. It is absurd that you are treated like you shouldn't know what is happening to you and your body. It is not their right to exclude you in decisions about yourself or your body. Informed people make better decisions. Information and openness are the keys to the kingdom.
Back to personal dignity---If males took pictures of female private parts without their permission it would result in more than what happened in Denver. Sometimes we go too far in fixing problems that we allow the same problem to fester and grow. Abuse of male patients is ignored or thought of as allowable. Everyone should be treated with dignity. When you watch videos of ER procedures or elective procedures care is given not to expose. Why can't they do that all the time. Teaching has to change. I think that anyone who wants to become a medical worker at any level should be a "patient" in their classroom teaching with their peers. That will at least allow them to know how it feels to be on display. It should be repeated periodically throughout their career so they don't forget. They also should keep in mind that their loved ones may be subjected to the same deplorable treatment they are giving to others.
Yes, there are some good people in the medical field. However, the bad experiences make us forgot the good ones as the bad ones instill distrust and the feelings of violation and abuse. I can say for sure that hospital post traumatic stress syndrome is real. JR
Maurice
I’m sorry Maurice but I have to say for the most part I’ve not had one positive professional experience. This explains why I’ve been on this blog and why I’m so vocal about the issue.
PT
Most of what is written on these threads is about what is wrong with the medical profession. This is in contrast to the classic duty, to the objective, where the professional must in any or all interaction with their patient are "set" or, in fact by its various members who are "dutied" to the patient beneficent attention, comfort,care and hopefully cure of their patient's discomfort, both psychological and pathological as the patient's illness which brought them to the attention of the profession in the first place. Anyone who does anything which ignores these basic criteria is unprofessional.
How do we screen for unprofessional intent and subsequent behavior of those physicians, nurses, technicians and others involved in the interaction with patients?
And who should do the screening?
In medical school, we as teachers, really do screening though mainly in the environment where we teach and are present to observe or hear complaints from others. But what happens after graduation? What happens in resources for other jobs in medicine, before or after technical completion? How can the patient community rid the entire medical system of those who violate the criteria of the duties as described above? There must be answers to the above questions I presented. ..Maurice.
Good Afternoon:
Dr. Bernstein, there are good men and women in healthcare that deserve credit for the job that they try to do under such adverse conditions.
It's not easy when the majority wants to go the wrong way.
I'm sure they feel bad when they turn in a colleague for violating a patient or rule to protect them.
These are the people the system needs but they are few and far between these days and yes they should all be given a thank you for the things they do.
With all the personnel shortages in the industry these days they are letting anyone in with a degree or certificate without first doing any type of psychological profile to see if they are a fit to the position they are attempting to get.
It's all those mentally unfit people that have gotten access to the system that is the problem & the system has no coping mechanism in place to weed them out and get rid of them until the damage is done.
My hope for the healthcare industry for 2019 is a greater resolve to let go of the past and work with both genders to help build a better system for all.
Yeah I know I'm asking a lot but somebody has to ask.
Have a safe and great new years eve Ladies and Gentlemen and I'll see you here same time same station next year. The year WE TOGETHER make a difference.
Regards,
NTT
Dr. B Thank you for all you do to educate caring talented physicians. For my husband and I it is not our Doctor or most of our surgeons that we have a real deep dislike and problem with. It is the as I refer to them support staff. In my job of 34 years, no one and I fell in that category although I was a contributor to many reports, who had less than a 4 year bachelors degree was classified professional. I worked in science related position, but not medical.
Our problem is with the never ending berating, ridicule, harrassment of men who do not want to be exposed to female staff. This stems from the many awful experiences with Cnas, scrubs, rad techs, nurses that he has been embarrassed by, forced themselves on when he refused , threatened by, humiliated by and berated by. I won't go into all the awful things these women have said or done to him. He says never again will he endure a heart Cath, colonoscopy, or prostate procedures again. Thanks to the hateful, demeaning support female staff, he will not go to the doctor by himself for fear of what the cna will force on him or pry into . I now accompany him to every appointment and if the cna tries to keep me out he says he will leave.
So again Doctor it is not the Doctors we either have problems with it is the female and for me male support staff. Thankk you again for helping those of us who need this sounding board. I have been following your blog for some time , but since we both have been putndown by scrubs, nurses and cnas on the You Tube videos we have commented on we have chose not to comment here. Happy New Year to all on this site. MS KS
Thanks to MS and KS joining the conversation.
I do want to invite those who read this blog thread and feel that the views presented thus far are "overblown" and that behaviors described here are indeed "statistical outliers" (though individually offensive to both the patient, their families and the medical system itself), as "outliers", these descriptions merely tend to destroy the public benefit of the medical profession and the healthcare system.
So, for those who do have opposing or modified views of what has generally been written here over the years, I encourage you to write a Comment here for publication and I will defend your right to express an opposing position without personal (ad hominem) backlash by others. After all, this blog has "Discussion" as part of its title and "discussion" does include varying or opposing views.
What I just wrote is my attempt to encourage other visitors to this site (and I know there are "others") to feel free to participate and tell us all what they know, think or believe. Nevertheless, I hope what I wrote will not discourage our ongoing population of contributors from continuing to express their understanding and views. ..Maurice.
Dr.B.
My criticism of the medical community isn't so much against the MDs as it is the staff/employees. I respect all the education and training that MDs have to endure before starting to earn real money. Not everyone is willing to make that sacrifice. It bothers me when MDs lose their licenses.
One of our MDs was fired [contract not renewed] because she spent too much time with patients. I felt somewhat bad since I was guilty of BSing with her.
I liked one MD, but his staff was so bad that I "had" to leave, even with the realization that medical institutions rank near the bottom of well run operations.
Our ophthalmologist was a true humanitarian whose actions for us and family implemented his words of caring. Plus he spent a month each year in India doing charity until his getting older resulted in weeks of recovery back in the States with "indigestion". Dr. Michael Lippman ran a one person office. He was even on-time for appointments.
In summary, I can accept the egos of the MDs, but not the staff who piggyback.
BJTNT
You all might be interested in a 2012 blog thread (with a response today) that could be applicable to patient dignity issue: Doctor Spying on a Patient's Blog" and, in fact, PT was one of the responders to that thread. ..Maurice.
So long as they are on their own turf , they're pretty much untouchable. They have more money ( partly through overcharging for services )
Most doctors are doing the best they can navigating a system run by insurance companies, non-medically trained administrators & regulators, and with lawyers prowling around the edges ready to pounce as soon as something goes wrong. I understand why the system doesn't work so well for them either.
I would not be alive today were it not for a diligent primary care doctor finding an aggressive cancer I did not know I had and the surgeon/oncologist that took over from there. In most things I defer to the judgment of my doctors on medical issues and I am generally compliant with their instructions.
My complaint with doctors and everyone else in the system is simply the manner in which they don't take into account patient feelings when it comes to modesty/dignity/gender matters. This is evidenced by their making believe that their convenience equates to necessity, that being polite equates to being respectful, and that gender doesn't matter for patients when it comes to exposure matters.
I have no idea how prospective students are screened for acceptance into medical school but where the system goes wrong perhaps is in not screening out the ones that are overly focused on themselves and that don't show much empathy for others. Maybe they can be coached in how to get through the interviews. I don't know but it would seem any facade couldn't be maintained throughout medical school. The male student that seems to enjoy "locker room talk" would make me suspect as to what his conduct will be with female patients. The female student that is an ardent feminist that sees everything in terms of men vs women would raise flags for me too. It is highly doubtful their future male patients will be treated with respect and dignity in the manner discussed here. I do appreciate it might be all but impossible to weed out such students based on such subjective criteria, but the reality is they can be spotted for what they are while still students and then they will be turned loose on unsuspecting patients if their personality defects are ignored in medical school.
Reference: "Can't we also drive out the misfits by speaking up before or at the time of the misbehavior or apparent crime,reporting to Boards and government and taking legal actions?" Dr. B
Short answer is "no" because the medical community is self monitoring in the most part. Not that egregious cases aren't penalized. The medical community is a monopoly that's sees itself immune from outside change. One way it's a monopoly is that it's a zero sum game. Patients can leave for another medical institution, maybe even several leave. Do you think they are going to tell their friends that they were treated with respect and dignity at the new institution? For the several that leave, several will return. The bean counter's model of zero sum is validated because the medical community's culture is ubiquitous.
Like most monopolies, the bosses couldn't care less about the people they serve. They do care about their customers, i.e. the government and health insurance companies that authorize and pay the bills. Co-pays by patients are rounding errors.
More males would frequent the medical community if they were treated with respect and dignity, but the administrators couldn't care less. Patients are not customers. The bosses are not managers. The administrators even obtain health administration degrees. Why? If the owners of medical institutions were interested in well run operations, they would hire those with business degrees.
My issue isn't so much with MDs. I can tolerate their demigod status. What I can't accept is that all the other employees see themselves as angels of the demigod and therefore can do whatever they want. And they are right. As long as they do the assigned tasks they can control patients with impunity. My main criticism of MDs, as a group, is that they don't advocate for patients.
The Hippocratic Oath nowadays is only useful to the medical community for marketing. It's been replaced with the Modern Hippocratic Oath. This Oath, largely from the one proposed by the Dean of the Tufts Med School in the 1960s, is the basis for the Modern Oath - not that most Med Schools don't have their own versions. Compare them side-by-side. Calling these versions the Modern Hippocratic Oath is analogous to calling the Communist Manifesto the Modern US Constitution. The Oath has been reduced to just a suggestion.
In perspective, a significant minority of employees have a value system that overrides the medical community culture, namely they treat patients the way they would want to be treated. These are the employees that receive the letters of appreciation. Unfortunately, the administrators see this as validation of their policies. If they were managers they would realize exacting the opposite. A manager would respond with "Why can't we treat all patients the way this employee treated a patient?" Let's make that our policy, train to that treatment, and penalize those who don't follow the policy. Fines and time off w/o pay will get staff attention, especially when you include the supervisors.
The MDs are the last priority on my criticism list. Receptionist are at the top since receptions make the first impressions and the easiest of any employee, along with the uncertified medical assistants, to replace. Only bureaucrats [health administrators in this case] would allow receptionists to treat the people they serve the way medical community receptionists do, but then again the administrators would have to care and be knowledgeable of staff doings.
BJTNT
Correction: When I stated Dr. Lippman ran a one-person office, I should have said a one-MD office since he had a full staff and exam rooms.
Good Afternoon:
Dr. B. you once asked “Why am I teaching students to participate within this "unprofession" to swim along with the others?”
Sir, you are doing what you do because you believe there's still hope that the system will see the error in its ways & that the people you are training today, will one day take over & run the system the way it should have been run from the start.
MS KS you are always welcome here to voice your opinion any time. We’re here to listen, exchange information, and come up with executable answers to resolve the issues we face. From what I hear from a close friend of mine who regularly responds to your messages of encouragement, you do a superb job on the YT sites.
Please don’t ever let them push you or your husband away. Your voices like everyone’s, needs to be heard.
Lawmakers & lawsuits may very well be the only paths to force change on a system that refuses to listen to reason.
For lawmakers that chose to cozy up to the special interests & follow the status quo instead of their constituents, by way of the power of your vote, they can be replaced (as what happened in the 2018 vote), with people who will listen and get the job done.
As for lawsuits, it’s up to the people to stand firm and not be bought off by the system.
If you have a legitimate claim against the system, bring your complaint no matter how painful into open court where it will be “on the record” for all to see just how inadequate and immoral our healthcare system can be.
Look at Johnson & Johnson and their talc issue. They fought tooth & nail to keep the issue hidden but plain ordinary people got together and found lawyers who believed in them and they won. And, they will win on appeal also.
Once society sees for itself how deeply entrenched the problems are and the real possibility that it could very well affect them or their loved ones one day soon, society will act to protect the people from a flawed system.
Doctors are under a lot of pressure these days because most practices are now hospital owned and everything revolves around that almighty dollar.
Not why the doc went to medical school for first and foremost. Getting paid a lot of money came after taking care of people.
Many doctors don’t realize they have an untapped resource available to them called their patients.
Even in this day of “modern medicine” men and women still demand their pride, dignity, and respect be kept intact at all times.
Doctors want to do doctoring not administrative work.
I believe if doctors put their administrator sides aside during that first meeting and talk to their patient as a person, they would find out about a patient’s boundaries and the patient about how the doctor handles different situations. After that first give and take each side can decide if their pairing would be a good fit or not. If they decide to make a go of it, the doctor can convey to staff any limits you and he/she agreed to so everyone from the office manager to ancillary staff treats the individual with the utmost respect and dignity at all times.
We can help each other. All you have to do is show us you heard us by making a few critical changes and in return you’ll have a backing to be reckoned with so you can get back to being a doctor first and administrator second.
Patients and doctors speaking with one voice will force any congress and/or healthcare system to sit up and take notice.
BJTNT I agree with you that most of the time one can put up with the uppity uppity MD. The only time I take issue is when his supporting staff treats his patients wrong. Then he is responsible because he hired the people.
Worst is the front desk in a urologist office where you have a nosey receptionist and she wants everyone behind the desk besides her to know why you are there. I infuriate them and the support cast, by telling them a male issue when they ask why I am there.
New year, new day, new start.
Let’s find a way together to give men back the choice that was taken from them over 50 years ago.
Regards,
NTT
MS and KS,
Thanks for sharing. My husband and I feel a bond with you. He, too, will never be alone again during a medical procedure. He was mistreated for the last time during a heart cath. It truly is a horrible experience. We are suing on several very vivid legal issues but we want the personal dignity issues brought up as to us they are equally important. Where can we find your YT site. Of course you will be harassed from medical people bc they is what they do until they do become a "patient" or one of their loved ones do. Then they too will have a different story to tell.
I go everywhere with my husband now as he is afraid that he may have another emergency and will be mistreated again. He needs a stress echo test but can't have it done as they would not allow his advocate, me, in the room. They said it was bc of blood, IVs, and if they need to work on him. Hopefully, they are not throwing everyone's blood around and he doesn't want them doing things to him w/o me having been informed first as they tend to drug him out of mind to make him compliant and have no memories. It is a scary world that of the medical industry. JR
Maurice,
As this thread is filling up fast, perhaps Patient Dignity (Formerly: Patient Modesty): Volume 94 should be Patient or Healthcare Client? I believe that the way that we, the healthcare clients (what was formerly called patients) INSIST on being labelled as healthcare clients (and NOT patients).
This will send a message to ALL providers that we demand respect.
I am ready to defend and educate on this position (patient vs. healthcare client).
(I am not sure that the profession of medicine is ready to deal with the subject or my ethical, intellectual, and moral defense of the term..)
-- Banterings
JR
Said “ Of course you will be harassed from medical people bc this is what they do until they do become a “patient” or one of their loved ones, then they will have a different story to tell.”
No, No, No they won’t.
When nurses schedule their mammograms they know it is a 100% female gender industry. When they deliver their babies L&D is a 100% female gender industry. They know that nursing is essentially 95% female gender industry. When they visit their female gynecologist they know ALL staff will be female. When they choose their female urologist they know all the ma’s will be female. When they choose their female general practitioner they know all the medical assistants are female.
When female nurses require medical care do they seek the medical services that are offered at the hospital where they work? Such as L&D, mammography or radiology despite the fact that they know females will be delivering the care.
No, No, No they won’t.
They seek medical care at other facilities where no one recognizes them even though it is females that deliver that care. These female nurses who seek care at facilities other than where they work make it a point to tell their caregivers that they are a nurse and they belong to the sisterhood!
Does this make them hypocrites,
Yes,Yes,Yes it does.
PT
Banterings, though, as noted in previous postings, the issue of defining the subject of medical diagnosis and treatment as "client" vs "patient" has had energetic discussion in both the ethics and medical community writings and I don't feel comfortable yet to define my patients in anyway as "clients" when I am preaching to myself and my students that those we diagnose and treat are "subjects", individual humans with their own interests and concerns and not disease "objects" to be manipulated. To be a "subject" is to be a human being, still alive and in need of medical assistance thus the individual to be attended to and attempt a cure. Calling the patient a "client" formalizes a relationship in some other social activity but not medicine. "Patient" is a special title to a special activity that does not exist in any other business or interactive relationship. It is the "passenger" not "travel client" who rides a bus, train or aircraft even though the passenger had the personal responsibility for selecting the mode of travel and responsible for paying to obtain the service. To define a patient as a client alters the true expected relationship between the ill individual and the individual to diagnoses and cure. So for the present I look to the term "patient" as the "passenger" of medical care.
Now, as we focus down on "dignity", the current blog thread title and the relationship between that of the patient and all those who are to and will "attend" the patient, what do you all think about how in the patient-doctor relationship, each in that relationship should call each other in conversation? Should physicians, nurses et al speak to the patient from the outset or later only with their first name? Should the patient speak to the physician as "Doctor..." or nurse as "Nurse..." or should the professional's title or job NOT be included and the patient should use only the professional's first name only or the last name only? "John, I have this pain..", "Maria, I need a bed pan.." Would both parties in a medical relationship show its consideration and strength and understanding and perhaps even more empathy by a more informal title given to each party? "John, I have this concern about unnecessary exposure of my genitals." "Bob, I'm glad that you told me before my exam since Mary, was to be my assistant in this procedure but I could get Robert in place of Mary to help me". Silly? Maybe. But how does your doctor name you and how do you name your doctor as you both converse? ..Maurice.
PT, It hasn't been all female staff for me with those gyno exams. Anyway that doesn't always make a lot of difference.
Dr. Bernstein, I see myself as a patient, not a client. I call all physicians Dr. so and so and expect to be called Mr. so and so in return. I expect all healthcare and administrative staff to call me Mr. so and so. It is just a matter of respect and proper protocol.
Nurses, techs etc that I interact with only ever tell me their 1st name. Often their name badges have their last name in such small print that it is hard to even see what it is. Often the name badge is turned around altogether or the last name is taped over or the badge is to the side of their hip making it hard to see. I'm convinced nurses and techs don't want anyone to know what their name is, and so I either use the 1st name if they give it to me or I don't use any name at all.
NP's and PA's are the problematic group for me. It doesn't feel right to me to use their 1st name and yet calling them NP so and so or PA so and so sounds awkward too, same with calling them Ms or Mr. so and so. Not sure what proper protocol is here.
If the doctor calls me by my first name then I call them by their first name. We aren't buddies and respect is a 2-way street. I have a title and last name just like they do. I especially get irritated when the 20 some snob nurse refuses to address me respectfully. It is like their mission isn't complete until they have completely belittled and disrespected you and made sure you know they have control over you. I think they go out of their way to I'm timid ate men especially middle age men. Just my observation. Men don't fight back but I will. JR
Biker
I’ll tell you what to call the np and pa’s, nothing. I have insurance and I don’t seek out those lower level wanna-be’s. Why should I? Unless of course I present to the Er in which case I ask for an md or do. Np and pa’s from what i have seen do not appropriately address their patients so who cares.
PT
OK, here is a very common scenario that repeatedly occurs as an instructor of first or second year medical students on a hospital ward, on the information provided by one student who just completed a history and physical exam, of course with the permission and cooperation of the patient, tells the instructor and students later, away from the patient's room that the student has found the patient has ascites (fluid in the peritoneal cavity of the abdomen). None of the other students had yet examined a patient with ascites but knows that there are special techniques of palpation and percussion to establish the possibility of ascites. The instructor then tells the group that it would be of value for the instructor and group to go to the patients room and all have a chance to examine the patient's abdomen for signs of ascites. As the patient who is yet unaware of the instructor's suggestion, how would you want to be informed about the teaching exercise, accept or reject the entry of 6 students and an instructor into your hospital room with their intent to examine your abdomen. What should the patient expect as the behavior of the instructor toward you and to the students usually all gathered around the patient's bed? You know you are in a teaching hospital but how would you want this scenario to begin (or not begin) and, if started, proceed to some end? What role should the patient have in such a teaching exercise? This scenario has a lot of issues of modesty and dignity and even a form of altruism built into what in my 30 years experience is a common and usual teaching issue and how it is performed is an important matter for patient, instructor and students. Let's hear from all "you patients" who might sometime be that patient in the hospital room. Be descriptive.
I have been writing a teaching paper on this subject for my medical school and would appreciate your input which could contribute to what I present. ..Maurice.
P.S.-If you would like to write me e-mail of your suggestions, not wanting what you write to be published do so. Remember, though, you will be disclosing your e-mail address to me.
My e-mail address, as usual is:
doktormo@aol.com
But for my use in the document I am writing, your input as a patient whichever way you present it would be valuable.
..Maurice.
PT, as a rule I try to avoid NP's given I have no way of knowing if they have much clinical training or experience. The diploma mills & online schools are churning out NP's that have never worked a day in their lives as RN's and who have very little in the way of real life experience. PA's have had 2 years training with many clinical hours, plus they work under the direction of a doctor, so I am more trusting of them than NP's.
In rural America patients increasingly only have the option of NP's and PA's for primary care. When I needed to find a new PCP, there was not a single primary care doctor or internist, male or female, within 1.75 hours of where I live that was taking new patients. There weren't very many NP's or PA's taking new patients either. I ended up finding a young male PA 1.75 hours away that was part of a large practice at a large teaching hospital. I figured I'd then at least have the option of being bumped up to a doctor if needed. Despite my going into it with reservations, he proved to be very impressive. Regretfully he left there within the year and I got assigned to a female PA. She's OK for that which I'll see her for as I have a urologist, gastroenterologist, cardiologist etc. for most of my care. I'm guessing much of the typical male physical exam is skipped at my age as my "Welcome to Medicare" physical with her did not include my pants coming off let alone my underwear. She did offer to do a DRE which I declined.
Maurice,
I think that you have the same fear that the entire profession has and that is there is a new paradigm in healthcare. The new paradigm is that the patient is actually a client. Unlike the passenger, the patient is not simply purchasing a service. The passenger has no input in how they are transported.
I believe that you also fear that I may be correct in this assertion that I make.
I would be very concerned if you did NOT have that fear, especially after the whole modesty/dignity debate.
The new paradigm is that of the death of paternalism and the rise of patient autonomy, the death of the independent physician practice and the rise of retail healthcare.
As medicine clings to the failed philosophy of paternalism, society minimizes it. Mid levels are replacing physicians, home testing and mail order pharmacies are bypassing the abusive atmosphere that exists in primary care.
Let me tell you where healthcare is going:
Computers and autonomous robots are going to replace human beings. Truly being gender neutral and not having the prying eyes of students and nurses, they will become the main providers.
For those procedures that require the human touch, plastic surgeons (and their commitment to customer service due to this being elective) will thrive and become the choice for surgical intervention.
Those necessary providers that require the human touch, such as cardiac surgeons, will become retail healthcare employees.
Spa technicians, body modification artists (tattoo, piercing, etc.) will take on more healthcare related tasks.
I can go on, but I will leave it here.
-- Banterings
Dr. Bernstein, the way I would like to be approached for the abdominal exam is with honesty and respect. Tell me that the 1st exam indicated the presence of some fluid buildup that you yourself want to verify and that you'd like, with my permission, to have the accompanying students also do the exam as part of their training; that learning in this manner is very valuable and appreciated. Each student should introduce themselves with their full name when it is their turn. Mary Jones, not just Mary. To all I am Mr. so and so.
Before lifting my gown for the exam I expect to be first covered with a sheet or blanket so that only my abdominal area is exposed.
It would be OK with me for the students to do their exam before you if you don't want to prejudice their findings by their already knowing yours. Just tell me that they will examine me 1st followed by you.
If the teaching experience involved genital exposure or examination by medical students, male or female, modest as I am I would try to say yes if asked. I would not be as generous with female nursing, tech, CNA, or other non-medical school students.
With medical student intimate exposure or exam, my expectations are again, proper introduction as indicated above, your being upfront as to what you are asking for, and signalling me that you realize you are asking for a lot by conveying how my exposure will be limited in extent and duration to that which is necessary for the teaching to occur. What will turn my yes into a no is your acting like it is an entitlement vs a privilege or any perceived misbehavior on the part of the students. By that I mean if any of the students are anything other than serious in their demeanor or if their body language is betraying that it is other than purely clinical for them.
When I had my initial bladder cancer surgery I was ambushed by 5 medical students in pre-op, 4 female, 1 male. I say ambushed because I hadn't been told ahead of time that it was a possibility. The only introduction I got was a singular "we're medical students on our urology rotation and we'll be observing your surgery today". I was too shocked to respond but afterwards resolved I'll never let that happen to me again. They didn't ask my permission, they just told me they would be observing. They as well didn't have a very serious demeanor about them which I found inappropriate under the circumstances. It was as if this was fun for them; that they weren't stopping to think what might the patient be feeling right now. This why my yes in your example will turn to a no if your student's demeanor is not appropriate to my situation.
I really do want to do my part to help medical students learn, but the onus is on you and them to show proper respect in pursuing it.
The majority of hospitals are teaching hospitals. If you are in ER, you may not have had a choice of where you were going. For me and my husband, the answer is no as no one let me practice on them for free for my educational purposes. If you are at a teaching hospital, then a reduction in rate should be done if they use you to learn on. You should be warned ahead of time and not have a flock of onlookers in the room while you are being told as that would be in my opinion coercion. As for the diagnosis, that should be given in private without onlookers so you have time to absorb it and handle the emotions in private with your family. I really don't care especially after what has happened if doctors and nurses get training or not. It is not my duty to offer myself up as their training vehicle. You may be at teaching hospital but I believe you still have the right to say who is involved in your care unless you are at a Catholic hospital which in that case neither the patient or the patient's family have any rights at all. I have the letter from them that proves that.
I was at a women's hospital when the nurse brought in another nurse. She said she was going to show the other nurse how to care for me after my C-section. I told her no that I was not a mannequin but that I had feelings and self worth. She said I should not bar someone from learning. I told her that if that was the case she was feel to lay down on the couch in my room and expose her private areas and I would also observe in case I ever needed to know how to provide such care. She got made but I was not used for practice and the learner nurse left. I told her if she would do that than I might consider it but apparently she thought it was above her station in life to expose her private areas to her fellow nurse. JR
JR et al,
The profession of medicine has imposed values on society that they themselves do not hold. They are nothing more than Bolsheviks, having one set of rules for themselves, and one set of rules for everyone else.
The first example is the fact that medical students no longer practice (intimate) physical exams on each other. The Hippocratic Oath requires it. Although it does NOT specify if the teaching should be done on patients OR physicians and students, it does state:
...To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else...
The profession of medicine is modeled on the medieval guilds in that it creates a monopoly, only "guild master members can train apprentices, there is a journeyman (resident) phase, the guilds must advance the technology of their profession, etc.
If medicine is to tell society that there is nothing wrong with students learning on patients, then the profession should lead by example. Facilities should have programs that identify when a licensed healthcare provider (previously licensed, student, etc.) is seeking treatment, there should be no less than 4 students from the medical professions (physician, NP, PA, nurse, MA, etc.) present and participating in the care.
As I stated above, participating in the training of students should be a requirement of licensing.
Then there is the imposition of altruism. First off, altruism is not exactly always what it is portrayed to be, OR may NOT even really exist.
While morally we SHOULD all be altruistic, altruism is NOT without limits. Even the AMA recognizes this, albeit in extreme circumstances.
Finally in a free society, one can NOT impose their values on another and treat it as a legal requirement. Many people choose a hedonistic lifestyle (and there is philosophical support for this). Many people take the approach, SCREW SOCIETY...
A very good article in the British Journal of Medicine takes the position:
...On the other hand, we offer several examples in which patients act altruistically. If it is patients and not the doctors who are altruistic, then the patients are the gift-bearers and to that extent doctors owe them gratitude and respect for their many contributions to medicine. Recognising this might help us better understand the moral significance of the doctor-patient relationship in modern medicine...
Again this supports my position of patient vs. healthcare client.
-- Banterings
Though I want others participating on this blog thread to present their views regarding my posting where I asked for how a instructor-group interaction with a hospitalized patient in a "teaching hospital" should occur.
However, Banterings comments makes me want to explain how the teaching program in my medical school currently would handle the issue of a group entry into a patient's room for education purpose.
First, the request for the event is made only by the one student who already has developed a relationship to the patient (by the patient's acceptance of that student to have taken a history and performed a physical exam. If the patient rejects the instructor-group entry, then that's it-- we obey the patient's decision and even though we will have missed an important teaching experience for all the students, we obey the patient's rejection without any pressuring. If the patient accepts and we all enter the room, what happens next is fully at the discretion of the patient. The patient is fully informed by the instructor and then permission is verified and the patient is made aware that at any point the patient is uncomfortable with what is going on, he or she should speak up and the patient's request will be followed with no argument. The instructor, as we always do on all patients in our practice, monitors the patient to look for signs of discomfort with what is going on and will talk to the patient about their continued willingness to participate. If the patient rejects further participation, that ends the session and we leave with our thanks for even allowing the group's presence and portion of participation.
At no time are we "bossing" the patient with speech or behavior suggesting that participation is the patient's duty because they are in a "teaching hospital".
This is how this exercise has been going on for years: no paternalism. All patient autonomy and definite all patient altruism if there is patient acceptance.
Remember, this is about first and second year student teaching. In the last two years and beyond, as a member of a therapeutic team, the relationship with the patient, as described here and elsewhere, is more complicated. But as a teacher in the first two years, I am comfortable with the above approach to a student learning experience controlled by the desires of the patient and no one else. ..Maurice.
Dr. Bernstein, the manner in which you describe your approach with 1st & 2nd year patients sounds very respectful to me. As noted before I would myself say yes so long as the behavior of all involved is respectful in the manner I had described and as you have described.
There are enough patients who would allow themselves to be teaching tools and plenty of patients who wouldn't. It shouldn't be assumed. Permission should be asked.
As far as the nurse just using her private area , she'd probably get fired, but you made your point!
THERE WILL BE NO FURTHER COMMENTS PUBLISHED HERE BEGINNING TODAY JANUARY 6 2019. CONTINUE PRESENTING COMMENTS ON PATIENT DIGNITY (FORMERLY: PATIENT MODESTY) VOLUME 94.
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