Patient Dignity (Formerly: Patient Modesty): Volume 94
Entering the "dirty pond" or "down the
drain", these expressions along with accompanying graphics are amongst a
host of verbal expressions with their visual analogies which I have used over
many Volumes to describe the status of the medical system as brought out in the
views presented by the contributors to this blog thread over the years. And now
with Volume 94 comes another: the medical system utilizing the conveyor belt
image within the process of diagnosis and treating of its patients. This analogy is spelled out in a "Perspective"
description of a clinical event in the January 3, 2019 issue of the New England
Journal of Medicine with the title of "Walking Away from Conveyor Belt
Medicine".
The story begins and the conveyor belt first starts moving
when a community hospital notifies a major medical-surgical hospital that it found
in a 70 year old demented patient who spends
his life simply "walking" that his previously surgically
stabilized aortic aneurism is enlarging compared to his previous checkup and he
was felt to be in need of immediate surgical repair to prevent rupture. He was on his way by ambulance "and the
conveyor belt started moving" in the major hospital to carry out all the
preparations involved in what was to happen on the patient's arrival. On
arrival "the conveyor belt is speeding up". Then the "belt was moving fast" as
all the many components which were needed to prepare and carry out this risky surgery
were proceeding and being accomplished.
And, if continued to the anticipated end-point, the patient, elderly and
demented would be dropped off onto the operating room table for the start of
this surgery and..and.. but, fortunately the conveyor belt stopped
running when time was taken for communication between surgeons and the family
who arrived and that communication changed everything and it was decided that
the risks of surgery was too great for this particular patient. So the patient was sent home with a pair of
slippers for his walking and was alive 6 months later and carrying out his life
as before his immediate life was governed by that medical system "conveyor
belt".
What impressed me about this article is a suggestion, which some may consider, that
the medical system may have a tendency to be employing a "conveyor
belt" mentality in its approach toward virtually all patients. And this uniformity of belief and action may
be contributing to a loss of dignity to each individual patient involved in the
system. "It's always done in this
way and so that is how we will do it."
That is, hopefully, until the patient or family intervenes and "speaks up". What do you think about this analogy? Do you see that you have been sitting on that
fast moving "conveyor belt" within the medical system as a patient? ..Maurice.
GRAPHIC: From Google Images and modified by me with ArtRage
Studio Pro
AS OF FEBRUARY 14, 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON THIS VOLUME. CONTINUE COMMENTARY ON
VOLUME 95.
AS OF FEBRUARY 14, 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON THIS VOLUME. CONTINUE COMMENTARY ON
VOLUME 95.
posted by Maurice Bernstein, M.D. @ 9:04:00 PM
175 comments
175 Comments:
Dr B ,
There are wonderful doctors that do miraculous jobs. The assembly line work that happens too much is because going to medical school is too expensive and not enough people can pay the price or take the time.
Also too much corruption from insurance companies and pharmaceutical.
I have something else on my mind. Pictures are on the blog on my phone divided up in 16 sections. Forcing me to check fire hydrants or traffic lights or buses. Is that just me or is it happening to other people to. It's obnoxious and time consuming and I don't see how it verifies that it's me anyhow.
JF, I agree that physicians actually do "miraculous" jobs however not every "miraculous" result is a result of knowledge and skill but by patient factors of which no physician or even the patient can fully explain. Medical students should be aware that every positive clinical outcome is not necessarily directly related to their skills when they become physicians.
With regard to submitting a Comment to this blog system, I have no control of the challenges the system has created to protect input source. ..Maurice.
Hello,
Does stopping the conveyor belt mean leaving w/ o medical treatment; or, will medical personnel be willing to alter their protocols? What "arguments" will be effective in even getting them to listen to an "opposing" view? What will cause them to amend their "evidence-based" beliefs? Why does this feel like David vs Goliath?
Reginald
Reginald, I interpreted the "conveyor belt" as a medical professional protocol upon which each patient sits from the onset of their relationship with the medical profession to the "end" whatever that may be. It is a protocol whose "speed" is set by the profession but in the case presented it took finally the important communication between the surgeons and the patient's family to bring the belt to a rational based stop. Like conveyor belts in industry, it moves the "object" through a series of actions or activities to hopefully conclude with a standardized product. But is that what we want in medical practice from the first placement of the patient on the belt (entry into the doctor's office, for example) through to the 10 minute history taking and onward to the exam room with its structural and other attending issues of privacy and then perhaps a procedure with the attending assistants and so forth. The "conveyor belt", as in the NEJM article is there starting up actually even before the patient arrived at the major hospital to "prepare" for the "endpoint".
The "belt" is for efficiency and meeting some goals set by the profession but are these the goals that the patient or family really need or desire. Once on the "conveyor belt" built and set in motion by the medical profession, even with legs dangling it may be upsetting or even dangerous to try to jump off.
So let's talk about this analogy and what it can do to hurt patient dignity. ..Maurice.
I suspect a piece of the conveyor is caused by both revenue maximization objectives (treat everything whether it makes sense for that patient or not) and also fear of litigation (why didn't you ......). The only way to get off that conveyor is speaking up, which is far easier to say than to do.
Three examples. At age 85 my grandfather was diagnosed with stomach cancer. He was in decent shape for his age but had a pacemaker. The doctor wanted to operate. My grandfather said no, had a good year or so of normal life, then got sick and died at 87. Surgery at 85 and with heart issues offered no guarantees he'd of gone home again or recovered enough to ever resume his normal life, but the conveyor belt said he had stomach cancer and thus must be operated on. He chose to get off it.
At 67 about 2 weeks before he died of pancreatic cancer I took my Dad for a doctor's appt. at the hospital. He wasn't eating, was down to skin and bones, and was too lethargic to be very communicative at that point. I pulled the doctor aside and said he had stopped eating. Rather than simply tell me this was a normal part of the endgame, to call hospice and take him home, they admitted him, hooked him up to IV's, ran tests, and so forth; all this being an hour from their home and with my mother not knowing how to drive. They finally release him a week or so later and he comes home to die within a few days after that. They knew he couldn't be saved but the conveyor belt said keep on treating him, and we didn't have the knowledge with which to say stop it.
Last example. At age 93 my father-in-law went into a nursing home with alzheimers and with prostate cancer that had spread to his bones. The mind was already mostly gone and the body was trying to follow but his doctor was still putting him through frequent bone density and other tests and appts until my wife finally told the doctor no more, just leave him alone as the tests and appts were more disruptive to him than any possible benefit that might be derived from monitoring his progress. Had she not spoken up he'd of likely stayed on the conveyor belt being tested and monitored for that which couldn't be cured. He died peacefully at 95.
Part of the conveyor belt problem is lack of communication on the part of doctors. Patients don't always know what questions to ask, be it about treatments options and necessity, or how they will be done, or who will be there observing. Part of the problem is the revenue side of this incentivizes doctors (and the hospital systems pushing the doctors) to keep patients on the conveyor belt rather than stop and think what is best for this patient at this time.
Biker, I agree. The "conveyor belt" approach to medical care is due to patient overload from hospital emergency rooms to individual physician's offices. Too many patients, too much financial demands and regulations by HMOs and others including the government, relatively too few individuals entering the medical system in all of its components (of both genders)---not enough time to sort things out appropriately with patients, families and other caregivers. The medical system may find the "automatism" inherent in the "conveyor belt" the most efficient way to deal with the "load". And one can see that the individual dignity of each patient is lost as the "belt" moves along. It would be wonderful to get patients off the "belt" and allow them to sit comfortably wherever appropriate as each patient's diagnosis and therapeutic course is individually considered---and the course need not be the standardized terminus of a "conveyor belt".
..Maurice.
This conveyor belt approach is even worse with a STEMI. They say time is muscle and they can't properly talk to the patient or their family about options but they can take 30 minutes to completely humiliate, ask stupid questions, and whatever else they deem appropriate. This conveyor belt does not apply anyone but them to know what is going on because it is about money and control. It belittles us as humans and takes away our freedom of choice. I don't believe doctors saved my husband's life but he survived despite all the horrible things done. Doctors perform the duties they have studied for and should do so well. If not they should not be doctors anymore. Mechanics, teachers, cashiers, etc. should also perform their duties well. True life-savers to me is the passerby that risks their life by aiding someone else.
I noticed today that the male tech in the stress test was very respectful but the female reached to unbutton my husband's shirt as he was not fast enough for her. I told her he was perfectly able to unbutton his own shirt so she did stop. He also found the courage to keep his shirt on as it is not really necessary for men to totally disrobe from the waist up. He unbuttoned it and kept it pulled together. That at least gave him the feeling of retaining some autonomy over himself. Small steps but positive ones. I guess that when females in a health setting are dealing with men their inter bully comes out. That's why he had me there. JR
There is no transparency in healthcare and no one knows where that conveyer belt will take you. One component of the affordable care act of 2010 was to make available to patients online the “ chargemaster”. That is the list of what the hospital charges for every item and/or procedure. As of this week it was mandated that consumers have access to this online for every hospital. Why should the government have to step in and mandate this? You are at Macys department store and you know the price for every item before you buy it. Grocery stores have available to shoppers a scanner so that you the consumer can scan it for the price.
Lately, I have started reviewing websites online of medical facilities, in particular is a men’s vitality clinic offering a variety of services. Now, I’m not in need of any vitality as I’m too busy unfortunately to take time to look into this, however, in reviewing the website it gives you no clue as to who the providers are or what their genders are. There are two guarantees that healthcare offers, you will be ambushed and you will be blindsided with unknown costs. Look at any car dealership online and it will show pics of the employees from the service advisor on down to the salesmen/saleswomen. Why can’t healthcare facilities do this?
PT
My miraculous cure was because of my surgery. If I wouldn't have had surgery, I fully believe I would have been dead inside of a month or two.
The fear of litigation doesn't seem likely to happen. Does anybody hear remember Gift bearer and how horribly her doctor treated her? Does anybody remember how cowed the other doctors and medical staff were?
I don't especially blame the other medical staff. There probably would have been some very real consequences had anyone of them stood up to that doctor. Afterwards Gift bearer couldn't get a lawyer to take her case either.
PT, that new pricing transparency law will prove to be useless. I took a look at my local small town hospital's site. The list of billables has 21,199 items on it and doesn't include the charges for the doctors who work at the cancer center, in anesthesia, the pathology lab, or that otherwise aren't employees of the hospital. What patient without insurance is going to be able to navigate their way through that to figure out what something will cost? It does note that patients w/o insurance will get a 10% discount and that if you don't have insurance and you prepay the estimate you'll get a 20% discount for those services you prepaid for.
Of course they want to make it easy for people so they also have a list of a mere 459 inpatient procedures giving you an average price billed for those procedures, but not including the associated professional services billing. Again, what average person can figure out what the hospital will code their services as, and even if they could there is still the doctor's charges.
Mentioning prices brings up the integrity of the medical community. Two and a half years ago, a medical center billed $50,000+ for my surgery with an overnight stay in the medical center. Medicare and my secondary insurance paid $2,000+. Even though I brought my own pills, the staff was under obvious pressure to provide the pills at inflated prices. Pity the poor schmuck who doesn't have insurance and is happy when he negotiates $24,000 to be paid over ten years at $200 per month.
I remember 50-60 years ago when car dealers advertised that they were honest. Dealers soon learned that they were simply informing the public of car dealer's reputation for dishonesty. You don't hear dealers advertise honesty today, but are they any different?
It's amusing to hear medical institutions advertise that "we care". This simply results in telling the public that the medical community has a reputation for not caring, but "we are the exception, we care". Sometimes there is truth in advertising even if's not the intended message.
BJTNT
Prices are out of control. When you are billed for lab worked the needle prick itself is an extra cost. Maybe I should just cut myself to save an extra thousand dollars? On my husband' bill for a pci, it was around $475,000. That was 2 nights in the hospital of horrors and doesn't account for the procedures they tried to bill for that they didn't do or the room he wasn't in that they tried to charge for. One Dr said the tavr they tried to charge for was for billing purposes. Out here it is called fraud.
Everyone should go over their bills and make sure they are correct. Everyone should read their medical records although you don't get all of them bc there are notes referring to something else that is not included. This is how we found out the nurses lied about what they did and the extra procedures they tacked on to the procedure report. JR
Now that JR has been writing about the monetary expense to the patient and family set and attempted to obtain by the medical system, I think that the following Abstract of an article"Dignity and Human Rights: A Reconceptualisation" in the 2017 issue of the Oxford Journal of Legal Studies which sets a definition between "inherent dignity" and "status dignity" and the behavior of the medical system can be challenged with the definitions. Here is the Abstract of the article:
Abstract
Human rights are often defined as entitlements that human beings possess just by virtue of their inherent dignity. This conceptual link between human rights and inherent dignity is as popular as it is unhelpful. It invites metaphysical disputes about what, exactly, endows human beings with inherent dignity, and distracts from the core function of human rights: placing constraints on powerful actors, especially states. In response to this difficulty, I reconceptualise the relationship between human rights and dignity in a way that maximally serves human rights’ purpose. I do so by distinguishing between ‘inherent dignity’ and ‘status dignity’, and by linking human rights to the latter, not the former. First, I argue that human rights articulate standards for respecting the status dignity of the subjects of sovereign authority, rather than the inherent dignity of human beings qua humans. Secondly, I suggest that not only individuals but also corporate agents possess status dignity. In particular, states that violate human rights lose their status dignity, thereby becoming liable to interference.
I would say that "corporate agents" can apply to those working within the medical system who by their demands and actions will "lose their status dignity and thereby "become liable to interference." This could apply not only to financial aspects of medical care but the other misbehaviors toward their patients. What do you think? ..Maurice.
Not much preservation of patient dignity at this facility:
https://www.theguardian.com/us-news/2019/jan/08/phoenix-woman-coma-gives-birth-hacienda-healthcare-ceo-resigns
REL
This Comment was attempted to be posted today on Volume 86 of course closed to further comments but I thought it was worthy of publishing it here on Volume 94. ..Maurice.
At Wednesday, January 09, 2019 2:30:00 PM, Blogger sam said...
As a child sexual abuse survivor it's hard for me having surgery and being without my undies on. I am having a hysterectomy and am already having a hard time with the nudity I will suffer through. For me the idea of taking off undies makes me feel vulnerable. There are sterile maternity mesh underwear that I have had to wear before due to being on my period with previous surgeries.
My previous history of abuse os just something for every nurse and doctor to keep in mind when dealing with patients. Not all are ready to admit to our past. Speaking about it makes it real. Not all of us are ready for it to be real yet.
REL
I should mention that the facility you mentioned was investigated and given a reprimand by the state because staff was violating the privacy of the residents while they showered prior to the latest incident. Which prompted the resignation of the CEO. These kinds of incidents are nothing new and happen not only at nursing homes but hospitals as well. Sometimes the public hears about them, sometimes we dont.
PT
I feel for Blogger Sam. We should not have to explain each and every time that we need to be treated with dignity and why. As for underwear for surgery, The Covr Medical Garment should be something that all institutions use. There is no reason that private areas not needing to be accessed cannot remain private areas. It is merely a power play that use to make us vulnerable, intimidated, and compliant. Naked people normally don't challenge a person in uniform. As it stand, violations have shaped our life and how we react. Although my husband (he doesn't remember what laughing nurses were doing to him as he was drugged) and I haven't been sexually assaulted, violations did occur. Even though he was drugged, he has underwent hypnosis and some memories resurfaced. One of his most vivid memories was of lying there naked and cold and wondering what was happening to him. He had no clue why, what, whom was doing it, and wanted me there for reassurance. He said he felt powerless and wasn't able to speak his concerns. He knew that he had had a heart attack but wondered everything else was happening and no one was talking to him or offering reassurance. They left him this way for around 20 minutes. There is no documentation of them doing anything within this 20 minute span. Even though I was there, they didn't acknowledge my presence until they had him in a procedure he did not consent to. They didn't tell me what they were doing. Instead they sent a warden to guard me (that's how I view it). He was a hatred minister and neither I or my son is religious. I asked him to leave 3 times. He refused. He did not offer comfort nor did he give us details of what was happening even though they called him and he on speakerphone walked away from us and announced to the whole public hallway my husband's name and what was happening to him. This went on for almost 3 hours. We were only told he was in a procedure and finally they were done. What and why were never answered. The warden accompanied us to the rude dr consult where the dr said he was upset that his Sat. night had been interrupted. The warden again invaded & violated our privacy by not leaving this consult. This is only the some details of the 1st part of our story. These violations will be with us for the rest of our lives. I feel that wouldn't let me see him as they had been called in and they were going to perform a PCI no matter what. No was not an option to them. Money and the conveyor belt type of thinking. Even though our kids are grown, they know what happened and they too will carry the scars with them forever. The lies, the manipulating, coercion, the lack of compassion, the lack of personal dignity, loss of autonomy, and the wondering if the care was lacking of quality will forever be with us. So much so that each time we encounter new medical people, we must explain why we are what we are now. It is being afraid of what will come bc we know as we age, it normally follows you encounter more of them. That is until you are put into a "nursing" home where you eventually become a total object and just are waiting to die without any dignity. Jr
www.azfamily.com
Former Hacienda manager speaks about patient abuse the CEO swept under the rug.
A patient in a vegatative state recently gave birth, police are investigating this rape case.
In another incident female nurses were standing around a non-verbal male patient’s bed
talking inappropriately about his genitalia.
In yet another incident the state reprimanded the facility for staff not giving residents privacy while
showering.
Oh, but we’re all outliers on the blog and Oh, this kind of shit never happens in hospitals and nursing homes.
PT
But, PT, what should I tell my first year students? Should I say "Do you know you are entering a cesspool of crime, cheating, squandering patient's money and dignity? How dare you do that if you know that?"????
Do you see any value in my students continuing on or they should quit and move into another but "clean" occupation such as religion, politics or business?
Or can we be realistic and say that there are "outliers" everywhere and the job of future physicians is to identify and do something about these "outliers" and in the meantime try to avoid being one of them and attempt to do the best you can for your patients. ..Maurice.
Dr. Bernstein, I would take a different twist than what you said. Simply telling them that there are outliers and not to be one of them more or less says most are good guys and a few are bad apples. That may be true for the most part but the larger problem is that the good guys look the other way as the system protects its own. The casualness with which healthcare staff accepts inappropriate and undignified banter about patients so long as the patient doesn't hear it more or less says it is OK to sexualize patients if the patient doesn't know. The same goes for exposing patients more than is necessary when the patient isn't conscious. The patient doesn't know so no need to protect their physical privacy.
Your students should be taught to not look the other way and to take whatever action is appropriate to the situation, be it confronting their co-workers or reporting them. It is no different than teaching children not to look the other way when they see other kids being bullied.
The other thing to teach the students, some of whom will rise to positions of authority in hospital systems, is to actual do something about weeding out the bad apples. The Denver 5 are still there working with nothing more than what amounts to a "don't get caught again" warning. Twana Sparks retained her hospital privileges and access to nude male patients. Staff who sexualize their patients rarely get fired or lose their licenses. Teach your students to change that when they're in charge.
PT,
If the place you are talking about is in TN, then I believe the state legislature is trying to pass a bill that female pts. cannot be attended by lone male(s). However, this is sexist bc males should not be attended by lone female(s). Females are not all pure and kind either without any sexual intent. The world needs to get real. Men should have the same kind of consideration as females. Equal rights and all that should be given to all.
Dr. B.,
They have to be taught that they are not gods and they do not have complete control over their patients. Patients still have autonomy. I think most of the issues occur when medical people think we are mere pieces of clay that they may shape at their discretion. This can happen in any walk of life such as a small town mayor or police officer that power goes to their head. It is up to men and women like you to instill the correct thinking into the younger ones. Respect at all times for the patient and their family. Medical people merely give us the decisions we need to make and they have the ability to carry out what we decide needs to be done. Our treatment is our decision not theirs. They also need to be aware that someday they or someone they care for may be lying there looking for compassion, respect, and expertise from a medical person. They also need to learn how to listen. Why ask us questions if they do not listen and make notes? We know ourselves better than they do. If we say no painkillers bc they have bad side effects then make the note. Don't neglect listing it bc you know it is the standard to use them.
To all I believe how medical treatment is delivered needs to change. My husband was present during my emergency C-section when my gut was cut into w/o any prep. I didn't get an infection from hair or from him being present. He wasn't in the way. There is no reason why patients cannot have an advocate with them or behind a glass wall where they can see and hear everything. If what happens was more upfront and not so secretive then half of the battle would be won. I think if medical people knew there were witnesses to their actions then they would be more respectful and compassionate. JR
Maurice
First of all as you may know I like you and I respect what you do but, healthcare has a bevy of problems!
A healthcare facility in Arizona called Hacienda healthcare operating a long term care facility recently had a young woman in their care for 10 years in a vegetative state suddenly deliver a baby. For 9 month no one knew she was pregnant, apparently she was raped by someone while in the care of the facility. The CEO immediately resigned.
The complaints made to the state before this were that residents at this facility were constantly being observed while bathing and showering. Complaints about this facility prior to this were that female nurses were making inappropriate comments about the genitalia of non-verbal male patients.
The CEO of this facility never took action against staff who acted inappropriately and thus over time this kind of culture fostered by a lack of leadership. Healthcare these days are managed by schmucks who only care about dollars and cents. A recently know of a pre-med student who after being given the opportunity to observe surgical procedures decided it was ok to take selfies of himself with the nude patient in the background while he is smirking.
What the F$&k is wrong with people these days, you know this problem is rampant. No one wants to admit it’s rampant so it’s convenient to refer to those or the issues as outliers. Is there an expected collateral damage and is that an expectation of doing healthcare business? The CEO of the facility I’ve mentioned has over 30 years suppressed complaints about inappropriate behavior and tried to cover up the rape of this patient in a vegatative state. The pregnancy of these woman was leaked to the police and the state.
If I had my way I would burn it to the ground and sweep the ashes into some little corner in hell and start over. In the very least staff need to be fired with license revocation, none of this well I’ll just go work someplace else. This goes for everybody, physicians on down to housekeeping, administrators as well.
PT
Maurice,
I would start with your students by saying that
-- Banterings
I don't want to turn this blog thread into a political battle, but I was wondering whether all the "bad behavior" throughout the medical system described here has a political origin and political sustenance. Is there an existence of political cruelty toward citizens and specifically patients or patients-to-be which is responsible for all the humaneness repeated described here? Shouldn't Presidents and politicians pay more attention to the way the citizens and citizens-to-be are treated when they become or are already sick? Could their attitudes be filtered down to these patient "uncaring" publicized or experienced medical actions described on this blog thread? ..Maurice.
Dr. Bernstein, in answer to your question I'd say no. If anything patients are treated better than was the case decades ago when the political discourse can be said to have been more civil. Patients have more rights now as well. There was no consideration for male patient dignity in my younger years. Professionalism has improved even if males continue to be 2nd class patients when it comes to their privacy and dignity.
You know, it would be of interest to compare the views of a now second year medical student with a year more patient experience to how the student evaluates the student-patient relationship.
As some of the visitors here will recall, having participated on my blog thread "Difficult Patient vs Difficult Doctor" , my first year student Surabhi Reddy started the discussion of the topic with his researched commentary and followed with comments several times during the ensuing discussions by myself and participants from our patient dignity blog thread, particularly Bantering. I haven't as yet been in contact with Surabhi since he moved on to the next year but I might contact him and see how his views have changed, if they have, with his further medical school experience and perhaps he can contribute to the current discussions on this Patient Dignity thread. Any thoughts about this suggestion? Do you think that the views of a second year medical student has any bearing on providing perhaps a different perspective of the medical system chaos which is steadily being noted and discussed here? ..Maurice.
I want to enter a new "wording" which may explain much of the non-frankly criminal problems or maybe even allowance of criminal problems that have been described here. That "wording" of the concept is that of "moral distress". Think about the personal conflicts of both physician, nurses and others in the medical field when they have seen or know of an action by a colleague or supervisor or medical executive who is or has been performing unprofessional or seemingly patient hurtful action. What does that observer do, what can that observer do within the limits of the system environment in which they work and participate?
This "moral distress" concept was first publicized in the nursing profession environment associated with a fear of "speaking up" when they asked to do or saw some behavior or action on their patient by their superiors which, to them, was unethical, immoral or attacking the dignity of their patient. The "moral distress" concept has now extended to others in the medical profession including even medical students. Think of a 3rd or 4th year medical student, working on the hospital ward, faced in this "hidden curriculum" with an order by a superior which defies what the student learned in his professionalism course in his first and second years but also his own concept of moral behavior. The condition called "moral distress" may start early in the medical career and may affect many workers. The challenge for these professionals is either to "speak up" and possibly adversely hurt their work or even lead to "occupational burnout" or remain silent to the system as though they were "not there". What do you think about this concept as an explanation of the patient harms within the medical system which are not treated or prevented? ..Maurice.
Moral distress is a good term so long as it also includes violation of basic privacy and dignity of patients. In the article the thrust is almost entirely over what the course of treatment is that a patient is getting. Much of what we discuss here is instead how that treatment is delivered.
The question then for your students is are they morally distressed if they see a patient being exposed more than was necessary (vs convenient for the staff)? Are they morally distressed if the patient's body language tells them he is embarrassed by the presence of the female MA observing his intimate exam? Are they morally distressed because they fear the gender politics that may ensue if they dared speak up for male patients?
The answer to these questions perhaps hinges on whether your students understand that gender is an issue for many male patients. Modern day gender politics perhaps doesn't even allow such a question to be asked.
I really don't think that they think it is a problem when they see a male patient being exposed or being subjected to person dignity degradation(s). However, if the patient is female I think the story is different. It is accepted in the medical community that males do not have the right to personal dignity. However, females do have the right as there are legal ramifications. If an unconscious male is sexually assaulted, then a maybe slap on the hands (ie. taking pics of penis). If an unconscious female is assaulted, then it becomes a legal matter.
Men are discriminated against and it is an acceptable practice. Men and their advocated need to be more vocal and not be afraid of being labeled unmanly. Men do have feelings and these feelings of self worth and those feelings are as important as the feelings we females have.
There needs to be more education out there as to what really happens during medical encounters. More education would make people aware and be able to be proactive rather than reactive. We will be proactive in the future but the feeling of being violated will never go away. You always wonder why those people who were supposed to be compassionate in their care of you were so mean and abusive. To me, it goes back to control. When you enter their realm, they think you are totally under their control. That is why they give you meds like Versed. It makes you compliant and more importantly, you have no memory of what they have done or how they have done it. It also makes it so if anyone might have objections then it can be justified that the patient won't remember it. No memory--no harm. The harm only comes if someone is aware and makes a fuss. And the majority of time, it is not a man filing a complaint. However, I would say that the majority of medical people will go back to the violating and abuse as it is a control thing.
My views are hardened bc of what happened this last time. The laughing nurses and the nurse who didn't care about exposure have forever changed my view of what is supposed to be a caring, trust worthy, and compassionate group of workers. I can't bring myself to say professionals bc they are only professionals of abuse and violators. JR
Maurice et al,
First, my comments did not fully publish. In response to your students, you should say:
...you are either part of the solution, OR part of the problem...
Second, you have asked if this blog has made a difference? My response has been that concepts put forth on this blog and concepts that are uniquely my own, have been making their way into the lexicon of the medical profession. One such is the recent discussion of dignity vs. modesty, appearing in more provider literature such as Patient Bill of Rights.
Another example that I have just seen in the "Moral Distress" article that you have presented is the concept of the patient-physician relationship (as opposed to the archaic, paternalistic term of the doctor-patient relationship).
I am not sure exactly which volume I have brought this up in, but I argue that this is a more correct term as the patient is the primary member of importance in the relationship and thus put first. The term physician is also a more accurate term describing a person that is licensed to diagnose, treat, and prescribe.
Three articles focus on the importance of shared decision making in individual patient-physician encounters as a means of mitigating moral distress. In response to a case in which a physician feels conflicted about applying hospital guidelines that recommend using a reduced dose of a drug in scarce supply to treat patients newly diagnosed with bladder cancer, Edmund G. Howe III discusses the importance of transparency as a way to preserve the patient-physician relationship while relieving the physician’s moral distress. Bonnie M. Miller, responding to a case of a student who feels conflicted about performing a procedure on an unwilling patient, argues that medical team members can respect the patient’s right to autonomy by being transparent about the student’s role. And Nancy Berlinger and Annalise Berlinger discuss moral distress that arises in situations in which unexamined “cultural” assumptions about a patient, family, or group might conceal larger structural problems or bias, arguing that students and clinicians should learn to think critically about such situations.
These are just 2 examples of concepts discussed here making their way in current terminology. I can NOT say that the enlightenment is coming from people at institutions reading this site, it may be that this site is being pushed by the currents of the enlightenment sweeping the profession. Personally, I am seeing these concepts appearing AFTER appearing here first.
I suspect that there are lurkers whose opinions carry considerable weight in the shaping of the corporate and professional culture at some very prominent institutions (such as the AMA).
-- Banterings
Maurice et al,
Here is another thought that I forgot to mention. In regards to the "Moral Distress" article, I have repeatedly put forth that part of the burnout that providers face is due to the moral distress from the way patients are treated. Those who have any assemblance of a conscience left after medical school realize that patients are routinely abused.
Much of what is happening in healthcare structurally (physicians becoming employees), MOC, etc. is a societal reaction to paternalism. The solution is "patient paternalism", that is physicians (and other providers) handing over complete control to patients.
What the profession fails to see is that with power and control comes responsibility and accountability. Even if you reject the notion that the patient as a client, there is always going to be an element of consumerism in the transaction thus requiring customer satisfaction.
Technology is making providers irrelevant:
— home testing
— AI (IBM's Watson)
— overseas pharmacies
— Rx's being made OTC
— midlevel providers
— robotic surgery
— enlightenment (dignity vs. modesty)
— etc.
— iwatch, fitbit, etc.
When we examine healthcare we find much of healthcare is ritual as opposed to science. The biggest problem is that healthcare has never owned up to its infractions on human dignity, asked forgiveness, AND made amends.
In 2018 we are still talking about pelvic exams on anesthetized women without their consent.
Forgive me, but I am justified in my criticism and my feelings...
How f***ing stupid are these supposedly intelligent people that ANYONE of them can think that this is in anyway acceptable, allow any part of the profession to continue to do this, AND not think that they will be just as culpable???
I did not even get to the apology. How many physicians in practice today participated in this practice? Do they NOT owe society or their current patients an apology?
So what is a patient suppose to think of a physician who they know went to medical school when pelvic exams on anesthetized women without their consent was business as usual and the physician has made no statement on this?
I will tell you, the patient will always have suspicions of that person and will write their own narrative of what happened.
-- Banterings
A. Banterings
I just have to add to your comments as well. How F**king stupid are the people who year after year keep voting the nursing industry as the most trusted profession. Who keeps F**King doing this?
PT
PT,
I agree. Who are these people who think nurses are the most trusted? I certainly did not get to vote.
Banterings,
What, in your opinion, is the best way for someone like me to help? I really want changes. However, it is going to be an uphill battle. There seems to be such an anti man attitude in this country right now. I think that male patients are more likely to be mistreated now than before as nurses may feel more empowered especially against older males. I, too, believe in inequality but not at the expense of another class of people like men.
Things I would like to see change are:
1. Everyone treated with dignity and respect. This encompasses personal dignity and respect of the "patient" and the family. No more calling the patient by their first name unless permission has been granted and no more trying to undress a patient or staying in the room while they are undressing unless the patient is unable to perform this task.
2. Realizing that the "patient" is the ultimate decision maker in their medical journey. No coercion, bullying, etc. allowed. Information should be delivered clearly and without bias. The patient and/or their rep. should be the ultimate decision maker unless they are unable and the rep. is not able to be contacted in an true emergency situation.
3. No more secrets. Patient info should not be kept secret from the patient. It is about them so they should know everything. Making notes about what they say should be mandatory like them not wanting certain meds like Versed.
4. Consent forms need to be made easier to delete unwanted items. None should be signed when drugged. Conscious patients but drugged should not be subjected to hospital's signing consent in their place and saying everything was explained to the drugged patient. The family should be informed in this case.
5. Patients should have the ability to have their advocate with them throughout the whole medical process.
6. Billing should be clear and upfront.
7. No more personal electronic devices should be carried by personnel carrying out patient care.
8. There are more but these come to mind first. Please feel free to add.
JR
PT
Because people want those that care for their health and even their lives to consider them as human beings. They can't accept that patients are just objects to be processed at the convenience of the bureaucracy. Consider how people treat their family and friends when they are sick. These people can't imagine that anyone, with rare exceptions, wouldn't care for patients with the same respect and dignity.
BJTNT
JR,
I am moving to educate personal injury lawyers about how mistreatment of patients creates side effects, thus allowing them to litigate.
This will change the system when it costs them money.
-- Banterings
As I stated previously, the systematic mistreatment of patients by the profession of medicine rises to the level of a Human Rights' violation. Here is a case of organizations being held accountable for Human Rights' violations from the 1940s.
Read about Johns Hopkins, Bristol-Myers must face $1 billion syphilis infections suit.
Yes, that is Billion with a "B".
How much longer before personal injury attorneys start going after teaching facilities for pelvic exams on anesthetized women or subjecting patients to a conga line of doctors in training?
I want to see jail time for Human Rights' violations.
Do you think that the public will have sympathy for any who has committed Human Rights' violations under the guise of medical education?
-- Banterings
Have we talked here about FF ('Frequent Flyers"), individuals (patients?) who repeatedly enter emergency rooms and seek attention of the ER staff and whether they are a result of system mismanagement or patient misuse of the system? Here are 3 links to the subject with some varying views of the issues involved.
https://www.ncbi.nlm.nih.gov/pubmed/16781914
https://www.verywellhealth.com/what-is-a-healthcare-frequent-flyer-2615173
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729222/
Could the repeated presence of such "patients" whether in need of "drugs" or even unwillingness to schedule an appointment with a primary physician be a factor leading to or caused by the medical system malfunction? Where is this population part of what we are discussing on this thread?
By the way:
I can also imagine that the use of the term "frequent flyers" might be an insult to those of you who are frequent aircraft passengers. ..Maurice.
Dr. Bernstein, I can understand that druggie and mental health type frequent flyers can frustrate ER staff and contribute towards a jaundiced view of the general public, but they are no excuse for treating the rest of us with anything less than respect and dignity.
In my small town elected position I deal with the general public. There are a few frequent flyers for whom nothing will make them happy or who see problems where problems don't exist. I handle them gingerly so as to bring the interaction to a conclusion as quickly as I can, usually with no action on my part as either what they want can't be done or they really just wanted someone to listen to their complaints. While they may be a drain on my energy I don't let them prejudice me against the rest of the community. I go on assuming anyone coming to me is OK and has a valid request or issue to discuss, and recognize the few exceptions for what they are, exceptions. That's how healthcare staff need to do things too.
Banterings,
Our case would be a perfect fit for that kind of a lawsuit. There was blatant disrespect of personal dignity for my husband both in physical and mental aspects. There was also blatant disrespect of his medical information and a lack of informed consent. There is also blatant disrespect of us, his family. There are also downright lies in his medical records to the point of entering wrong procedures. There is omitted information that was vital to him having bad reactions to painkillers and Versed in the past. There was an entry saying he had a husband whether than a wife that was sent to the Catholic hospital which turned into the show of horrors. We feel that may be the key as to why they mistreated him so badly and wouldn't communicate with his "husband" (me, his female wife). We need the right fit with an attorney bc we have so many issues. JR
JR,
Find the right lawyer and go for it!!!
I would also refer the lawyer to this web site for direction.
-- Banterings
Dr B ,
As a CNA taking care of elderly , even if a patient gets under my skin and I would get noticeably agitated that still isn't going to cause me to be grouchy towards another patient.
It SHOULDN'T cause me to be rude or grouchy towards that same patient later on in a later encounter after the incident is over. I seriously doubt that there is a connection between people over using the ER. I DO think some of the abusive behavior might have to do with staff being tired from over work or being hungry. Tired or hungry people, often aren't on their best behavior. Even if the abusive behavior is caused by being upset with patients for something tangible that the patient(s) do , I still wouldn't think that normal people would out or retaliation expose that patients naked body to other people on account of it.
Banterings,
That's just it. All the attorneys we have spoken for say we more than have a case but they don't want it bc it would be an uphill battle. They only want "easy" cases such as death or injury beyond horrific. We are still looking for the right fit attorney and hopefully we will find one. If not, I will publish everything the 2 hospitals did and let the chips fall where they may. In any case, I think things like what happened to us should not stay quiet as that lets them continue to happen. We have filed HIPAA privacy violations and suppression of freedom of choice/religion with the OCR. We have also filed 2 complaints with the state's nursing board on 2 different nurses. None of those complaints have been resolved yet. The complaints on the nurses were very serious as one didn't know what procedure had been done 2 minutes after the procedure ended and the other nurse did not know how to hook up equipment and made more than 20 false entries on his medical records. This is in addition to the lack of personal dignity which the one nurse willingly admitted she did not know how to protect him from exposure in a room full of people, the 2 nurses alone with him while he was drugged and they were laughing hysterically, forgetting for hours that he had a family waiting to see him, etc.
I am invested in getting changes done. That will be my therapy. I cannot trust any medical critter in any way in any form. That trust has been shattered beyond repair. However, since they saddled my husband against his will with lifelong medical issues we must deal with them but it is under extreme stress in any encounter with them. He too feels that no one else should suffer as he and we did. That's a lot for him as he normally isn't an activist but these encounters have changed him forever too. As I have said before, the heart attack wasn't the worse thing that happened that night but the treatment was. The scars of the treatment will never go away. How is that good medicine?
JR
I think for some in the medical field, exposing a patient's body is just easier for them to do. Taking extra care to be respectful takes more of their energy and they would rather not spend that energy towards making a patient more comfortable. Some attitudes are may be that you are here so suffer the consequences bc we here to offer medical treatment and not respect or compassion. That is an extra itemized cost that insurance does not pay for. Some may do it bc they form an opinion about a patient or some may do it bc they do not like men. Some may do it bc they are uneducated in the way to compassionately give care. Some may do it bc it is an inside joke or prank they have within the hospital. Some may do it to get back at a patient. It really doesn't matter bc they should not be unnecessarily exposing patients. Most patient exposure in hospitals are males being exposed bc women if they are conscious will mostly complain or do something about it. Most men will not bc they think that will make them look like they aren't being manly. And truthfully when you mention this to a doctor they only give you blank stares like "What is your problem? I am godlike and I am saving your life."
However, I do not believe they save lives but rather are doing their jobs properly. Sometimes doing their jobs properly isn't enough. And to do their jobs properly they must treat all the person including their mental well-being. If they mentally abuse a person while helping them become physically well is there still harm? Of course there is bc they have created another malady. They forgot we are not objects but we also have brains and most important of all, feelings.
My sister recently went into a nursing for recovery. It was horrible! They had men helping the women with showering and toileting and vice versa. They had men and women in the same halls w/o any thought to personal privacy. The person in the first bed had no privacy from their roommate or the roommate's visitors. Curtains were never pulled. People no longer people but objects just waiting to die. Sad!JR
What JR has brought up and should be an important element in the discussion of patient dignity is the necessity for patient respect to be maintained by those attending to patients. Patient respect is different than patient autonomy. Patient respect is based on the concept that every patient is not an object, they are human beings just as those attending them. And, you know, respect for the patient, the subject of the professional attention, regardless of the patient's requests or even the patient's behavior. To repeat, respect even in face of what one thinks of the patient's behavior including misbehavior.
We all should read (I have) this article "What Does 'Respect' mean? Exploring the Moral Obligation of Health Professionals to Respect Patients" in the Journal of General Internal Medicine"
Yes, the medical system "respects" the pathology, its diagnosis and treatment, but what is equally important in the maintenance of patient dignity, beyond patient pathology is respect for the patient too. ..Maurice.
Dr. Berstein,
I do think that you are right. Maintaining respect for the patient should mandatory. It is not the right of medical staff to judge patients. Even those addicted to alcohol or drugs should not be judged as theirs is an illness too. So-called frequent fliers to ERs should not be judged as they also have an underlying issue most likely and it will not be discovered what it is in the brief encounter with medical personnel.
I think if medical staff can view us with respect that we deserve as being part of the human race, then other issues might improve such as personal dignity issues. As long as we are viewed as objects while within their "care" they will not treat us with respect or dignity.
Given our recent issues with medical personnel, I recently asked one of my husband's doctors when he asked his series of questions if he was really going to listen to what was going to be said. He looked at me with an odd expression so I told him that by name of the institution that asked questions but really didn't want the information. I told him if questions are important to ask then they are important enough for them to listen and note the answers and not be dismissive. He was taken aback but did recover. I told him that if he couldn't listen then we don't have the time or will listen to him. In this same setting, I also told the female tech that tried to unbutton my husband's shirt for the EKG that he was not a child or unconscious. I told her it was disrespectful to number 1 touch him w/o his permission and; number 2 don't treat him like a child and; number 3 that she should not try to disrobe him period as he is competent and conscious. If he needed help he is able to ask for help which he didn't but she automatically set about to do. I wonder if she also does this to women--I doubt it. When they told him to remover everything from the waist up he said he wanted his shirt on as a small victory in reclaiming his personal dignity stolen from him by another facility. They probably talked about us after we left but that's okay as we made our points. If enough of us make our points then maybe change will come about.
How's this scenario for not just a total lack of respect, but something quite more serious, and I don’t have the words to describe such abusive, aberrant behavior!!! I have a female friend in her fifties who has had lifelong problems due to an attack she endured when young - the perpetrator smashed parts of her spine with a metal object. So, she's had lots of pain, no surgery possible, other side effects coming from the original injury as time takes its toll. And yes, she is overweight, though not obese, due to decades of illness. Now, one of recent problems was a series of small heart attacks. A vital vein/artery was blocked, and she was rushed from our tiny, super shitty, full of MRSA, full of incredibly abusive nursing hags (I'll leave that story for another time) rural hospital to a mid-sized one in a popular resort town. One might hope one might receive respectful care there, but no it’s the same C%$* everywhere! Once she was in the Cath Lab, the physician, a female from Vietnam, proceeded to tell my friend that they don’t perform stent surgery in her native country because “HER PEOPLE ARE NOT LIKE GLUTTONOUS AMERICANS. AMERICANS ARE FAT, GREEDY, GLUTTONS WHO DESERVE TO SUFFER!” Yep, let’s see, we need another acronym (not enough of those!) and I’ll call these kinds of physicians – RAGS – reckless, arrogant, greedy, you fill in the last word… And, when my friend awoke from the procedure, said physician was still there, and repeated the above abusive rant, which led my friend to leave the facility in tears. I told her to report the RAG, but she’s so traumatized she won’t fight back. THIS RAG ALSO TOLD MY FRIEND SHE PUT IN THE WRONG TYPE OF STENT – CAN WE SAY MALPRACTICE? Was the RAG further emotionally abusing my friend, or did she really put in an incorrect stent? This sort of bizarre, well, let’s call the thing for what it is – this sort of behavior is a form of INSANITY! THIS IS CRIMINAL BEHAVIOR! It reminds me of the transplant surgeon in the UK who would burn his initials in the newly transplanted livers of his victims! “HEALTH” CARE? NOTHING LEFT TO SAVE! And I’d like to thank Banterings, who supports mention of vaccines, because this filthy practice is at the very black heart of medical ops, and if this is not understood then one is not aware of the future agenda to chip everyone, no chip, no job, no food, no nothing…. Yep, it’s a coming (yes, I realize normalcy bias shouts against current and coming realities), and many will be totally unprepared to fight for their independence and inherent human rights. And who will be thugs inserting the chips? Medical Ops! Though widely credited to the general Sun Tzu, the saying was from the military of his day – know thy enemy. Yes, the makemsick industry is, as I say, the thinking man’s enemy. There will come a time when those who refuse vaccines (well, some actually are being quietly disposed of) or the chip will be disposed of. Know thy enemy! The “government” is not your friend; it is just a humongous, all invasive cartel that redistributes money – that’s it. The sad spectacle in the Oval Office is nought but a dog and pony show to distract the populace while the REAL rulers, the banksters/war mongers carry out their agenda. The makemsick industry is not your friend; it kowtows to the government cartel, Big Pharma, and the poison model which passes for modern “medicine” as we have seen fostered by Rockefeller and like ilk. So many healing modalities which could be practiced today – but those who do so do at peril to not only livelihoods, but lives. Time to leave Disneyland, and see the world as it is. EO
EO
Since you mentioned the physician and her opinions I’ll mention another female physician from the state of Ohio who made it known that she would give Jews the wrong medication as well as other anti-Semitic comments. This disposition is rampant in healthcare not only among physicians but more prevalent among nurses. For those of you who have not worked in healthcare I’ll just say you cannot fathom the discrimination, the sexualizing, the negativity that spills over, trash talking patients and their families by nursing.
As I have mentioned many times yes it’s true many people abuse the emergency room, drug seekers as well as those who are not financially responsible for their healthcare and feel somehow that healthcare is free, however, I’ve seen hard working people, nice people with health insurance who just want to get well get F@&ked over by nursing. I’ll reference the female physician who made anti-Semitic tweets is no longer employed at the Cleveland Clinic.
PT
Did JR write the Comment at 8:23am today?
Please be sure that all Comments here are identified by some pseudonym to identify the writer. Personal Identifiable Continuity, is a worthy factor in communication. ..Maurice.
All patients or their families, if the patient is not able, demand patient respect from any healthcare provider, period. ..Maurice.
Dr. Bernstein,
My apology--I thought I had put my usual JR.
To EO--Sadly your friends probably doesn't remember everything that happened as they use drugs like Versed to purposely erase memory so they can do what they want to do and make no apologies about the manner in which it was done. I would bet money that the things they said and done during the procedure time were downright inhumane as the Versed allows them to do so. It is a sick, despicable drug that should be banned. It makes already ill and defenseless people victims of the medical system.
I know from my husband's medical records that 2 minutes after the procedure officially ended that the nurse who holds a liquor license didn't know what procedure she was recording that he had done. I know that they do not know the number of stents he had put in. I know that in the middle of the procedure log that out of the blue this same questionable nurse noted a underlay waffle mattress in the midst of what medically was happening. I know that huge chunks (30 minutes at a time unaccounted for) of time are missing. I have noted quite a few other irregularities too. I know that they are downright falsehoods (about 50) in his medical records. I know that they insist on charging him for 3 nights when he was only there 2 nights. I know that they thought he was gay and treated him as such (this particular Catholic hospital on the southside of Indpls. has been in lawsuit over treating gays). I also know that they released him w/o him or me knowing what he had done and he didn't know anything that he needed to do after his release as he was still suffering from fentanyl and versed. I know that they did not talk with me even though they should have but somehow they would not as they thought he was gay. All they wanted was to collect over $153,000 for the pci and 2 day hospital stay not including doctors, labs, and xray (ekg) bills.
From our encounter, I know that medical encounters can be worse than the illness that brought you to them. The uncertainty of not unknowing what they did to you when you remember how they violated, abused, and mistreated you when you were able to remember, not knowing how and why the procedure was done and if it was done with the best intention, not having information about your condition, etc. is a lasting emotional festering sore that will never heal. By the way, my husband is unlike me. He is the nicest person and everyone who meets him says so and with that being said, I know he did nothing to provoke this behavior in them. It is their philosophy that allows them this behavior and to agree to the molesting of young boys by priests. Twisted!!!!!
It is not that these instances (hospital violations, abuse, mistreatment) do not happen but rather they are not talked about publicly. That is why it is now my mission to make these things public. I have initiated contact with 2 state senators and will continue to get the word out there. I use to be a state employee labor rep that was not afraid to take on hard issues. It has been a few years but I feel I still know my way around. JR
Hello,
The following appeared in this month’s Outpatient Surgery Mag. (Jan 19).
Please note 13, 15 and 24. Why is it that parts is parts always seems to refer to male parts?
(#15 – circumcision – presumably male, #24 - his – also, presumably male. Apparently, OR nurses don’t retrieve items from female surgeons’ pockets.)
Reginald
Outpatient Surgery Magazine
January 2019
Behind Closed Doors
You Might Be an OR Nurse If...
Category: Outpatient Surgery > Humor and Jokes
1. You're certain that the surgeon you worked with today uses his personality as birth control.
2. You really think the best photograph of yourself lately is the one on your ID badge.
3. Your cabinet at home has more of those blue containers left over from sterile packs than it has dishes. (They've even replaced the butter containers.)
4. When you're bathing or showering, you start from the center and wash out, like you do on a prep.
5. You do a better shave prep on the patient than you do on your own areas that need a shave.
6. You'd rather get 15 minutes more sleep than put on makeup or fix your hair before going to work. (Besides, the cap and mask hide a lot — and whom are you trying to impress anyway?)
7. You know that wearing the cap and mask is going to hide your identity, so when you face this patient at Wal-Mart, he isn't going to know who you are and try to talk to you.
8. You insist your phone service plan has caller I.D. on every phone. That's the first thing you check at 0630 when the phone rings on your day off.
9. You always write RN after your signature — on your credit card receipt, your checks and the speeding ticket you got coming in on call.
10. You think that the vending machine in the lounge should have Prozac right next to the chocolate bars.
11. You believe that all patients should be put to sleep, and as soon as possible.
12. Unless you're old enough to know better, you still think you might marry a surgeon.
13. You can actually look at a naked (that's necked here in the South) body and you really do think "parts is parts."
14. You can eat things like that "green stuff" in that blue bowel that's been in the lounge refrigerator for more than a week, and not get sick. You might even ask around for the recipe.
15. You can look at an adult circumcision wrapped in Coban and think "Hmm ... it does looks like a Doberman pinscher's ear."
16. You're finding that the multiple pairs of scrubs at home are slowly replacing your other clothes and you're actually taking them on trips with you as loungewear.
17. You save PTO's/vacation time and every penny to go to the annual AORN meeting somewhere far away, and prefer this to going on trips with the family.
18. Sexual harassment? All these years you thought sexual innuendos, bawdy jokes and remarks about your anatomy was normal OR conversation.
19. You believe that "a chance to cut is a chance to cure."
20. You believe that the size of the patient is in direct proportion to how long you're going to have to stand beside that surgeon holding those retractors with his elbow constantly hitting you in the breast.
21. You haven't worked in the OR for a while, and you come back and find that the smell of a burning cautery stimulates fond memories.
22. The CDC or OSHA classify your OR shoes as a biohazard.
23. You can look at a tissue specimen and start to plan what you're going to cook for supper that night.
24. You can retrieve a pager or cell phone attached to the surgeon under his sterile gown and never so much as think about where you're putting your hands. His parts is just parts, too.
25. You go home and realize you haven't been to the bathroom all day. Your bladder has the capacity of an elephant's.
26. You know how a situation is going by which four-letter words you hear in the OR: oops, uh-oh and two others we can't print that are usually preceded by either "Ah, #@*%" or "Oh, &!%$." OSM
Reginald
I agree that "spreading the word" ("speaking up") to individuals who hold the potential for beneficial change in the medical system is the main and logical approach to attempting to resolve the dignity issues long described on this thread.
Although there is much "clinical medicine" information spread by drug companies and by others on current television and on the internet and increasing possibility for robots to do the work performed by the medical professionals of today, I can't imagine that direct contact between professionals and their patients in medical diagnosis and treatment will ever be "gone" and so the sooner society drives changes in behaviors described here, the better the life for all patients and their families. Also hopefully reduce the "professional burnout" frequently a topic of medical conversation. Anyway, that is my philosophy. ..Maurice.
One of the latest trends in healthcare is to hold the profession accountable to the terms that they are using. We have seen this with compliance/adherence, modesty/dignity, and the patient-physician relationship. here is the latest term that I am having issues with: chaperone.
I think a better term is voyeur.
The Merriam Webster Dictionary defines voyeur in this way (note this is the second definition):
a prying observer who is usually seeking the sordid or the scandalous
It goes on to say:
Voyeur is a fairly recent addition to English; our earliest written evidence for the word dates from the beginning of the 20th century. It comes directly from a French noun meaning, literally, “one who sees.”
Initially, voyeur referred to someone who derived sexual pleasure from watching others undress or engage in intimate acts; it was synonymous with Peeping Tom. By the middle of the 20th century, its meaning had broadened to "an unduly prying observer," particularly one interested in squalid or shocking details:
One who sees seems to describe what we call chaperones.
-- Banterings
Article in the NY Times today:
“Can a Nice Doctor Make Treatments More Effective”,
https://www.nytimes.com/2019/01/22/well/live/can-a-nice-doctor-make-treatments-more-effective.html?action=click&module=Discovery&pgtype=Homepage
Not surprisingly research shows “nice” doctors have more effective (simple) treatments, as judged by the patient.
I don’t think it is a stretch to conclude that treatments that would also involve other medical staff are more or less effective depending on how the patient is handled by those other medical staff and how comfortable the patient feels during the procedures with other staff. Stating the obvious to this group, but medicine hasn’t had the aha! moment yet… - AB in NW
So, except for those well-publicized "criminal behavior" of some doctors, one can say that virtually all doctors are "nice" but the behavior of the doctors' staff (or non-physician hospital staff and ?administrators?) is the element that needs to be dealt with. Gosh! I do feel better now that we all consider that it is the "staff" for which all patients and their families should be concerned. I am not sure where medical students are taught how to select and deal with staff members. We have a Professionalism course in our school but I don't remember that much time is given to how to "run an office". But this is where the instruction should begin. AB in NW, where do hospital or clinic administrators learn this business and its ethics? ..Maurice.
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Maurice,
How many doctors, nurses, etc. turn a blind eye to patient abuse? Look at the case of Dr. Twana Sparks. The abuse went on for 10+ years. How many knew what Dr. Larry Nassar was doing? (See How was Larry Nassar able to abuse so many gymnasts for so long?)
Just read:
This first article is indicative of the problem...
An Esteemed Doctor, Child Sexual Abuse Claims and a Hospital That Knew for Years
Pennsylvania pediatrician sexually abused more than 2 dozen young patients, cops say
In the age of #MeToo, investigation finds doctors keep licenses despite sex abuse
5 doctors who abused patients while sedated
Finally, here is one that you should be aware of at the University of Southern California's Engemann Student Health Center in Los Angeles:
2 doctors’ photos play role in sexual abuse claims involving hundreds of victims
-- Banterings
A. Banterings
Your recent post brings me back to the same analogy. If a man were caught and arrested as a peeping tom he goes to jail, he is now a sex offender. Could face a fine, imprisonment and loss of employment etc, yet the Denver 5 get 3 weeks of paid vacation. This is where we are right now in society. Am I correct in saying that medical staff are rewarded when male patients are the victims of voyeurs, it seems that way.
Furthermore, hospital administrators look the other way when male patients are groped and molested, Dr Twana Sparks. It’s cell phone fodder for nursing staff at a Penn. hospital when everyone crowds into a small operating room suite to take cell phone pics of a male patient’s genitals during surgery. Not one staff nurse in that room was reprimanded nor investigated by the Penn state board of nursing.
PT
Reginald Number 25 on your list was a hoot but some of the other at least I felt were in rather poor taste. PA
After having thought about it for some time I am seriously considering writing a third email to the Director. After receiving her letter there were some unanswered questions including things that I never did discuss with her on our final phone call due in no small part because I hadn't yet received her letter. For those who are not yet familiar with my case I first wrote about it on this site on October 30, 2018 and then October 31 and then again on November 6. PT also commented on this and actually this letter is mostly written to him.
Even though I had posted it before I will repeat the paragraph in question from her letter. She writes "The preparation prior to you entering the procedure area does not require sterile but clean conditions. That is why when staff was shaving your groin, we can allow the groin and your private area to be covered either with your gown or linens. Once you are taken to the procedure area and placed on the special X-Ray table, we now have to make your areas of puncture and work environment is sterile. That means, the gown has to be pulled above the pelvic and hip area since the gown is not sterile; at the same time we are using a sterile towel to cover your private areas so the tech can perform a surgical scrub. This occurs on every patient and is explained to each patient as we are performing."
The critical phrase is "the gown has to be pulled above the pelvic and hip area since the gown is not sterile. At the same time we are using a sterile towel to cover the private areas..." When I spoke to the Director over the phone she stated in no uncertain terms that there were no exposure issues but here she seems to be saying something different. She seems to say that the prep nurses or whatnot performed a "needle threading" or "tightrope walking" procedure. If the sterile towel cannot touch the gown because it is not sterile how can it touch the skin because the skin is also not sterile? PT you seem to say that there is no problem if the gown touches the sterile towel which makes more sense. In contrast to what the Director said you said that the gown can merely be moved out of the way. What is the purpose of the sterile towel anyway? Why not just put in the introducer and let it go at that? What is the introducer anyway? Are they two tubes that stick out of the femoral artery and are capped? The Director stated that the purpose of the introducer is in case there is an emergency where time is of the essence and the Doctor has to go into the femoral artery. Although no one would dispute that this procedure should be done in sterile conditions the key question is how sterile? Nobody seems to be saying that the conditions should be on a par as with a patient infected with bubonic plaque.
There is also the issue of the Doctor saying that if I failed the test I would have a stent put in. It still remains unclear as to how the sterile draping plays a part in this and what happens if a stent is put in. What is the purpose of the sterile draping anyway?
The Director has kept her cards VERY close to the vest. She has been playing defense all along. I am not sure what to expect if I send another email but I'm not sure I can just let it go at what has happened either.
Thanks for all your comments in the past PT. I will await your reply and possibly others as well. PA
PA
Depending on the procedure I am about to do I might use Cloroprep or betadine, then I might use something else. These solutions that I’ve just mentioned are used to clean and sterilize the area. I use the applicator in a circular motion as I swab, clean the area. Then with my sterile gloves on I lay a paper drape over the area I’ve just cleaned, made sterile. The paper drape has a 3 inch diameter hole in the middle.
As I lay the drape over the area I press down around the hole as the cleaning solution acts somewhat as a glue, but then some drapes have an adhesive around the hole where it touches the skin, either way I don’t care, I’ve rendered the site sterile. There can be patient underwear, clothing etc under the drape, I don’t care. All I care about is making a very small area sterile so that when I place the introducer ( a fancy needle) which allows you to thread wires and small cables through to perform some procedure in the vascular system.
Introducer means to introduce something, allows you a pathway.
Now, when you get some nursing director who will cover for her unprofessional staff to attempt to explain to you a methodology of which she is never present anyway when these procedures are done, what do you expect. What she says is a lie.
PT
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I’m compelled to offer one more tid bit of experience.
After 45 years in healthcare I’ve never met one nursing director who is truly out for the welfare of the patients. Directors know other people want their jobs thus they spend much of their day performing “ damage control” and/or covering up for the unprofessional staff. They won’t admit it but I assure you this consumes the bulk of their daily tasks.
If they admit their staff are unprofessional that says the director can’t perform their management job, they can’t manage staff and insure the patients are safe and cared for. If seen this over and over. I’ve seen them lie in staff meeting, lie to administration etc. Most suvccessful directors are masters at bullying. My advice, take your complaints around them, over the top of them and through them.
PT
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P.S.--if some individual or institution is NOT specifically named in a Comment or if the issue with that individual or institution has been published in the news media, then, of course, such specific notification which I wrote about above is not necessary. ..Maurice.
This comment has been removed by a blog administrator.
JR, no need to deny your entering your Comments to this blog thread. I just wanted to remind you and all the Comment writers here to avoid writing the specific names or identification of the specific parties involved in some improper (or worse) behavior unless the misdeeds are already publicly known and discussed in the general media. Those individuals or institutions, if they are accidentally named should be notified by the writer that this blog thread would encourage a public response here. If you have further concerns or questions, write me: doktormo @aol.com. ..Maurice.
I contend that much of the problems with physicians occurs in medical school when their conscience (common sense, and societal norms) are destroyed creating sociopaths and sexual assailants. Read the following Kevin MD article, "The time I was a 16-year-old standardized patient".
The most telling part was near the end, when the author states:
...Then there were the 1 percent of medical students who still persisted. They thought the “I’m on my period” bit was like the “I have headaches” ruse, and they were too smart to fall for that twice. They were going to examine me whether I liked it or not.
Here’s a tip for medical students: if a standardized patient encounter ends with a 16-year-old girl yelling to get your hands off of her, then you have failed.
-- Banterings
JR,
Where is your blog. I would like to follow you. I hope you find a lawyer that will take on your case. The things that happened to your husband are much like some my husband has had to deal with. With his heart catheterization he had signed and had witnessed , agreed upon by cardiologist,as he said wrist would work on him and no groin access needed. Wrist only. They had him drugged , took him back and he said the female scrub and nurse ripped his gown up and exposed him to everyone in area. He was protesting but the scrub said she didn't care what he put on consent she was prepping anyway. To us that is sexual abuse pure and simple. She was denied consent and that if at the time we had known we would have done more than complain to patient advocate at hospital and our insurance. What a joke the so called patient advocate is.
He had other procedures where he was exposed needlessly and these female support staff thought his wanting to keep his modesty funny. We have both heard them make their comments and threaten him with shoving catheter up his penis if didn't cooperate etc. What these female support staff do to men is a form of rape and needs to be stopped.
Please don't stop expressing yourself. You have a way of saying things the way many of us feel unable to do. MSKS
JR's recent comments has been removed at the request of JR ..Maurice.
Banterings, this is a silly story originally from a humor document and this is not how standardized patients are used or treated in my medical school. Standardized patients with a medical student are observed and supervised by an attending physician instructor in the room or by video. If the standardized patient would say "No" to the student and the student disregarded the "No" that bit of unprofessionalism wouldn't do well for the student. In all my years of teaching, I have never seen 1. a 16 year old "standardized patient" nor have I seen a patient's "No" disregarded by a student.
..Maurice.
Following that same line, my husband has said he will not accept being given any drugs in the benzo. class (i.e. Versed) or fentanyl or other powerful painkillers. He has stated the adverse effects they have on him. He goes on to state that if he has been given any painkiller or meds that create memory loss or confusion than all medical decisions have to be cleared through me as to he is no longer coherent enough to make his decisions. I have his power of attorney. He had that added to all his medical records, however, my we have been getting copies of the medical records we have found:
1. The info not being added
2. The info was added but was crossed out.
Apparently, the medical industry does not feel that humans have a right to say that certain medicines are unacceptable and they have the right to refuse them.
No only means no if they agree. Otherwise, they will do whatever they want to whoever they--whenever they want. That is the message we have received loud and clear from out here.
Dr. B.,
I commend you for how you teach your students. However, not all are like you. Furthermore, you have no control over these students once they leave your instruction. Hopefully, what you teach will stay with them but I know as a former educator that is not always the case. I knew another instructor who always taught them the gift of listening but he himself said that many thought his excerise and lectures were a waste of their time bc they were going to be a doctor holding the power of life and death in their hands.
I think if hospital administration would set better policies and enforce them that some of this would end. I also think that more people should speak up and become informed consumers as medical services are just that--services. I do not tolerate rudeness, godlike and/or condescending behavior from store clerks, or any other type of bad behavior. It is a mystery why we allow medical people to continue to get away from such behavior. If I had acted like that with a dr.'s child or to them then I would have faced serious consequences. I would like to publicly thank you for understanding and removing my posts as we are moving forward in our effort to seek remedy for the atrocities and violations of law and moral conduct suffered by my husband, myself, and our children from that horrible span of time. We will never forget it but by making this effort perhaps we will play a small part in making at least 2 hospitals know what they have done and that others may be as vocal too. JR
Good Afternoon Ladies and Gentlemen:
Saw this the other day.
https://nypost.com/2019/01/19/how-a-1970s-satire-changed-the-medical-profession/
Regards,
NTT
GOMER, GOMER AND MORE... I actually had a blog thread on the topic with the title
"Medical Slang Leading to Logical Fallacy: A Practice to be Avoided The text is below in two sections but also go to the thread and read the Comments. ..Maurice.
The following original article which I wrote and was published today at Bioethics.Net website is reproduced here with permission. I will put some additional comments as an Addendum at the end of the copy. ..Maurice.Medical Slang Leading to Logical Fallacy: A Practice to be Avoided in 2013.
The following original article which I wrote and was published today at Bioethics.Net website is reproduced here with permission. I will put some additional comments as an Addendum at the end of the copy. ..Maurice.
05/03/2013
MEDICAL SLANG LEADING TO LOGICAL FALLACY: A PRACTICE TO BE AVOIDED
Maurice Bernstein, M.D.
Medical slang is a form of slang used by doctors, nurses, paramedics and other hospital or medical staff. It is expressed either in informal vocabulary as words, abbreviated terms or also as acronyms (words made up of initial letters of the words the acronym represents) related to medical terms or conditions, persons or events. Presumably the basis for the use of medical slang is to communicate one’s concept or clinical finding or evaluation or diagnosis to other caregivers in a rapid and concise way. Unfortunately, the use of medical slang may lapse into derogatory expression or become ambiguous. Derogatory means that findings or persons are expressed in a disrespectful or degrading manner. Ambiguity can be related to the fact that an acronym or abbreviated word may not be sufficiently distinctive and can be used or interpreted for more than one medical term.
Examples of medical slang can be as benign as but also potentially ambiguous as the following medical transcription terms: “lytes”=electrolytes, “nitro”=nitroglycerine,”sats”=saturations, “crit”=hematocrit, “mets”=metastases, “osteo”=osteoporosis. On the other hand, medical slang can be derogatory even though amusing when applied to medical specialties. For example: “baby catcher” for obstetrician or “butchers” or “knife happy” for surgeons. Examples of medical slang as applied to patients include “dirt ball” for a patient who enters the emergency room filthy and smelling badly or “druggie” for patients known or suspected for illicit drug use or “goldbrick” for a patient who demands more attention than their (minor) condition warrants or the acronyms LOBNH for “lights on but nobody home” for a patient with suspected dementia and, of course, GOMER for “get out of my emergency room!”.
My argument is that medical slang generally can not only be or become disrespectful or ambiguous but also in the case relating to patients themselves, the derogatory descriptions may actually represent an action by the professional to create a logical fallacy. What is a logical fallacy? It is an error in reasoning that renders an argument invalid. Why attribute a medical slang expression as promoting a logical fallacy? First, a basic premise within the profession of medicine is the responsibility to obtain history and facts, if possible directly from the patient, and then to attempt to draw and present a conclusion from the facts. Drawing that conclusion is a logical exercise. Because, unlike the application of medical slang to “conditions” when this slang is applied to a person (an ad hominem), it may allow a fallacious conclusion by the healthcare provider originating the slang which rejects any argument or facts given by the patient since these arguments or facts are trumped by the provider’s own conclusion about the character or reliability of the patient. This is a logical fallacy since such a conclusion may be unwarranted. The explanation and facts provided by the patient must be logically evaluated separately for their validity and value and not invalidated by simply the provider’s personal decision regarding the patient as a person. The doctor can’t fairly make a judgment that the patient’s descriptions of pain should not be considered and reconsidered because the patient is known or suspected and described as a “druggie.” Some person on the street may say “that guy over there looks like a druggie” but that person is not required professionally to go beyond that assumption and so the statement may only be considered “unfair” or “uncouth.” My argument is that in a doctor-patient relationship such a slang expression by the doctor would represent a professional ad hominemimproperly affecting the doctor’s judgment regarding the history and facts presented by the patient.
For a number of reasons, including medico-legal, there is said to be a diminution in the general use of medical slang. Hopefully this is true and will continue to diminish. Certainly, expressions by physicians, nurses and other healthcare providers which are non-humanistic, are demeaning to the patient and indirectly to the profession itself and finally, as a consequence, allows a logical fallacy to be exercised, which distracting from and preventing proper clinical evaluation of the patient, cannot be considered of value to be continued to be used in medical communication.
Addendum: Beyond the issue of how derogatory medical slang may affect a physician's fair decision making responsibilities, what do you think about medical slang in general, particularly if it was applied to you as a patient? ..Maurice.
Dr. Bernstein, I see two categories of slang, one understandable even if possibly unprofessional, and the other unacceptable under any circumstances.
The understandable kind is using slang referring to bad behavior. Here I include the drug seeking patient faking pain or injury, the person coming to the ER for non-emergency purposes but expecting to be treated as the highest priority case, or the patient that is just loud, rude, or obnoxious by normal standards of society. Staff calling it like it is amongst themselves in cases of this nature is understandable. They are not assaulting the patient's basic dignity but rather the patient's bad behavior.
The other kind is slang intended to strip patients of their basic humanity or dignity based on the patient's physical attributes or mental state or dignity concerns. Here I include derogatory statements or terms about a patient with dementia, the homeless person in need of a bath, the obese person etc. I also include the patient who dares to request same gender staff for intimate procedure matters or who otherwise speaks up about their dignity concerns. To use slang or derogatory terms for any of these patients is unacceptable at any time.
I appreciate Banterings suggesting changing the title of this thread to "Patient Dignity" from "Patient Modesty". This change allows modesty issues to be discussed but also enlarges the content to a host of other aspects of how the medical system treats their patients. Enlarging the discussion without ignoring modesty suggests the following analogy relative to the medical system: an old automobile (the medical system) limps along and it turns out that tires are flat and there is a defect in the carburetor and more. The dignity of a smooth, efficient transportation is missing due to multiple defects in the system. How's that for an analogy regarding this blog thread? ..Maurice.
Good Afternoon:
Can't the American healthcare system do anything right?
From USA Today.
Hospitals across the country began posting their prices online this month, pulling back the curtain on a deeply secret world of exorbitant American health care costs. While millions of prices are now finally public, there is little hope for turning this transparency into actual savings for patients.
Experts say the effort is well-intentioned but functionally useless: The pricing sheets are so complex, voluminous and misleading that no layperson could use them to decipher hospital prices, much less actually compare hospitals as intended.
“It’s fair to say it’s a noble intent,” said John Deane, a former hospital executive who runs a health care nonprofit in Nashville. “The problem is, the way this is unfolding, it is virtually irrelevant.”
Unbelievable.
Regards,
NTT
I think dignity is more fitting than modesty. Dignity reflects how they respect you or don't and how bc of the respect or lack of effects your treatment and what you think about your treatment. All of us know that areas that are not generally viewed may have to be viewed when seeking treatment. However, it is the rudeness, the violating, the inappropriateness, and exposure w/o cause or permission that is the main point of contention. I also think their is sexual discrimination by nurses/techs/drs against men. I think modesty makes people think we are just shy and complaining for no reason. However, if they would suffer the abuse like some of us have then I am sure their comments would be different.
Yes, the medical field is broken. I read an article other day on MedPage that said providers don't like having the patients involved in the decision making process. I think that is outrageous. We, as humans, have the right to listen to medical advice that we pay for, and decide what and if we want done. They do not have the right to decide for us. I don't imagine they go to the hair stylist and say do want you want bc you are the expert. They probably don't go to a contractor and say build what you want for my home as you are the expert. It just goes to prove my point that they think they are godlike and have power over anyone coming to them for medical treatment which is just advice until you say "yes." Just going to them is not an automatic yes. This needs to be taught in all medical schools.
Dignity is how they deal with you as a whole. If they don't respect part, then chances are they respect none. I can say w/o a doubt that this has been our experience. They may be able to part into separate, neat little compartments how they abuse you and your family then they want you to feel out a survey saying how wonderful they were. And if you voice your issues, then they do not acknowledge them. It shows the disregard of dignity and therefore, respect. They think bc you didn't die you should be fine with whatever they did during the process but it doesn't work like that anymore. Again, I will say the so called cure effects should not be worse than the illness itself. JR
JR interesting point with regard to sustaining a human's dignity as they become a patient in the medical system.
A good question to answer is to what degree of detail regarding a patient's personal financial situation should be obtained by a physician and then utilized to be considered in the process of diagnosis and treatment of the patient's illness?
Our medical students are taught in their first and second years to obtain a work history (as part of understanding the "Present Illness" (which may be related to possible diagnoses) and in a Professionalism course, they learn the need to be aware of the medical insurance which the patient currently has in place. But, to my knowledge, they are not taught nor do we require them to ask their patients for any information detailing "cash on hand", money in the bank, investments or their personal properties.
My question is whether all this additional information beyond simply "medical insurance" is proper for physicians or hospitals to require. Should all this information be available to complete the understanding of the providers as to what to inform the patient regarding the most financially reasonable tests and treatments? Or to insist on obtaining this financial information is taking away important aspects of a patient's dignity, financial privacy. Or if one is sick, should full financial privacy be considered visible to the medical system as is the physical body privacy? Any thoughts about this? ..Maurice.
Absolutely not. It is up to the individual. Such interference would lead to even more sub standard care.
Would it not also be appropriate for doctors and hospitals to have to disclose relationships and financial ties to drug companies and medical device suppliers as these greatly influence what they direct to have done and what meds they prescribe. All trips paid for by drug companies disclosed. They would certainly feel it was an invasion of their privacy.
What my financial status is none of their business or office staff. Social workers are already too intrusive and mostly not needed or wanted especially during moments needing physical respect. JR
Maurice,
I am sorry that I am just getting back to you. As to the article I posted, I realized that there is a sense of humor, but there is truth in the base of the parody. One of the most well known parody sites (and one of the worst (in regards to patient dignity) is the Gomer Blog.
Read the article American Geriatrics Association Published Guidelines on Gomeritis. While this is a total assault on patient dignity, there is some truth to the composite image of the patient presented.
- Banterings
On the Gomer blog, there is a link to this article:
https://gomerblog.com/2019/01/a-growing-trend-with-men-vasectomy-procedure-plans/
An ultimate in male patient demands! ..Maurice.
The category of "patient dignity" is a broad one. I can't believe that this present brief hiatus in discussion is because we have covered all the issues here. On the other hand, it may be that the northern mid-west and east freezing temperatures does affect internet input (frozen fingers) of our commentators.
To add a topic to the patient dignity discussion I look to PT and AB in NW or JF to give their views of medical management for prisoners in correctional facilities or transfer to hospital care or return to prison. How are these patients treated? Are there patient gender differences in care or in their dignity? (Or can one say that in the United States under the 8th Constitutional Amendment these patients in jails or prisons "cruel and unusual punishment" is not permitted?)
Anyone want to input the dignity issues for patients in this category? ..Maurice.
In nearly 69% of the confirmed staff on youth sexual victimization cases, the victims were boys, and the majority of perpetrators (55%) were female.
www.eji.org
Federal study finds increase in allegations of child sexual abuse by staff in juvenile detention facilities.
Why do so many female teachers target young boys (students) for sex
www.educationviews.org/female-teachers-sleeping-students
Why are there high increases in boundary violations in nursing
Odd that healthcare facilities do their best to conceal sexual misconduct
They need to protect their $4 Trillion dollar a year cash cow.
PT
Dr B. I don't know that you'll agree with me or not. ( probably you won't ) but I really think a lot of the way things have been done , where done that way BECAUSE of wrong motives.
When I learned ( here ) of how young boys were made to depants for hernia exams and seen by teachers and even girl students ( other boy students still wasn't right ) In my opinion that was sexually motivated by whoever made that happen. Whoever else could have stopped it and chose not to were at fault also.
I was a student when the mandatory school showering was going on and im my school the female students were required to shower together also. We were required to be completely naked and our phys ed teacher came in to watch and make sure we did it. ( I refused )
The well woman exams that accomplish more harm than good , that invention was created out of wrong motives. Partly out of a desire to get sexual gratification and partly because of desire to charge the patient extra money. ( that doesn't mean I think every Healthcare employee is guilty of sexual or financial exploitation. Some are just following their job description )
Even the female chaperone policy chaperoning male patients , that was some medical staff fetish that they made happen. Parr of the problem is the number of patients who share the fetishes.
I kinda think that pushing for more male nurses and CNA's is just a partial solution. Most of the intimate care shouldn't be happening in the first place. ALWAYS a patient should be made aware if intimate care is going to happen. Allow patients to say yes or no!
Female guards strip searching male prisoners? Somebody with too much power to abuse had that as a sexual fantasy and made it a reality. Teachers , be they male or female. Regardless of whether their targets are male or female are SEX OFFENDERS! When they are caught their crimes are ACKNOWLEDGED as sex crimes. Unlike the medical world who are free to amuse themselves at patient expense. Even if it causes patients to not return for care. That doesn't matter to them because there's PLENTY of patients.
I think practices that hire only female staff do so to maximize the comfort of their female patients rather than to explicitly exploit their male patients. That some of those females seek such employment for the access is a different issue. What drives women to seek work in urology vs pediatrics or OB/GYN for example?
JF mention school children. No way could this occur today but I recall in 1st grade I think it was 4 boys at a time would be brought to the outer office of the principal's office. There in front of the female secretary we were made to undress down to our underwear and wait our turn. When the previous batch of boys was done, we went into the (female) principal's office where she and the female nurse were. There we were told to drop our underwear. I don't recall an actual physical exam (heart lungs etc) or them touching our genitals but rather just a visual exam of our bodies. I have no idea what they were checking for but it didn't seem right at the time. Complaining to them or at home was not an option in those days but why did they need to look at the genitals of 6 or 7 year old boys?
I still remember in 6th grade where the boys were made to undress down to our underpants in the boys locker room, then march up the stairs single file to the main corridor of the Middle School and wait in line outside the nurse's office. The line slowly inched its way into the room but while we waited in the corridor female teachers and girls were allowed to walk past us getting to wherever they were going to. Once in the (female) nurse's office we faced her and a female secretary of some sort and had to drop our underwear for them. The worst part was that occurred right in front of an open interior door that connected that room to the main office where we were in full view of anyone coming or going from that office and to some of the women that worked in the office. Again it was a visual exam. There wasn't a physical in the classic sense of checking heart and lungs and again they didn't touch our genitals. What it was all about is still a puzzle, and no way was complaining to anyone allowed. Most boys hadn't started puberty yet but a few of us had. Again, why did they see this as OK to do to 11 & 12 year old boys? There wasn't a similar examination of the girls that I was aware of.
Such things as I describe above would be lawsuit material today and thus likely doesn't occur anymore in schools but in my mind I think the way boys were treated back then is part of the underpinnings of the medical system we have today. Unhindered access of females to at least exposed boys if not also men was treated almost as a right then, and that thinking continues today in hospitals and medical practices.
It would be entirely possible to make BOTH genders more comfortable if that's what they wanted to do.
Does it take a brain surgeon mindset to come up with different floors for the different genders? A male floor as well as a separate floor for females?
Why are WE able to think up these things and they can't ( or just won't )
Of course there's patients that either don't require intimate care or don't have a preference about the gender of the staff giving that care. They could be on the mixed floor.
All this could be accomplished by ASKING in the paperwork.
If males are blantonly disregard in the medical world , what is the solution? Serial killers coming back for revenge?
I remember as a little/young girl how ashamed of my gender I was because of how easily the other girls cried. Now I can see how much we were PROTECTED we were because of it. Had girls been treated that same way there would have been MASSIVE and hours long crying and sobbing going on. The crying would start back up on the following morning to because the girls would be trying really hard to not return to school the next day out of fear of it happening again.
As far as prisoner's rights--it depends on the crime. If they have murdered, raped, or molested then they have no rights.
I, too, remember the grossly inappropriate physical ed. teacher who made sure you were naked everyday so she could stare at you. What a job for a sexual pervert. Luckily my children did not have to go through that wildly inappropriate ceremony of leaving your freedom of choice at the locker room door.
As I have said before, this country is very backwards. It has bent so far to accommodate one sex that it has failed to protect the other sex. They say it has always been that nursing was a female profession. Times have changed--women no longer stay home to raise children but can become construction workers or CEOs. Why can't they change this antiquated way of thinking that men should be okay to be totally naked and most of the time drugged in the presence of one or more female staff members. They don't usually do the male staff member alone with a female patient. I just don't understand it at all.
To say that medical staff check their sexual feelings at the door is totally living in a land of fantasy. I think that when alone many of these female staff members get some thrill of making a man subservient. That they can do it and the man will likely not remember anything or everything is an added bonus as they can get away with it. I think all patients should have the option of an advocate of their choice. That advocate should be able to witness everything including surgery prep, the surgery itself, the recovery room, and bringing them to a room. Exams and tests should also be included. In other words, patients should be allowed an advocate of their choice for any medical encounter.
I wanted to make everyone aware of another way they abuse your right to privacy. We found out that they send all your info to different voluntary data collection businesses. They send your name, address, and most importantly your social security number. Once this is done, these businesses have the ability to follow you for the rest of your life knowing whatever medical treatment you receive. The hospital played like they did not know everything that is inputted but since I had the forms in front of me, I gave them the education when they said it didn't require all the invasive information.
As for me, I have been busy. The hospital has reached out after we filed fraud charges and now all of a sudden, they want to talk. The woman who had initially told us-- they had the right to do whatever they want, however they want-- is no longer with them. When I told the new person about the letter that I read to her, she played like she was shocked. Also, the attorney general investigation is moving right along on the license investigation of 2 nurses. Hopefully, the HIPAA and the Freedom of Choice/Religious investigation will be moving again now that the fed. gov. is opened for business again. I don't believe the hospital is sincere but I think that they know from going over his medical records, they have issues that are very serious. JR
I am speaking for physicians, both genders: I believe the vast majority, virtually all physicians do NOT look at their professional activities as a means of satisfying their sexual interests when they are interviewing, examining or performing a procedure on a patient of either gender. I believe their interest and their behavior toward their patient reflects "doing a good job..the best they can" in diagnosis and treatment. If, the common public conclusion is otherwise, I think the public is wrong. I speak not for the nurses or technicians or others in the medical profession though I have never seen their sexual misbehavior either but that is how it goes for a physician in office practice and in the past generation not involved in "hospital observation" except as current member and former chairman of a hospital ethics committee (actually in years past chairman of two hospital ethics committees).
Physicians have a job to do and they try to do it, do it and the job leads to "burnout" to many and as far as I can tell from my reading, this work "burnout" is not related to "too much sexual misbehavior". I have always agreed that the news stories document sexual misbehavior can and has been carried out by physicians but they are named anomalies with regard to the entire physician population.
There is too much work to do and too many lives to improve or save for physicians to carry out "sexual interest" or play "sexual games".
I truly wish for physician visitation to this blog thread and speak up to all of us their personal experience and observation of other physicians. It is uncomfortable for just "me" alone to defend the vast majority of physicians. ..Maurice.
Dr. Bernstein, I agree that the problem is not the physicians. Yes, there is the exception but that occurs in every industry. The problem is primarily below the physician level with female staff. Even then I'd say that most aren't purposely being inappropriate but rather that their near total dominance below the physician level has fostered a culture in which being casual with male exposure is deemed acceptable. For those that enjoy it in ways they shouldn't it's just a side perk for being part of the sisterhood.
What we have with this female dominated world below the physician level is no different than what existed in all-male environments in other industries. As women broke the barriers into those all-male environments, the guys had to clean up their act and behaviors. That hasn't happened yet in high-intimate access areas such as urology and dermatology that are still 100% female staff enclaves in most instances.
Maurice
Upon reading your comments are you suggesting that sexual misbehavior by physicians be considered outliers. There is much online and documented on state medical boards and I’ll add, at least in my opinion, that sexual misbehavior by physicians includes boundary violations with patients. No one here on this blog would ever expect you to defend the behavior of the entire physician population and at least when I post here I like to think that I’m speaking to a broad audience that I don’t see.
Many sites would not tolerate the discussions on this matter and if you look at allnurses they are very adept at initiating a gag order, ie revoking your access, without a judge or jury. Personally, I think it is a violation of first amendment rights but you know there are many dinosaurs on that site and quite a few are expiring every year, which is a good thing, extinction and evolution are wonderful in thinning out the stupidity in herds.
When we post our experiences and opinions we are not directing them at you, we all know you well enough, your patience, wisdom and energy you’ve expended on this blog, know that you are appreciated!
PT
PT, one vile physician is too many and I know only from my reading here and in the news that there are many more than one. Look..even at the university where I teach we have had "at least" 3 "vile" physicians whose behaviors has been detailed in the newspapers. Are there more here? I hope not.
But think "there are 950,000 active licensed physicians in the United States"
I don't want necessarily to finger out female nurses as "the villains" but time-wise they are often the individuals who are attending to the various intimate or potentially intimate issues of all male or female patients, particularly those who are hospitalized or in nursing homes.
Of course, my philosophy may be prejudiced and in error...Maurice.
Dr B and Biker , So what about Mike's doctor and the other doctors who share his mindset? Did Mike's doctor get sexual gratification from doing his vasectomy? Not so far as we could tell!
Did his doctor protect his dignity? He didn't! There was no requirement from his staff that they knock and wait for a response. Had his receptionist knocked ( like they're supposed to ) that doctor , without a second thought would have invited her in. Mike was an assignment in that doctors office. Deserving less dignity than a 6 year old child.
There are no shortages of those kind of doctors. In my mind a scribe "seeing it all " is the same blanton disregard. Teens having to completely undress and be examined in front of parents ( some might be ok with that. Others adamantly against it ) Siblings having to be intimately examined in front of siblings. Some kids don't care so awful much. Other times, permanent damage is done to their relationships with each other.
No screens or curtains blocking doors. Also to say doctors never get sexual gratification from checking out patients isn't realistic. That doesn't mean that any inappropriate touching happened but sometimes the facial expressions give it away or body language. Much of the intimate exams SHOULDN'T be happening!
Most of the time, a male doctor is accompanied by a female nurse when doing an exam. However, the female nurses are left alone with the opposite sex as if they cannot or will not do any harm as they are female. Society has already installed distrust into the male doctor/female patient but not into the female nurse/male patient. Oftentimes, the nurses are young females and if you hear them talking, you realize how immature they are. The older nurses often go along with the younger ones bc they want to be cool and fit in. We know abuse can happen even though there may be more than one nurse bc people are like cattle and will follow or they come together to protect one of their own rather than doing the right thing and stopping the abuse.
Dr. B.--I think that most of us know that not all are bad. However, not knowing who is bad makes this the situation it is. Many times we are at our most vulnerable so we have to take a hard line on this. However, I do think that many female staff do purposely do things that make males in their care more subservient. What better way than to have a male entirely naked and vulnerable? I worked with a doctor who taught at a local university who said that is why the "nakedness" for males is done. It makes them less likely to object when their last line of defense is literally stripped away. Most naked people will not argue with a room full of dressed people. You are no longer on equal status.
For males, they are told to drop their pants and bend over. Does that happen for a female exam? Females are given gowns to privately change into along with a cover. Just the pic of a man who really can't move bc his pants and unders are around his feet is disturbing bc it is a lack of dignity. Then he has to pick up his pants and get dressed in front of whoever is in the room. Females they leave the room and knock to re-enter the room. What a difference in the handling of dignity.
So while this is accepted, it does not mean it is right. It may not be an outright sexually inappropriate behavior such as someone wanting sex from that person, but it is behavior based on sexuality. Therefore, it is sexually inappropriate and discrimination. It should not be happening. It is the responsibility of the doctors who may not be directly involved but they are in charge of their staff and they should be aware of what is happening in the hospitals where they are working. Ignorance also does not excuse or make it okay.
Also, we hear more about male doctors abusing females bc as a society it is believed that nurses are sacred. For too long, they have survived in a protected state. But what about the protection that should be afforded to all of those receiving their care? JR
As to the issue of sexuality: You can NOT change hundreds of thousands years of evolution. Seeing a naked body of either gender is an erotic (sexual) experience. One may eventually become desensitized (bored) with the repeated stimuli, but that does not mean that it is NOT sexual.
Indeed, if it was the case that providers are nt aroused, we would have heard about INTIMATE BURNOUT among providers.
...from seeing so many naked bodies as a medical provider and being desensitized to it, I am unable to get aroused with my significant other. There is no intimacy in our relationship...
We have never heard this because it does not exist!!!
These people think that they are the smartest people on the planet and everyone else is an idiot. The real problem is that they have preached this BS so long, many believe it and can NOT see what common sense tells us.
As to the abusive practices of forcing people to be undressed, Power corrupts; absolute power corrupts absolutely.
How many people would require their customers to be naked IF they could?
Other than morbid human curiosity, there is the component of the power differential.
We have seen it time and time again in World War II and Abu Ghraib (just as examples). It even happened in the Stanford Prison Experiment.
It is best summed up by the philosopher Michel Foucault: ...because we can.
-- Banterings
That doctor at the University said what? How AWFUL! Nothing like making it so a patient can't tell his concerns! If that patient can't force himself to come back for needed care , I guess that shows who's needs in that encounter is important and who isn't! Dr B. Please don't think the doctor/ medical staff bashing includes you. There's plenty of good doctors. I've even had some as my doctors. Some WONDERFUL doctors even. If you didn't care about patients you would have closed down this blog a long time ago!
Good Day:
Part 1.
Men, women, boys, or girls, we are all human beings. As we are human, we are all sexual beings its part of who we are.
Most people know how to and they control their sexual urges and feelings until the appropriate time and place where they release them.
Then there are others that don’t have control over their sexual urges and feelings and if given the right circumstances, with release them and usually it’s the wrong time and place and someone gets hurt.
Yes, there are doctors out there both male and female that abuse their patients. They do it because of a sense of power they think they have over a mere patient and because they think patients are too afraid to turn them in.
I suspect there are more of them out there than the general public will ever know about simply because our society and the federal government allows the healthcare industry to run under a veil of secrecy instead of demanding complete transparency on all levels.
So, after taking the deadbeat MD’s out of the equation, you’re left with a fairly decent group of people.
The biggest issue I see with doctors is that of transparency up front. Very few if any say upfront, this is how I do things then spell it out to you the patient. They tend to wait until the issue arises then afterwards explain things.
That’s why there’s such an issue these days with chaperones, scribes, and being ambushed.
This could all be avoided if they were explained up front in the first meeting between a doctor and his patient or in paperwork given to all new patients to go over and sign on their first visit.
A lot of patients could avoid being needlessly embarrassed and humiliated which in turn would lead to fewer bad reviews by patients of doctors if everyone was transparent upfront.
That’s how you fix the doctor issues.
Now, where the real problem comes in for more than 90 percent of patients is the MD support staff whether it be in an office, imaging center, ambulatory care facility, or hospital setting it doesn’t matter.
In all the different skill sets within the healthcare industry, today’s healthcare worker is woefully under trained when it comes to all aspects of people skills.
I attribute this not to the training they did or didn’t get in medical, nursing, or technical school but to a culture that with the blessing of mgmt., has been allowed to grow within facilities and doctor’s offices that teaches workers that they are superior over their patients in every way. They not their patient has the final say as to what will or won’t happen.
The power trip has gone to the heads of the MD support staff and it’s that culture that’s been allowed to grow and fester that has made going to medical facilities toxic to many patients.
The medical community like our society is slow to accept much less implement change.
Since the rise of feminism in healthcare back in the late 1960’s when men’s healthcare was forced (to this day I might add), to take a back seat to women’s care, society has seen a steady rise in the number of men dying earlier than they should. The medical community has most people believing the reason is because men just don’t take better care of themselves. Most men will agree that is true but, that is only part of the reason.
The other part is because men do not like the way they are treated by our medical community. Rather than always being embarrassed and humiliated, men have chosen to walk away from needed healthcare whereby raising the number of men who die earlier than they should.
continued.
Part 2.
Our society is not ready to accept the know fact that MD support staff abuses male patients on a regular basis throughout this great country of ours. The American healthcare system has had so many years of practice of burying patient abuses behind their veil of secrecy that, unless there are extraordinary circumstances (like Pittsburgh & the Denver 5), male patient abuse never sees the light of day.
It’s the same ignorance that society shows towards female teachers abusing male students. Society still believes for the most part that a female teacher could never sexually abuse a male student. Only in the last couple of years have people started to take a harder look at the issue. If a male teacher has a sexual relationship with a female student, society calls that rape & the guy is crucified and sent to prison. But when a woman has a sexual relationship with a male student, society says “he had the time of his life”. NO. It’s rape just like the male teacher.
Texas has taken the lead and it putting these female predators in prison where they belong. The rest of the country is still thinking about it.
It’s the same issue in healthcare where the MD support staff (mainly female), leaves a patient needlessly exposed for no medical reason, or brings in extra staff that have no reason to really be there other than to further embarrass or humiliate the patient.
Since the rise of feminism in healthcare, our medical community has held on to and drilled into the heads of all healthcare workers since the 60’s that it is absolutely okay that they see a male patient in the nude at any time they deem necessary.
The only way we the patient are going to change their cultural belief is to get society to address the issue the same way they are starting to address the female teacher issue.
Women already have their privacy protected. It’s time society starts thinking the same way about male patients.
In an open forum start talking about the issue. Let people know that the MD support angels are really devils in disguise.
Nurses get that award every year because I believe most of the people being asked have never had to personally interact with one. Their vote in many cases would change if they did.
If we want change, we have to first change society’s views of the issue.
Society has to demand total transparency from our medical community and that will in turn make changes possible throughout our broken system.
It’s time to introduce legislation to put our healthcare system on track. No more secrecy.
continued.
part 3
On another note.
As many of you know from firsthand knowledge, many tests done by our medical community leave us the patient in very compromising positions and needlessly exposed.
We now have our own way to counter needless exposure if we so choose to use it.
My contact at Covr Medical Garments reached out to me today and wanted me to know and pass on that as of today, consumers can purchase medical garments directly from the company rather than hope the medical facility will have something available for you. For example, if you were scheduled for a cardiac catherization you could go to Covr and order their bilateral medical garment which would keep the genital area covered while allowing access to the femoral arteries in either leg. Garments must be brought to your medical or surgical procedure in its original, unopened packaging. Do not try them on at home prior to your procedure.
This is a way to send a message to the medical community that one way or another our dignity will be respected and our privacy protected at all times.
Maybe, just maybe after they see how much more at ease a patient is when they aren’t worried about prying eyes, they might see the light and order their own supply of garments.
We have a job ahead of us but it’s not impossible. Put your fears aside for you and/or your sons and grandsons then speak up loud and clear that the system is broke and men demand changes.
In the short-term the least they can do to give men that want privacy for gender specific intimate issues is remove females and have male hospitalists take over male patient intimate care. That’s not costing them a cent as they would be using people already in place.
Sorry for the length of my msg today.
Regards to all,
NTT
I cannot believe students go into the emotional and financial strain of medical school and the training-work beyond just to have the opportunity to "look at" and "touch" alive naked human bodies. There are plenty of nudist colonies around the world which would permit the same opportunities to observe and associate with alive naked human bodies at far less the time and cost of a medical education.
The emotional burden on virtually all physicians is the need to meet the requests and demands of patients, to meet the requirements of attention to the physician's "patient load" and to find time for their own non-professional home life.
I can tell you, at least from my experience for over 30 years with first and second year medical students, I never have gotten the impression from them that they were participating in learning an occupation which would directed to dominance over patients nor for the student's and later as a physician's sexual self-interest. ..Maurice.
The really sad and scary part of all this is that we do not know how abusive and inappropriate the behaviors are. A lot of the abusive and sexually inappropriate behavior happens when patients are sedated. The sedation is a purposeful act that renders memories of the abuse to be erased in parts or in whole. Sedation allows more disrespect to happen bc at that point they really don't have to be "caring" or even act appropriately. Most other medical staff will turn a blind eye or even take part in the abuse situation so they won't be single out. You would think that when people are at their most vulnerable that oaths that these medical people have to take would actually mean something. However, since it does seem to be a power trip and we are not humans but rather objects put there for their manipulation and in some instances, entertainment. Since we probably won't have any memory--what's the harm? They are stressed and have burnout. My solution is to get another job where human contact is not needed.
The nursing field seems to be ran by the good ole girl's network. Many know of what is happening but they remain quiet which does make them just as guilty. I know several certificate workers who think they are doctors so it is not far fetched that they too abuse and overstep their power especially with men. Working in a school, I would sometimes sit in the teacher's lounge and listen while some of them talked about so and so bc they know someone who works in a dr's office or the hospital. HIPAA be damned. Once you become ill or have a medical encounter, then you no longer have any right to privacy either physical or in any other manner.
Does anyone wonder how many cameras are in an exam room or operating room? There are but even though it is you that is being filmed, you cannot have access to it. The consent form you sign gives them permission to film or video you. They use this form for everything. Most will freak out if you want to x out parts of the form. Asking questions cause mass hysteria from the staff bc rarely do they have to explain the form. The electronic versions leave no room for you to exclude parts you don't agree with. Not signing it does not mean they cannot still video you or send your info wherever. You have to object in writing.
Dr. B.--Maybe they don't go to school just to look at naked human bodies but a lot them do have an holier than thou attitude towards their patients. And yes, many of them feel they are superior to us mere mortals. I don't believe they actually save lives but are merely doing a job they went to school for. I don't believe we should be considered totally incompetent of making our own decisions once the person we pay for advice gives us that advice. It is our right and only our right to decide our medical treatment. It is a dr's demi-god attitude that allows either their bad behavior or the bad behavior of nurses/techs. I have known drs w/ the demi-god behavior and I have known drs w/ normal egos. I have even known a dr who said to me and why he perceived me as his confidante is unknown but he said as a "FP I am the jack of all trades and the master of none. I am so low on the dr totem pole that I am laying on the ground being stumped on by the others." I have also heard drs complain when patients want to be informed and make their decisions as these drs believe that it is up to the dr to decide what the medical treatment is to be and no questions allowed. I am afraid but I will have to disagree but it is a thing of power trip and to drs when a person is undressed they are less likely to argue. Nurses/tech also use this technique as a way to dominate and to hold power over especially males. I, in no way, am saying that you do that or that you teach that. I wish that more teachers were like you. JR
Biker, If males did what your female superiors did in grade school, they would be called perverts, rightly so. When females violate male modesty, it's more about control, control, control. In the medical community, females can not only control patients with impunity, but can retaliate when the patients don't respond accordingly. It's why the medical community is made-to-order for insecure females since the administration only cares for their customers, i.e. the government and health insurance companies that authorize and pay the bills.
Patients are just objects that the staff is free to control with impunity. Of course, the bosses will tell you otherwise, but grade the integrity in the medical community business dealings by listing your good and bad experiences with the non-medical employees.
Dr. B., What do you think of the staff getting their jollies from control rather than sexual?
BJTNT
BJTNT, staff should be made happy by contributing in all their professional ways to a good, beneficent outcome to their assigned patient. Nothing more. Nothing less.
It is the underlying pathology the patient is bearing that demands "control" and not something to enhance the self-interest of the staff member.
..Maurice.
I’m back! I’ve been gone for good reason, but I won’t get into that. Instead, I’ll make a few comments.
First to you Maurice. You seem to be attacking windmills (or, maybe you’re parrying their attacks) in Sunday’s 10:27am post and today’s 2:21pm post. I don’t know anyone (let alone the general public) who makes the arguments you ascribe to them (whoever “them” are). Maybe they’re out there somewhere; if so, they must exist on the fringes. On your Sunday 9:00pm post, you state that “my philosophy may be prejudiced and in error.” I am interested in what your philosophy is, but I looked long and hard and could not find any philosophical statements made by you. What is your philosophy?
It’s funny you make reference to your philosophy – indeed, it’s an example of what Jung would call synchronicity. Not two hours ago in an email to a hospital social worker, I attributed to you what I believe to be a moral philosophy. I should run it by you to make sure I’m not off base. Maybe you’ll experience an epiphany much like that experienced by William Chambliss, known best for his piece on the differential treatment of middle class and working class gang members called “The Saints and The Roughnecks.” Before he published this article, he read a paper at a professional meeting that was an historical/structure analysis of pirate organizations. After he read it, a colleague commended him for doing the best Marxian analysis he had ever heard. It was a epiphanous moment for Chambliss. After accusing Marx of anticipatory plagiarism, he dedicated the remainder of his career to conducting Marxian analyses of different phenomena including crime in Seattle (On the Take: From Petty Thieves to Presidents). -- Ray B.
Ray B., when I wrote I don't want necessarily to finger out female nurses as "the villains" but time-wise they are often the individuals who are attending to the various intimate or potentially intimate issues of all male or female patients, particularly those who are hospitalized or in nursing homes.
Of course, my philosophy may be prejudiced and in error. perhaps I should instead had written "my interpretation of why frequently what has been written on this thread regarding female nurses behaviors sets them as the 'villains'" And Yes, perhaps my interpretation was in error.
My philosophy and what I teach is no patient is an object but every patient is a human subject and not to be manipulated leading primarily to the benefit of the medical professional.
I hope this clarifies my philosophy. ..Maurice.
BJTNT. Or a combination of both!
Continuing on with the general topic of "patient dignity", what do you think about the medical system stating that the patient was "dismissed" from the hospital rather than the usual term "discharged". Why change? Well, the expression "discharge" within the medical nomenclature has a "pus" like connotation. This change was suggested on a bioethics listserv to which I subscribe.
The reason I bring this up here is that to patients "words count" as well as other professional behavior (or misbehavior). ..Maurice.
Dismissed makes it sound like the patient was naughty. Discharged has served us well for a long time. No need to change. We all know what it means.
The word "dismissed" brings in mind of an authoritarian figure giving a subservient person their permission to leave. It is all in the words. School children are dismissed. Drill sergeants dismiss the new recruits. For doctors and hospital administrators, it is all about power and money.
I was just told today by a cardio office manager that Indiana has some new law that now gives medical staff the ability to send a dead person to the cath lab to fix them. This will be done automatically and w/o consent. Just more money on the gravy train called medical interventions. I need to look this up and verify it but I don't doubt that the need for hospitals to have more power and money hasn't lead to this atrocity.
Dr. B.--No one expects you to defend all doctors. You cannot bc you do not have knowledge of what their mindset is nor the way they run their practice. You can only speak for yourself and how you teach your med. students. You can only hope that they follow what your have taught or you are only responsible for your own actions just like the everyone else is responsible for their own actions.
All of us are guilty of making broad sweeping statements. I know that not all nurses are bad and not all techs are bad. However, the badness that I have encountered has unfortunately made more of a lasting impression and I have met more bad as of late than good. So now, I view all with a leery and untrusting eye as does my husband who used to trust medical people without questions (he had to learn the extremely hard way). I view police the same way as there are some who are on a power trip and make it difficult to trust the ones who truly want to do good. I have seen cops who have stopped to help an injured animal and cops who change tires but I have also seen cops who make comments that are inappropriate, abuse their power, and are all around a--holes. However, my interactions with police have not been due to me being one of their "customers" so I let it go. However, with medical, it is different. They shook us to our very core bc it was personal and a nightmare of an experience. I do not recognize doctors as authoritarian figures as I am paying them--not the other way around. Police are supposed to enforce laws but what laws are doctors and nurses enforcing expect the policies and money making medical world machinery? Supposedly, we have freedom of choice in this country but has it changed when you need medical services? During the time of medical service, do you give up all your basic rights in order for treatment and still have to pay? That seems to be the way the medical community view it. Doctors and nurses become that by free choice. It is not my problem that it is costly, the hours long, and they often give up their private lives. It was their choice just as it was my choice not to become a doctor or nurse. I have seen teachers resenting the kids bc they felt trapped in their profession too. However, I would tell them that if they are that unhappy that they act on their happiness on the children or parents then they should find another job (notice I didn't say career). Many of them drink to ease their pain. Many medical people drink and do drugs as access is easy. I think we would all be surprised at how many of them do this. The hours are long and all over the place. I think that a couple of the nurses attending to my husband had some sort of problem. They test us for diseases but fail to safeguard us against healthcare workers who may have been drinking or doing drugs before reporting for duty. Again, so backwards. There is no thought for us either in dignity or safety. JR
Words do have connotations. The medical community changed from the practice of medicine to the delivery of medicine. Apparently "practice" had the connotation of not being perfect, even though it could be heading that way. So, the change to "delivery" has the connotation of pushing pills to me, but maybe that's because of the opioid epidemic.
Timing is everything. My high school friend said that college speech professors decided that communications would be more appropriate than speech. They changed at the same time that computers and communications appeared, so now when he says he's a professor of communications, many people think computers. He said they wished they had kept speech as the descriptor of their profession.
BJTNT
BJTNT
Delivery does sound like pill pushers and that is what modern medicine does. They seemed upset that my husband wasn't on a steady diet of prescription pills at his age. They did make sure through their actions that he was even though he didn't want to be. Pushing of pills is big business and all receive their share of the rewards except for the people taking them bc oftentimes the pill cure leads to needing other pills or procedures to "fix" the "fix".
As for the opiate crisis, it is no wonder that there is one and I believe the medical community is guilty of fanning the fire. Many addictions start from having been given the miracle painkillers from their doctor dealer. I know young people that I had in high school who got their addiction start that way. I know from our experience even though you tell them you do not want painkillers and tell them to put it on your chart (they will ignore it or cross it out), they are on a mission to give them to you even without your knowledge or permission. EMTs are especially bad about giving fentanyl to unsuspecting victims. My husband neither needed or wanted them but we later found out through his medical records that he was given 100mcg of fentanyl w/o his knowledge and w/o him being in any pain. It was like they were preparing him for the slaughter/nightmare to come at the hospital so that he would be incapable of defending himself from their plan of attack and abuse. They knew what they were doing but we had no idea at the time. These drugs are given too easily and too often. I wonder how many of the staff also dip into these drugs? Again, it would be easy for them to do it. They use these drugs to keep you vulnerable, unable to defend yourself, and they are able to do whatever they want and how they want to do it.
NTT,
Thanks for the info on Covr. I wrote to them over a month ago about wanting to purchase some to keep on hand in case we need to have protection from more abusive and violating behavior(s). I also liked your post from Monday. You covered many good points. JR
Forgot to add: Discharge has tradition. It's fine.
BJTNT
Regarding nurses and abuse, Maurice, I take my lead from the earliest published book with which I am familiar that reports on research about domestic violence (Strauss and Gelles, Behind Closed Doors). The authors found that children were more likely to be abused by mothers than by fathers primarily because mothers spent more time than fathers with their children. For the same reason, one would suppose, to the extent that male patients are abused, that abuse would most likely be delivered by female healthcare providers.
I commend your philosophy; it has its foundation in international and national codes of ethics.
NTT – Your observation , “Rather than always being embarrassed and humiliated, men have chosen to walk away from needed healthcare whereby raising the number of men who die earlier than they should,” is consistent with my and my students’ findings some years ago, findings I reported in the past on this blog. Ray B
JR
Interesting you bring that up about healthcare workers who are impaired, alcohol/drugs. A few years I posted here that 8% of healthcare workers are on illicit drugs. I believe that does not include alcohol and yet we should include those that have criminal records or have been sanctioned. Here is the worst part of the equation, those who have not been caught.
PT
Ray B, I think I found your observations written to my blog back in 2007. ..Maurice:
Monday, October 22, 2007 6:48:00 PM
I and nursing students in a research course I instructed found the following regarding
subjects' gender preferences of nurse for different procedures: genital exam -- 77.3%
same sex; rectal exam -- 66.7% same sex; shave pubic hair -- 71.2% same sex,
27.3% doesn't matter, 1.5% different sex; empty bed pan -- 59.1% same sex; 37.9%
doesn't matter, 3.0% different sex. All the differences were statistically significant
at below the .001 level except bed pan (p = .069). We broke up the reasons subjects
gave for their preferences into four categories ("personal" including discomfort,
humiliation, embarrassment, modesty, shyness, and stress; "patient rights"
including violation of privacy and compromise of dignity; "culture" including not
used to them and goes against my upbringing; and "prejudice" including don't like
opposite sex, don't trust opposite sex, opposite sex not sensitive, and technical
knowledge not sufficient. "Personal" responses were, overwhelmingly, the most
frequent and the differences were highly significant (p < .001).
Back in the early '90s, students and I conducted research which resulted in findings
consistent with comments made by a number of the posters to your Blog. We
hypothesized that the greater the social distance between male physicians and their
patients, the greater the patient dehuminization. We failed to find a significant
relationship using all our indicators of social distance except on the variable sex.
And, the relationship was the opposite of what we expected; women were less likely
than men to be dehumanized. After one of the subjects proclaimed that she would
never go seek health care because she didn't want to be "clinically raped," we
decided to do a little probing. We created an instrument to measure how badly
people felt about having been dehumanized (some items reflected the affective
reactions of rape victims) and found that men who were dehumanized tended to
feel worse (more embarrassed, more humiliated, more angry at themselves, etc)
than women who were dehumanized. We also found that men who were
dehumanized were less likely than women who were dehumanized to complain
about it. In short, men were more likely than women to be dehumanized by health
care providers and were less likely to complain about it in spite of feeling worse
than women about having been dehumanized. We also expected, consistent with the
literature, men's "macho" image of themselves would explain their tendency not to
complain. Instead, we found, consistent with what some folks have written in this
Blog, that it was dehumanized men's perception that others would think of them as
being less of a man that deterred them from complaining.
That tired me out. Sorry about the long-windedness -- c. ray b.
Who wrote at 5:36pm today? To All: Please remember to identify yourself with a consistent pseudonym just before you post. ..Maurice.
PT,
During one of our recent interviews for the right doctor and medical staff, a medical asst who used to work for a lab that was contracted to do hospital drug and alcohol screenings. After telling her about part of our beyond horribleexperience at the other religious hospital , she said we would be amazed at all the drug and alcohol screenings that would come in positive. She said it is a huge problem that is kept hidden from the public. She said she is leery about receiving medical care bc of this problem. I thought her remarks were very enlightening and scary. I do think that some of the staff may have had an impairment issue as it was Sat. night and they had supposedly been called in. Their backgrounds hold some interesting information on them.
It isn't as though most of us don't know that sometimes care from the opposite sex will happen. It is the manner in which they deliver that care. Although now, he does not want any personal, private care delivered by any female as he feels violated and afraid of them. He no longer will even remove his shirt bc he wants to maintain some semblance of control. These medical encounters are very stressing for him, a heart attack survivor and a man trying to survive medical "rape". JR
Ray B.,
I found your research from several years ago right on target. I know from our experience my husband and I both feel raped. Some say we shouldn't say raped as it diminishes the actual physical rape that "women" suffer (do they not know that a man can be raped too?). However, rape leaves deep, lasting mental scars. It is a crime of control and power. This was what was done to both of us. My husband--they did by exposing him multiple times for extended length of time to scores of needless people. They also broadcasted his PHI in public over a speakerphone and isolated and manipulated him into being submissive. Me--they placed a warden to be in charge of me who severely limited any information I received, didn't allow my husband and I to consult on his care as we won't told that a cath lab was an automatic do but rather he would be going there for info on possible solutions not a you're having this done bc we say so thing, isolating me from my husband for over 5 hours w/o any need or explanation, having this warden invade our privacy during a dr. consult w/ a dr. who was rude, didn't want to be there, and said he was tired. They also violated my conscious or freedom of choice/religion by forcing this clergyman upon me when I asked him to leave 3 times and he refused. We both have been dealing with feelings of rape as they forced us into things and situations we had no control over. My husband said that while that had him naked and cold he felt so alone, confused, and afraid bc he was unable to defend himself. He felt as he was an onlooker in an horror movie that he was the star of. He said all he wanted was to see me and talk with me as they had promised him and wanted to know what was going on. We both live everyday with a heavy feeling in our hearts and stomach and know with his condition could worsen and what will happen again? We view all medical people with distrust as they could be lying just like the other 2 hospitals did. It is truly a miserable existence.
JR
Alright, I’m going to now elaborate on some impairment issues I’ve seen during my career and how I believe this impacts the modesty/ dignity concerns. Over the course of over 40 years in healthcare I’ve known many physicians who came to the hospital while intoxicated and ultimately were given a reprimand by the state medical boards. I’ve known one physician who was caught at the airport with a suitcase full of heroin and cocaine, he lost his medical license. I also know of a male physician who was a pimp on the side and money laundering, he went to prison and was reprimanded. I’ve known a number of nurses and techs who were impaired, stole medications meant for the patient, found unconscious and overdosed from taking all their patients meds. One nurse overdosed from patient meds she stole from patients and found dead in the the women’s bathroom of the hospital.
The truth is it’s so pathetic I could write a book about it all and give proof in the index. Now, if these physicians, nurses and techs that provide care to people who are ill while impaired themselves do you think they provide care in a dignified manner to their patients. How can they if they, steal meds meant for patients, come to work drunk or with a hangover or high from something. There is data published that states that about 8% of all healthcare workers are impaired by drugs or alcohol. You have to ask yourself, what is the actual percentage of medical staff who are impaired and/or enjoy bullying patients.
Finally, hospitals spend millions and millions of dollars each year on drug dispensing machines in a failed attempt to track all drugs meant for patients. It’s not a foolproof system and furthermore it’s chickenfeed compared to $4 Trillion dollars healthcare industries pull in. Thus it’s important to remember you are paying for these futile attempts to ensure you the patient get the medications dispensed to you. Well, getting your pain meds in a timely manner, well, that’s a whole different story when no one answers your call light as the nurse surfs the web.
PT
Nurse who administered wrong medication to patient resulting in patient’s demise to be charged with homicide.
The hospital did not report patient’s death to the state as a medication error as required by law.
Who concealed this information from the patient’s family as well as the state, risk management.
What is the job of risk management as i’ve Said on this blog for several years now.
To hide, conceal by lies, prevent dissemination of information to the news media or the public of bad doing.
The full story on Allnurses.
But wait, theres more.
What about the fancy words hospitals use like transparency.
They can’t even tell you what your hospitalization, procedures cost.
That too is a lie, it’s a secret.
PT
PT,
Thanks. I think that may have been part of our situation. We have done some investigating and the one nurse in CCU certainly likes to drinks and talks about being hungover. The other nurse in the cath. lab has had liquor licenses and many driving violations. This is part of the research done for our case. We truly feel something was not right on the Sat. night. I think it was a combo of things which I feel can happen frequently:
1. Impaired staff by alcohol or drugs
2. Cultural differences that play out as the interventionist seemed not to like to deal
w/ women.
3. A religious hospital's right (they said) to act as they want. The first hospital made
my husband gay by saying his spouse was a male--husband. I have been female since
birth. We saw this info on the emergency paperwork in the med. records. Our grown
son was w/ me and I think they thought he was the husband as they never asked for
our names and relationship until 4:15a. The abusive nurse seemed very surprised
and asked me to repeat who I was and my name. She even then asked my son who he
was. I didn't think anything about it until I found the above.
4. Most of the staff our young people who lack maturity.
5. Most of the staff our females and many of them do not respect male dignity.
6. Most healthcare workers have the false impression that whatever they say or do
is the "law" and patients/families do no have any rights.
Although all the attorneys we have talked with have said without a doubt we have a case on many issues, they do not want to spend the time and effort to win since he basically didn't die. We know he has damage physically and we all have damage mentally and it should be enough that they did what they did. Hospitals know this and this is how they can operate on the "fringe". I think our legal system is just as broke as medical system. However, we are still persisting even if we have to represent ourselves. I think
the law needs to be informed that wrong is still wrong and needs to be corrected and not just swept under a wall to wall carpet so the dirt is trapped forever.
I did notice the other day when we were arguing with an office manager over their office consent form that she called patients--consumers. She also said that signing the form really didn't give them the rights that it said it did. This is how people are trapped into signing something that don't agree with but now are stuck with because they signed it. I also noticed that we were the only ones who actually read it. Most just signed it. Like lambs being lead to slaughter. I also know that they automatically import your social security number from their Epic medical system without your permission. JR
I still haven't found any evidence that dermatology's full body skin exam includes a check inside the patient's nostrils. I suspect such a check might be more beneficial than looking for penile lesions that men would already be aware of and could draw attention to if present. Another very sad case here: https://www.foxnews.com/entertainment/ray-donovan-actor-steve-bean-dead-at-58
REL
What a difference a year can make. Some may recall my posts from a year+ ago about my first dermatology appts at the large teaching hospital I had consolidated all of my care at. It was shocking to me in part because I had previously found all of my other interactions there to be very positive, including the ability to easily ask for a male nurse for cystoscopy prep in urology.
A year ago asking for only male staff (scribe & LPN accompanying the dermatologist) in the room for a full skin exam was met with open hostility from the scheduling staff, to the LPN taking history before the doctor arrived not wanting to talk about it, to a scribe walking in while I was completely undressed after being told not to come in, to the Resident I had been assigned to walking in the room and the 1st thing he says as he shakes his hand in front of my genitals being "you have a problem with women?", to the Section Chief not responding to my letter of complaint.
After elevating it to Patient Relations I got an apology for how things went, a commitment there would be some protocol training, a new policy was established that men can have exams with just the doctor if they request such, and I got reassigned to the Section Chief.
Now a year later I went for an annual checkup exam and it was very different in a good way. They still don't have any male scribes or LPN's but the attitude is completely different. Upon check-in I say I only want male staff & as I expected get told there isn't any. There wasn't any hostility in conveying that and I respond that I don't really want to make more work for the doctor but I do want my privacy respected, and could she send someone to speak to me about that.
A couple minutes later a woman comes for me and we go to a private spot to talk. She starts the conversation saying absolutely my privacy will be respected, that she understands, that some of their other male patients feel the same way, that she'll take care of it. I tell her I don't want to make more work for the doctor, that I know the scribe is important to him, that I object to standing there naked with two women observing, but that I'm willing for them to be there if it can be done while also protecting my privacy. She says she'll speak with the doctor and take care of it. There was nothing negative in her demeanor, tone, or body language at all. It was treated as perfectly normal request.
I get roomed and the LPN comes in. She had already been spoken to and tells me she'll stay out of the room but that the scribe will come and will leave when that part of the exam occurs. Again, there was not anything negative in the interaction.
The doctor comes in with scribe trailing him, and immediately tells me that he doesn't have any male staff but that my privacy will be assured. There was nothing negative in his mannerisms at all. Clearly he had been spoken with by the woman I met with too. When it came to that part of the exam the scribe didn't leave but she faced away and he positioned me so that she'd not have been able to see anything had she tried to anyway.
I have no complaints about how this all unfolded, and am thinking part of the dramatic change in attitude and protocol came about from my complaints a year ago. It does pay to speak up. I wouldn't be surprised if they were being more cognizant of male patient privacy even with the guys that don't speak up.
Ray,
WELCOME BACK!!!
Maurice,
You state that your philosophy is:
My philosophy and what I teach is no patient is an object but every patient is a human subject and not to be manipulated leading primarily to the benefit of the medical professional.
So how does one distinguish between primary and secondary motivations? That goes to the situation that lead to living wills and DNR directives and these being ignored at medical professionals. That is why I argue there can NOT be any exceptions to patient consent. One such exception is if it is an "emergency" situation. Indeed this was the famous case of Brian Persaud and NewYork Presbyterian Hospital (2008).
The repercussions of this lead to the review of the protocol for a DRE in the trauma setting and the SCIENCE concluded there is No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients.
Read more here and here.
NewYork Presbyterian Hospital attempted to justify this sexual and physical assault on an alert and oriented patient who was neurologically intact and walked into the ED by claiming it was an emergency situation. Although the battery of sedating ant intubating him was secondary in making the encounter easier for the provider, they claimed this was an emergency situation and the primary goal was saving the patient's life. (Spoiler alert, there was no emergency.)
Maurice, you can see the flaw in your philosophy. I think that a better philosophy would be that goal of medicine is for the benefit of the patient, and benefit needs to be defined by the patient.
JR,
You stated:
...All of us are guilty of making broad sweeping statements. I know that not all nurses are bad and not all techs are bad...
Just like the police that you point out, you are either part of the solution OR you are either PART of the problem.
BJTNT,
Let us not forget the latest goldmine for facilities: ADMITTED and OBSERVATION.
PT,
Beyond impairment, the latest kerfuffle in Virginia. This is status quo for medical schools. It supports my theory that medical school kills the conscience. Read the article: Virginia governor's medical school found a pattern of inappropriate yearbook photos.
Here are some really good quotes from the article:
'"There's been a pattern," Eastern Virginia Medical School President and Provost Richard V. Homan said on Tuesday. "Some are repugnant. Some are unprofessional. Some are shockingly abhorrent, like I mentioned."'
'Homan said when he was informed about inappropriate images in the 2013 yearbook, he decided to discontinue the yearbooks. None have been made since that year.'
...So these attitude continue to exist and this stuff still goes on, just not officially.
'Former Virginia Attorney General Richard Cullen will lead a third-party investigation to examine past yearbooks and to look into the culture of the medical school, the school said.'
'He said that the issue was about the institution, and not any individual students.'
'Dr. William Elwood, who worked with others on the layout for the 1984 yearbook, told CNN that photos for personal pages were chosen by the individual student.'
...Doctors passing the buck...
-- Banterings
Speaking of sexual abuse by providers, here are some very good recent articles on the subject. I will start with MedPage's 3 part series on the subject:
Part 1: When Docs Sexually Violate Patients
Part 2: How Medical Centers Fail to Police Sexual Predators
Part 3: State Boards, Regulators Paralyzed on Physician Sex Assaults
Surgeon With Sexual Misconduct History Accused Again
This is a really good article.
Sex abuse in hospitals, nursing homes affects patients of all ages
Note the article states:
"I've wondered if nursing home care draws that particular type of predator," said Dominique Penson, a partner at the law firm Barasch McGarry Salzman & Penson.
"I think it's pervasive," Penson said of alleged abuse in nursing homes and other medical facilities.
"I don't think there's any question it's pervasive."
There were several cases in 2018 of medical staff accused of patient abuse in nursing homes and hospitals, and a 2017 CNN report found the federal government had cited more than a thousand nursing homes for failing to prevent sex abuse at their facilities—or mishandling the reports.
"Unfortunately, it could be a physician, it could be some sort of health care professional, it could be maintenance," forensic psychologist Dr. NG Berrill said of the staff who have access to patients.
-- Banterings
Thanks, Archie. It’s good to be back.
You mention the case of Brian Persaud and NewYork Presbyterian Hospital (2008). I contacted one of Persaud's attorneys before the trial by email to find out what arguments he planned to use. He was hopeful that Persaud would win. In fact, though, he lost. One of the jury members joined a blog and spouted off about the criteria jury members used to make their decision. Basically, the jury seemed to have used its power of nullification to make its decision. Persaud’s attorneys argued that Persaud had a right to refuse treatment but he was battered by providers in the process of forcing the treatment on him. According to what the jury-member blogger wrote, the jury seems to have pretty much ignored the evidence. Providers insisted that Persaud was lying and the jury agreed with them. They agreed with the defendants because of extra-legal factors that were not at issue – they believed the rectal was a valid way to judge spinal injury, Persaud had sued people in the past, and Persaud was bi-polar. Juries not infrequently use their power to nullify the law when defendants, such as healthcare providers, occupy positions of high esteem and plaintiffs are people of color, as Persaud was.
I tried to get in touch with Persaud's attorney after the suit to find out if he was going to appeal the decision, as reported in the media, but he never got back to me. I have not seen anything about the appeal. I assume the firm did not appeal or the appeal was denied. Does anyone know anything about it?
Since Persaud, NY Presbyterian, which is connected with Columbia University, has breached the law on numerous occasions including the following: In 2014, it was fined $4.8 million by Health and Human Services’ Office of Civil Rights (it administers HIPAA) for the computer breaches of 6,800 patient records https://www.modernhealthcare.com/article/20140507/NEWS/305079946
In 2016, it was fined $2.2 million for allowing the filming of two men without authorization. The Chenko family sued but a judge decided that the emotional stress caused by the knowledge that one’s loved one was exposed to the indignities of being filmed as s/he was dying was not “outrageous enough to justify damages on that count.” The Chenko family apparently didn’t get a penny in damages. https://www.nytimes.com/2016/04/22/nyregion/new-york-hospital-to-pay-fine-over-unauthorized-filming-of-2-patients.html
What the piece above does not tell the reader is that a patient may be filmed by commercial film crews (considered business associates of a hospital) if a patient is deemed unable to give consent and a legal representative is not available to give consent. In Chenko’s case, the family was present to give consent but its members were not consulted. Furthermore, as they spoke in a waiting room by themselves, they were taped without their knowledge by an ABC crew led by Dr. Oz. Commercial film companies apparently have no trouble finding hospital administrators, physicians, nurses, and other hospital inhabitants who enthusiastically embrace the virtue of allowing commercial film crews access to patients’ records and patients themselves as they are stripped naked and catheterized. I have it from the horses' mouths (the CEO and President of Johns Hopkins, both of whom are physicians) that the right of the public to know via visual and auricular access to patients’ confidential information and persons in their times of great crisis and vulnerability trumps their rights to privacy and dignity. – Ray B.
Ray B., I fully DISAGREE that "the right of the public to know via visual and auricular access to patients’ confidential information and persons in their times of great crisis and vulnerability trumps their rights to privacy and dignity. " I thought HIPAA regulations was a beginning to wipe out that concept. ..Maurice.
Maurice,
HIPAA grants (validates) access to PHI to more people than it protects it from. Read about Exceptions to the Privacy Rule.
Ray,
As to Brian Persaud, the real reason that he lost the lawsuit was because the ED staff changed their story AND lied about performing the DRE.
They muddied the waters by saying they ONLY attempted to perform the exam but did NOT COMPLETE it.
See the story here: Note that it states:
There was conflicting testimony at trial as to whether the rectal exam was completed. Persaud woke up handcuffed to the bed and soon was charged with misdemeanor assault against the doctor.
There was also the issue that the hospital argued that due to a head injury he was NOT competent to refuse. His lawyer countered that he WAS competent (and the hospital was aware of this) by the fact the hospital tried to press charges for assaulting a doctor against him.
-- Banterings
No, HIPAA does not secure a patient's right to privacy. Hospitals know that the OCR will not do much if anything in lone cases. As for respecting patient and/or family rights in times of trauma, that is when they will most likely violate them. This is what we learned the hard way. Anyway,hospitals have big money and lots of attorneys. Here in Indiana it is dam_ near impossible for a patient to win against 4hem thanks to the late and not great Dr. Bowen who was governor and instrumental in getting protection in place for medical communities to use and abuse.
We found an attorney who said they would take our case but have to make sure he is not just going to take our money. The others said we have a solid case but they are not interested in using their resources as it takes too long.
It is a sad state of affairs when hospitals can literally do whatever they want and feel confident that there is no consequence. If only it had happened to me then someone might actually care. Need to think of a hashtag for abused men and try to start some movement. JR
Dr. B.--
A patient is in the emergency room and sometimes they will purposedly isolate them from their family, they will say they have the right to overrule Informed Consent. This way no one interferes with what they do. Most consent forms give them theright to film and whatever else they want to do. JR
JR
Yes, I too have lived in the state of Indiana and I’m fully aware of a once governor Otis Bowen MD, who made it difficult to sue in malpractice cases. But then it’s not a progressive state either in many regards. I once had surgery at a hospital in their so called glamorous city of Carmel Indiana. The manner in which I was treated actually started on the path I’m on now, disregard for a worthless industry that cares only about dollars and no sense. Common sense that is.
PT
Question: Is it true that 6 or more malpractice suits (simply filed not adjudicated) can often double a physician's malpractice insurance cost?
REL
REL
Depends on the specialty and the degree of malpractice, however, I would think at some point the state medical board might intervene since with that many cases negligence might be a factor. In some cases where surgery was involved the surgeon, anesthiologists and the hospital are found to be at fault. I’m not concerned with malpractice as it relates to this subject at all.
I have more of a concern with nursing and their unprofessional behaviors and the lack of leadership displayed by hospital administration as well as state nursing boards. Maybe nursing should face hugh fines when their behavior falls outside of the scope and practice as set by perhaps a more defined nurse practice act and state nursing boards that hold people accountable.
Society should hold it self accountable as well for assuming that half of the population can do no wrong. Privacy is just that and it’s based on the bill of rights in our constitution. Privacy dosen’t end when you set foot in a physicians office or hospital. There should be no secret
core values that you don’t know about, no secret staff that suddenly are present in exam rooms and no secret health care costs.
PT
Here is an example of where "malpractice" is NOT the fault of the physician but the results of the insurance industry on the very patients they are to insure the best of practice:
https://www.ama-assn.org/system/files/2019-02/prior-auth-2018.pdf
This is an example of the insurance industry's lack of confidence in the judgment of the patients and physicians for whom they are designed to serve. ..Maurice.
You know, with Banterings suggestion to change this thread's title to Patient Dignity, as I may have noted previously, it does open this thread to a host of topics which has been discussed on this blog in the past but which does fit to at least bring up on this thread.
One such topic is about doctors hugging their patients which in 2007 had brought up 50 comments from a number of different visitors.
If you are interested in this topic in terms of sustaining patient dignity you might want to skim through the responses and write something here about your conclusion.
Here is the link to that 2007 discussion:
http://bioethicsdiscussion.blogspot.com/2007/11/being-hugged-by-your-doctor-invasion-of.html
By the way, if our visitors here find a previous thread which is pertinent to the Patient Dignity here post us the link. ..Maurice.
Some people are natural huggers and others of us are not. I imagine it would be very difficult for a doctor to know which camp a patient falls in, so a doctor initiating a hug is fraught with peril.
I do not want to be hugged by a doctor or other health care provider or anyone that is not a close friend or relative. Though I've never been hugged in a healthcare setting, in other settings it happens frequently enough and I just graciously accept it. I know it is almost always well intentioned even if I'd prefer they didn't do it. Were a doctor or anyone else in a healthcare setting to hug me, I'm just let it pass and accept it as the human gesture it was meant to be so long as it was just a simple hug without a sexual component to it.
To me, a physician hugging a patient is a sign of empathy by the doctor and a meaning of "we are in this task to make you healthy but together".
My philosophy is that those physicians who hug their patients are demonstrating that the doctor is not an "object" nor is the patient and that they will be working "together" to achieve the best goal for the health of the patient. Thus, an expression of personal dignity for both parties.
I must admit that I have rarely initiated the hug but I remember being hugged by patients.
I have not instructed my first or second year medical students to hug their patients but I have emphasized the extension of the student's hand at the time of the student's introduction of themselves to the patient.
By the way, clinical information about the patient can be obtained by offering a handshake at the onset of the relationship, though that should not be the rationale for initial handshaking. It should be a sign to the patient that the student cares and wants to be involved with the patient and his or her problems. And it is the beginning of a relationship that may lead to the laying on of hands on other parts of the patient as part of the student's later physical examination, of course with the patient's permission. ..Maurice.
..Maurice.
REL,
I will speak to the malpractice insurance issue. Most of my work is paid (or should be paid) by insurance companies. I also assist in, OR handle situations that insurance companies handle, because I do it quicker, better, and/or more efficiently which translates saving money.
Insurance coverage comes down to a simple algorithm: (money in) : (money out).
Here is biggest complaint about how insurance companies handle claims; they settle fraudulent (or exaggerated) claims. Here is how this situation works...
If we have a fraudulent claim (worth $0) asking for $1 million, OR an exaggerated claim (worth $10,000) asking for $1 million , AND the insurance company settles it for $20,000.
The $20K is money out, so to counter this, premiums rise.
Now the insured (the physician, facility, or practice) argues that the insurance company should fight the claim to show that it is fraudulent or really worth. But in this example, it will cost $100,000 to do this, thus the payout is 5 times the settlement and the increase in premium is also 5X.
The insured says that the insurance company is only looking out for itself. The harsh truth is that the insurance policy does what is in the best interest of the insurance policy, NOT the insurance company, and NOT the insured.
The best interest of the insurance company would to (essentially) deny all claims and pass on all costs to the insured. The best interest of the insured is to fight the claims regardless of cost. The interest of the policy would provide for the cheapest and most efficient resolution thus saving BOTH the insured and the insurance company the most money.
ANYTIME a claim is made, it costs money. Money for the insurance company or the TPA (third party administrator) to set up, investigate, and recommend a resolution. If there is a lawsuit filed, it costs even more because an attorney must be retained to represent the insurance policy (attorneys do NOT represent the insurer OR the insured, they represent the policy). Even if the claim is dismissed at the first hearing, substantial money has been spent.
So why does the insured have to pay these costs? Because the claim is being made against the insured. It is the insured's responsibility to ensure work is done correctly and customer satisfaction is maintained. (Can you say Press Ganey?)
For this reason I tell anyone whose wishes (consent) or dignity was NOT respected to file as many lawsuits as possible because they create a cost to the provider.
Back to (money in) : (money out): 3 practices have a claim that paid out $100K. Premium for each physician is $25K a year.
The first practice has 1 physician. So the policy has paid $75K more than it took in. The second practice has 4 physicians, so the policy has paid out as much as it took in. The third practice is a big, regional hospital with thousands of physicians. The policy has only paid out less than 1% of the money it took in.
This is a very simplistic overview of insurance, but you get the idea.
-- Banterings
If someone wants to hug me they can knock theirselves out, I don’t care. If it’s in healthcare, at the resturant, coffee shop, dosen’t matter. I think in society we have shifted to a different time period where no one trusts anyone. It’s sad really, I don’t hold doors for women anymore as I might get reported to the #metoo movement. I always shake hands with my GP, it’s just a sign of respect.
PT
Banterings, could you also speak to the issue of "prior authorization" (PA) function of the insurance industry and its effect on how patients are treated. What did you think about the physician survey https://www.ama-assn.org/system/files/2019-02/prior-auth-2018.pdf which I referred to in yesterday's posting? ..Maurice.
Maurice,
This survey is NOT designed well. Take the category Impact of PA on clinical outcomes. The negative category combines significantly negative impact and somewhat negative impact. I think that not knowing the severity of the negative impact distorts the real impact. This sounds like 91% of the time the patient dies.
What is missing from the survey is how many times the PA treatments were appropriate: guidelines followed, cheaper alternatives were tried first, etc.
This is also based on a survey of only 1000 physicians. This is not a good sample size. I am sure that the data was also anecdotal, not research.
PA is also assigned to overprescribed, low yield, expensive, and experimental treatments.
Without a proper study, I cannot speak to PA.
Finally, PA meets the ethical principal of justice that has been bastardized to support the liberal, socialist, global agenda that is infecting our society. If the profession would undo the this and interpret it properly, then we will reduce the burden of PA.
I am sure that if I surveyed 1000 insurance adjusters they will say that 91% of the time physicians inappropriately prescribe treatments requiring PA.
-- Banterings
This comment has been removed by a blog administrator.
Banterings,
Would it be correct to assume that it is the Dr's responsibility to make sure the Informed Consent has been properly done? I think many have handed this down to staff and are not even signing the form. I think they try to label as many as they can as emergent but that shouldn't work if the person was conscious and family was available. It is the conveyor belt mentality and their smugness that they can do whatever.
As far as insurance, my husband's company has been great. However, I believe they have too much power and control just as does the medical community. The only one without control is the patient.
As for doctors or nurses hugging, I would not want that bc they are my least favorite groups on earth. JR
Missouri prison nurse accused of killing husband setting home on fire so she could marry inmate.
PT
Maurice,
I do not have time to elaborate on these due to another crazy day, but here are 2 very interesting links:
What do the images on this page say about patient dignity?
General Surgery News
Finally, as per this article on KMD, could Maurice and his people to be responsible for all of this? (Note this is meant to be humorous based on the article title.)
Why bioethicists fall short of connecting with clinicians
-- Banterings
I think most of us non-medical people would be surprised at how much of our information including photos or video taken during surgery is out there. Since it is clear that there is very little respect for patient privacy and/or dignity, it means nothing to them to use us like that. The Informed Consent forms give them the right and even if it didn't, they would assume they have the right.
If you haven't been a victim of this medical system, then it is difficult to understand. You don't know what happened to you when you were put "under" and your memories were purposely erased. It is akin to rape and you have no idea how many strangers participated in the fun of your situation. You don't know how cell phones may have pictures of you and to who those pictures have been sent to.
Not only for us is what happened during the cath lab an issue but it went on to be an issue when a nurse and at least one other nurse couldn't refrain from laughing and smirking. These same 2 nurses also were alone with a drugged, defenseless man for hours while they purposely isolated him from his family. There was no medical reason why they kept him apart from his family except they could and did. Also, the nurse freely admitted that she exposed him needlessly because she claimed about over 10 years of nursing and being in the Cardiac Critical Care Unit, she somehow did not know how not to expose the genital area when looking a the groin wounds. And to top it off, she was laughing when she said it. It is the knowing that these people who we pay to take care of us during our illnesses are sometimes exploiting us. It is the not knowing everything they did to you while so vulnerable but knowing enough to realize what they did was very, very wrong and sick and you feel defiled. Going to the hospital should not create this feeling but when you have suffered abuse, it does. Now, we look at each and every one of them as a possible sexual predator. We do not have faith in their ability not to do or cause harm. That night he had his heart attack, we were unprepared for all of this other.
And for those who say, get over it that they see naked bodies all the time, haven't yet experienced the feeling of total helplessness, betrayal, broken trust, and emotional trauma that was caused. My husband had prostate cancer and is no stranger with his genital area being exposed. However, it was the manner and how they did it. There are respectful ways and there is a way that this hospital of horrors did it. There was no reason for his genital area to be exposed. His groin is not his penis. Even if they needed to sterilize the area which they don't need to as the Covr garment takes care of that, it could have been done quickly and covered. They did not need to strip his clothes off of him without his permission and stuff them into a pink garbage bag (yes, pink for woman power-ironic isn't it?) and leave him totally naked and exposed for over 30 minutes without a blanket or gown in a room full of 4 women, 3 EMTs, and countless techs and others such as a registration lady and possible minister. How in any world is this okay to do? Why does a registration lady need to see his genital area? He didn't get to see hers and she certainly would have been offended if he had mentioned this but she and others shouldn't as being naked doesn't matter or does it?
I have decided that I am going to start Twittering as much as I dislike it. I think the hashtag I have decided on is #happens2mentoo. I think the public needs to be made aware that females nurses are predators too. Too often the story is about male nurses. It is not that female nurse do not act inappropriately but rather men don't make their sexual abuse public as they feel they will be victimized more. I am also thinking about #cathlabsRcesspools as my other one so maybe people will become educated as to what really happens at cath labs or has the potential of happening. JR
Banterings, physician clinicians are not a minority in ethics discussion or arriving at clinical ethics conclusions. There are many active and thought provoking physicians (incidentally, beyond myself) who participate on the multiple clinical ethics listservs, attend clinical ethics meetings, write articles and are essential parts (including chairpersons) of hospital ethics committees. Thus, physician clinicians are active participants and provide input to the discussions of all ethical issues by philosophers, social workers, lawyers and other non-physicians.
Clinical physician ethicists do exist and we are communicating with and requested for consults and education by other physicians in medical practice. ..Maurice.
Well, we've been describing, analyzing, and complaining for years. Let's do something about what we've been describing, analyzing, and complaining about for years. Sociologists who have studied social change tell us that change in a system (e.g., health care system) will not get to first base unless there is some degree of collective dissatisfaction. Martin Luther King observed that collective dissatisfaction is not possible unless people know what's going on. For example, black men who were subjects in the Tuskegee Syphilis experiment did not become disgruntled with their treatment until some upstart physicians and attorneys with solid ethical foundations informed them of what government doctors were up to. So, the first step in fostering collective dissatisfaction if not outrage is to inform people's ignorance regarding the unnecessary indignities that have been and are taking place in healthcare and the differential distribution of ethical/legal violations by gender that are occurring.
I recommend that we pool our knowledge and complete a paper to send to a widely read journal designed for public consumption such as Men's Health. Tomorrow, I'll let you know more specifically what I have in mind. -- Ray B.
Maurice: I was reading some earlier contributions to volume 94 and noted that several people mentioned outliers. It brought to mind Milgram's mock-shock research whereby subjects believed they were giving dangerous voltage level (over 400 volts)shocks to Milgram's confederate (who was not really being shocked). Before the experiment began, Milgram asked people in the know (psychologists/psychiatrists) what percent of the subjects they thought would follow his orders to shock all the way to the end, they answered somewhere around 8%. In fact, 2/3 of the subjects followed Milgram's orders to the end. Milgram's research was deemed unethical and was never fully replicated. About 10 years ago a psychologist (last name Burger) was challenged to replicate part of Milgram's study because so many people were of the opinion that people were different now. Burger made a few cosmetic changes in the method, received IRB approval, replicated part of Milgram's study and found the same thing that Milgram did. My point, although our faith in human kind may compel us to expect all but a few outliers will do evil things, we are likely to be disappointed when the facts become known. History is ripe with examples. -- Ray B.
Ray B.
I am with you in doing something. I am going to make an appt. w/ my local state rep and state senator discuss:
1. The inequality of intimate care for males and females
2. The lack of true Informed Consent
3. The use of conscious sedation drugs to selectively erase memories
4. The overuse and use of drugs such as fentanyl to control & make pts. compliant
5. The falsification of medical records and the lack of complete reporting
6. The use of medical information meaning your information is sent everywhere
7. The shroud of secrecy that protects the medical community
Please anyone, feel free to add to my list as I want a comprehensive platform. Being pro-active is the only way to get things done.
I saw on tv this morning about a nurse singing to her female patient in TN and my immediate thought was all my husband got from his female nurse was violated. We are beyond grateful with all they did to harm him that he was able to survive their abuse. Going to the hospital and having encounters with these people should not add to your illness and you should not have to defend yourself from them at such times of crisis. It is time for a change and better treatment for all.
I have filed w/ the OCR on HIPAA and freedom of religion/choice violations. I have filed with our state's attorney general's office on the nurse's licenses. I have filed with the State Board of Health about the hospital. I have done reviews on all the doctors and the hospitals involved on places like Yelp. I want everyone to know about these places and people and what they do especially in the cath lab and when men are drugged out of their minds. At least when functioning normally, you have a fighting chance but when they purposely drug you for compliance reasons, you are totally defenseless and at their mercy of which they have non.
Medpage did a piece yesterday on HHS wanting to expand EHRs. I think this is a bad idea as most providers you go to do not need your whole history. Also, your social security number no longer needs to be used but is transferred if it is on your EHRs. For cath lab records, my husband's ssn is on just about every form. That is so once it is entered into the NCDR national database for cath lab and chest pain, they can track him forevermore. This was done without his permission. We are now in a battle to have his name, social security number, and information removed. Since he didn't sign the consent form, he didn't agree to this. The hospital from hell says it is too late that they sent his information. I said that's too bad get it deleted as you did not have his permission to do this nor could you have explained a 3 page consent form to a drugged man laying naked, violated, and coerced on your cath lab table while being prepared for said procedure in a room full of nurses, emts, and clerks. Informed consent is not supposed to be done that way. No one has taken credit for saying they actually gave him informed consent which is curious that no one is willing to take responsibility for this dirty deed. Since the procedure records are full of inaccuracies their accounting of the events are suspect as they couldn't remember 2 minutes after the procedure ended what they had actually done. Although it seems like a clear cut case, we know it will be an uphill battle. However, with the discrimination of them thinking he was gay, the blatant invasion of privacy both in his medical records and physical being, the great number of falsifications of his medical records along with their federal violation of freedom of religion/choice of my son and myself, I think we have a case that with persistence can be won. I know that don't care but they do care about the bottom line and that is money and power. The other thing they like doing to patients is exposure and I want to give both hospitals plenty of exposure as they seem to like exposure. JR
Ray B, if I understand what those experiments were about they were about people knowingly following orders to inflict pain. I'm not sure that is the best analogy for healthcare.
The problem patients face, especially males, is the casualness with which they are left exposed either for staff convenience or simply because they don't think it matters. Here I'm talking about the masses of healthcare staff, not the purposeful voyeurs or sexual predator exceptions.
The attached YouTube video speaks volumes about the casualness. This guy is lying there totally exposed and nobody is in a hurry to cover him up. Why? He's under anesthesia and doesn't know he's been left exposed and so presumably the staff thinks it doesn't matter. The leg not being operated on has already been wrapped up which begs the question how long before the start of the video has this guy been lying there exposed?
https://www.youtube.com/watch?v=eXWDA5xb1_4
I would add that the fact that they were creating this video for educational purposes and still thought leaving the guy exposed was OK speaks volumes for just how casual the thinking is that patient exposure simply doesn't matter to them. I don't know who the audience is that is being trained but they are being taught patient privacy is a non-issue once the patient is sedated or anesthetized.
I do wonder if it was a female patient would one of the women in the room have covered her up.
JR,
Have the hospital respond to your removal request in writing. You then can sue for a violation of your Constitutional right to due process. The fact that a name can NOT be removed means that the system is defective as it does not allow for corrections or one to change their mind.
-- Banterings
Good Afternoon:
Biker, I saw the video you referenced. Without a doubt in my mind if the patient was a woman, the other females in the room would have made it their number one priority before doing anything else to make sure she's covered up and her dignity was protected from everyone else in the room.
The mindset in the medical community is if its a female, cover her up and keep her covered. If its a male, who cares, if we get to it we get to it.
Regards,
NTT
Biker: I don’t reference Milgram’s experiments and other experiments such as Zimbardo’s Stanford prison experiment as analogies. They have been used and continue to be used by academicians to help others understand why people, including “good” people, do evil things and why people put themselves in harm’s way.
After the Abu Ghraib debacle was made public, news shows on the major TV stations used both Milgram’s experiments and Zimbardo’s experiment to help explain why the debacle occurred. Phillip Zimbardo was interviewed many times following Abu Ghraib and spoke of the Lucifer effect – why good people do evil things. The experiments have been used to help understand the rise of the Nazis, the Sand Creek massacre, the My Lai massacre, the Tuskegee Syphilis experiment, the outrages of the American eugenics movement, and so on. They can even be used to help explain why a female McDonald’s manager ordered a 17-year-old female McDonald’s employee to strip naked at the orders of what the former believed to be a security officer giving her commands from the main office over the phone. The studies can also be used to understand why the girl truckled to the demands of her boss to strip even though she could have refused to do so. Similarly, the studies can be used to help understand why some healthcare providers do evil things to patients and why most patients let them do it.
By the way, Zimbardo was hired by the defense of one of the Abu Ghraib defendants. His function was to get the jury to understand why a soldier (whose name escapes me) who, until he messed up, could have been a poster boy for the armed forces. Zimbardo may have been persuasive, but the jury convicted the soldier anyway and he was sentenced to the max – 10 years. -- Ray
Biker: I forgot about my Feb. 12th 11:00pm post. I may be becoming demented or maybe I was half asleep. The analogy is this: We often hope that people who do evil things are outliers -- exceptions to the rule -- when, truth be known, their behavior is replicated many times by many others. Those experts who believed that only 8% or so of subjects would follow Milgram’s orders to the end were among those who believed that only outliers would do such things. They were off by about a factor of 8. I would have to be hard pressed before I agreed with someone who said with authority that it’s only outliers in healthcare who do evil things (including defending the evil doers). How many doctors and nurses participated, directly or indirectly, in the evils that occurred at Abu Ghraib. If you believe Steven Miles, M.D. (“Oath Betrayed: Torture, Medical Complicity and the War of Terror”) the answer is, “All of them.” That’s hardly evidence of outliers. At the same time, however, there is reason to believe, from Milgram’s study, that the people who commit evil acts may, in fact, be outliers – it depends on the situation. He and his colleagues found that only 3% of subjects followed an authority figure’s orders when they had to put the confederate’s hand on electrodes to shock him. At the other end of the continuum, 93% of Milgram’s subjects followed his orders to the end when they played subsidiary roles in the exchange. These findings, among others, are behind Zimbardo’s (who was Milgram’s student) observation that whether or not people participate in evil depends on the “power of the situation.” In some situations, almost all actors will participate in evil while in other situation only a few outliers will do so. -- Ray
Ray, thanks for the explanation. I posit that most of the privacy/modesty/dignity violations in healthcare settings are not at anyone's direction but rather because the staff just doesn't care, especially if the patient is a male or is sedated or anesthetized.
Somehow long ago the group-think in healthcare arrived at the conclusion that normal societal norms concerning privacy/modesty/dignity don't apply in healthcare settings. That video I posted really does speak volumes in the casualness in which they left that guy exposed, especially given it is being used to train future OR staff.
The true disconnect is when healthcare staff almost universally insist that they do respect patient privacy/modesty/dignity. If so that training video would never have been done in the manner it was..... unless they truly don't believe it matters once the patient is sedated or anesthetized. Personally I think it matters even more given patients aren't in a position to defend or advocate for themselves.
JR: Have you filed a complaint with the State Board of Medicine and the State Board of Nursing? Some states have a Board of Healing Arts. Have you tried to find an attorney? Have you tried to find a media person who might take an interest in your situation? Did you file a complaint with the Joint Commission?
If you do all of these things incuding what you've already done, you'll probably find that the typical response is no response. However, you might raise an eyebrow or two. -- Ray
Biker: Can you find any reference to the healthcare organization in which the youtube video on prepping the knee was made? The only reference I see is to the Pedestal Project. I've not found anything that makes sense when I've gone online to track down the Project. The video can be referenced in the paper I wish to write, the first part of which I will post in the next few minutes.
Regarding that video, I interviewed a Master's prepared nurse with 20 years experience who taught BSN nursing students. She was also a state representative. She said that typically, patients are left naked en masse while being prepped for surgery. A dozen naked bodies of both sexes may occupy the prep space. Apparently, it's not only healthcare providers who have visual access to these patients but people from many walks of life, even other patients. Regarding the latter, I interviewed a 23-year-old female college student who was flabbergasted when she was wheeled into a prep room to prepare for surgery and saw a bunch of naked anesthetized men, one of whom was getting his pubic hair shaved. She asked the physician who was going to do the surgery on her if she would be treated the same way as the men. According to her, he laughed and said, "No,we will give you your privacy." -- Ray
Ray.
Of course he was going to reassure her. As as long as nobody was interested in seeing her naked body , then she would maybe be covered up or maybe she wouldn't.
Ray,
On the credit page it says you can email them at Pedestal42@icloud.com I believe. We have shown people this that work in surgery and this is common. They say they just tell people they are only going to expose area needed to make us think we are treated with respect and dignity. One of our friends is a scrub tech. She said there many people that do not have any reason to be there to be in the OR with us when exposed. When several of them were making fun of a woman who was overweight she said she sent them out for bad behavior. Yet, when she found my husband had surgery she was upset and asked why we didn't tell her he was having surgery because she wanted to check him out. And she met it in way I took it. We feel that any surgery where they expose us (which is all) we should be given all same gender support staff if we choose. We after all do get to meet a surgeon and even get second opinions if we don't feel trust in them, so why Not get a full team we are comfortable with. At our hospitals we are not allowed to read the consent. According to them it is a federal law and we have to sign and not make changes as is a contract. Videoing and others present along with photographs is included in the consent. How can this be legal? How can this be informed consent?
In our business if I give them one of our contracts and they need to make changes we all sign and initial any changes that that customer needs. Every contract we have can and often needs to be altered. We sign, and date any changes before we complete the transaction.That way the contract is between and agreed upon by both parties. MS KS
Biker,
We have filed against 2 nurses with the state AG (here in Indiana they oversee prof. licenses) and they are currently investigating. The Board of Health said they while we have issues the issues that we have are not ones they investigate as they only investigate issues that would result in Medicare revoking a hospital's Medicare payment. As for the Joint Commission, they said they would not investigate as this hospital from hell does not belong to the Joint Commission. I have not filed against the doctors involved--should that be done? There was one monster doctor who said the informed consent had been done and he was the admitting doctor. He does not say he did it or who or when the consent was supposedly done. Then there was the monster who actually did the procedure and he just said consent had been done but again not by who or when. On the actual consent form, 2 of the cath lab heifers signed it 5 minutes after they inputted into the Epic system that consent was on file. There is a wavy line where a doctor is supposed to sign but there is no time associated with that wavy line. That wavy line may also be part of one of the heifer's signature--it is hard to tell. In any case, we will file with whoever we can. Also, we have given the case to an attorney here who does a lot of medical cases.
Does anyone here on the board know if a staff member with radiology certification should be present during a PCI? There is not one listed as being present in his file. The four heifers involved are just listed as being RNs with one being a scrub. The scrub was the really vicious looking one who was really mean to him. The radiation concern is another reason why he would not have agreed to this procedure as he has had cancer in the past. We have since found out that the doctor they assigned him was not as experienced as he should have been and the amount of radiation was higher because of his lack of experience.
Has anyone seen this site? http://www.easeapplications.com/nurses-perspective-communication-operating-room/
The first thing I noticed is a nurse standing there with a cellphone and video on? It is an app. I think that any cell phone should be prohibited from patient care areas especially including the OR or such. I am going to our local chamber of commerce on Friday as our state rep usually goes for the luncheon. She is a wife and mother of 3 sons. Hopefully, I can get her attention about some of these issues. I am preparing my presentation. JR
Ray, based on your input and my having thought this through a bit more I am changing my mind on a couple things.
First to answer your question, I don't know anything about that Pedestal Project but was able to see the sports medicine piece was at the Children's Hospital of Philadelphia. The video I had posted wasn't anything I was looking for but rather it was something that popped up when I was looking for something else. It was just a momentary curiosity that caused me to watch it.
In my heart of hearts that likes to think well of people I really would prefer the lack of concern for (especially male) patient privacy/modesty/dignity as simply being a culture that doesn't see how disrespectful and inappropriate they are being.
Your comments about that group prep is perhaps the proverbial final straw disavowing me of the way I've wanted to see this stuff. I doubt there is any patient literature published anywhere that informs patients they might be lying naked on a table in a room full of other naked patients, and subject to being seen by other patients just entering the room. That is utterly beyond the pale for civilized people.
I will add that for things like cardiac caths a patient isn't going to get more than a passing reference to hair clipping and certainly there are no videos out there showing how it is done, nor of the patient lying there needlessly fully exposed while the area is disinfected. When it comes to intimate exposure the healthcare industry is largely silent. As a result patients end up either ambushed when they realize what is happening or they never even knew how disrespectfully they were treated once anesthetized. That the medical industry hides all this info from patients tells me that they know it isn't right but they do it for their convenience nonetheless.
It makes me glad I chose to go the no-sedation route for procedures that normally call for sedation. Thus far that has included colonoscopies, an upper endoscopy, and a tranesophageal echocardiogram. None of them were a big deal unsedated. Does anyone know if cardiac caths can be done w/o sedation?
Good Morning:
JR, I read your list of things you want to go over with your elected officials.
4. The overuse and use of drugs such as fentanyl to control & make pts. Compliant.
Dr. Bernstein, correct me if I’m wrong please.
Fentanyl, is just an opioid which is just a very strong pain killer. If I’m correct, fentanyl has nothing to do with making the patient compliant.
What causes the patient to be “compliant”, are the benzodiazepines they use along with the pain killer.
Benzodiazepines like Midazolam (aka Versed), lorazepam (aka Ativan), and diazepam (aka Valium), are the drugs used in anesthesia. Those are the drugs that doctors and anesthesiologists use that wipe your memory of what happened from the time given until you wake up from your ordeal. The effects these drugs have on the human mind can last for weeks or in some cases the memory lose can be permanent.
The other drug worth mentioning is propofol. It’s not a benzodiazepine but is has the same loss of memory that the benzodiazepines have and, it’s a favorite in the operating room to induce and maintain general anesthesia and in outpatient procedures for “conscious sedation”.
They use these drugs a lot with colonoscopies so the patient is compliant so they can get them in and out as fast as possible and keep the money train moving. Propofol or a combination of fentanyl for pain and versed (aka midazolam or dazzle), to wipe the memory clean of whatever they did are the drugs of choice.
It has always been my belief that drugs like propofol and the benzodiazepines should only be used with complete patient knowledge and approval.
That doesn’t happen because neither the doctor nor anesthesiologist tells you what’s being used. If they say anything all they say is “don’t worry, you won’t remember a thing).
There has to be other drugs available to the medical community that won’t wipeout a patient’s memory whereby leaving them defenseless if something goes wrong because they can’t remember anything due to what they were given before surgery started. The patient will lose every time.
The medical community has a nickname for propofol. It’s referred to as milk of amnesia because of its white milky color and the effect it has on the patient’s memory.
These drugs are what helps keeps that veil of secrecy secure for the medical community. They should be outlawed.
So, JR I’d speak to your elected officials about tighter restrictions on the use of propofol and the benzodiazepines where surgery and procedures are concerned.
Patients should be told while they have a clear head, what drugs are going to be used, what they are for, and what if any side effects they may have. Then let the patient decide if they want to do it or use other drugs.
Regards,
NTT
Good Morning:
PT. I’ve been looking at state nursing boards and into fines & sanctions. Most boards have a female majority so I see no chance of any male who gets caught in their web to be treated equally and get a fair shake.
I know in my state currently there are nine board members eight of which are women. Seven medical people and one citizen. There are current still 3 positions open, two citizen spots and one LPN spot. I’ve put in for one of the lay positions so as to better equal things out.
Fines and sanctions are unbelievable. Female nurses are being sanctioned left and right for alcohol abuse or theft and/or use of drugs.
Why are these people allowed to “clean up their act” and come back to work with patients again? These people should be fired and their license permanently revoked. I don’t want them are me or anyone I know.
Ray:
In regards to the video Biker asked us to look at, Welcome to the PEDESTAL PROJECT. This page was created to assist with the surgical education of practitioners. Please direct all questions to Pedestal42@icloud.com.
Maybe pedestal42 will tell ya. From looking at another video in the series, the Knee Scope and Prep video was done at the Sports Medicine and Performance Center at the Children’s Hospital of Philadelphia. Can’t say for sure that the knee prep was done there though.
Regards,
NTT
Here is the summary of the study I mentioned in an earlier post. I plan to make it the first part of a paper that I will submit to Men's Health or another similar journal. What I'll need help on is placing anecdotes of privacy violations and other indignities into named categories. For example, we can create categories based on a label given to the violator and the circumstances of the violation. You've already given me an idea for one category. Someone wrote about being ambushed. The first category can be dubbed The Ambush (representing the circumstance) and The Bushwacker (the label given to the ambusher). Beneath that rubric, we can list true-to-life anecdotes, of the sort reported by JR. What could we label healthcare providers such as Twana Sparks (Silver City, NM dermatologist) who batter men by touching their genitals without consent or justification? What are some real life examples, other than the antics of Twana Sparks. What can the circumstance be labeled? What about those who play peek-a-boo and the circumstances around those people who play this game? Consumers of popular media like anecdotes.
What follows is a summary of the research and its findings.
In the early ‘90s, I and nursing students in a research class I taught made a serendipitous discovery. We tested a hypothesis founded on a theoretical proposition: The greater the social distance between subordinate and superordinate peoples (operationalized as patients versus healthcare providers) the greater the likelihood that the former will be dehumanized. Contrary to our expectations, providers tended to be equal opportunity dehumanizers; we failed to find that the relative differences between patients’ and physicians’ statuses significantly influenced the likelihood of unwarranted and unnecessary dehumanization incidences. However, we did find something that was inconsistent with conventional wisdom and which we did not expect to find; viz. male patients were more likely than female patients to be unnecessarily dehumanized and the intensity of this dehumanization was greater for men than for women.
I sought to understand what was going on here, sometimes with the help of students and sometimes using quantitative approaches and at other times qualitative methods. Ultimately, analysis showed that, although men were more likely than women to experience unwarranted dehumanization, they were less likely to say anything about it when it happened. Could it be that dehumanization just didn’t matter to men, as common wisdom would lead us to believe? Nope! Men who were dehumanized tended to feel worse about their treatment than women. Then why were they less likely than women to complain? Was it because, unlike women, their self-image (strong, macho, stoic, in control, etc) precluded complaining about such petty matters? Nope to that too; men who felt badly about how they were treated but didn’t complain tended to fear that, were they to complain, they would be subjected to unflattering labels (e.g., sissy, baby, immature, disturbed, insecure) and sometimes malevolent actions (e.g., refusal to treat, scolding, or verbal/nonverbal confirmation of insidious labels). In fact, the men who reported that they did complain about their dehumanization were more likely than women who complained to report having experienced dismissive or malevolent responses by providers and they were less likely to report that providers honored their requests or demands. -- Ray
Continued . . .
Continuation
Further investigation also revealed that male patients’ fear of unflattering labels being imputed to them had some validity. Commonplace among healthcare providers is a unique lingo (which supports gallows humor) that contains many pejoratives directed at “bad” patients, among whom are those who complain about being unnecessarily dehumanized. A man who complains about being dehumanized may be symbolically castrated; he is labeled a “crybaby,” a “pussy,” “unmanly” or a P.U. (an “unmanly pussy” with the letters placed backwards to signify contempt) – more child or woman than man. The complaining man may also be typed a N.A.T (as though he were a bug) for “Not a Trooper,” originally a reference to women in labor who complained more than providers thought they should about the pain and discomfort associated with labor and delivery.
Male patients, then, were more likely than female patients to be dehumanized, if dehumanized they were less likely than women to complain about it even though they tended to feel worse. Men’s reticence to complain tended not to be due to some masculine self image but to a legitimate fear of stigma, dismissiveness, and malevolent reactions by providers.
Our findings may have implications for understanding why men are less likely than women to seek healthcare and why they are more likely than women to delay seeking care until their acute problems become chronic. Conventional wisdom would have us believe that character defects in men account for why they are more reticent than women to seek healthcare. Men’s pigheaded pride, it is believed, accounts for their unwillingness to seek help for illnesses; for them, seeking help is a sign of weakness and dependence on others, character defects that no real man would find desirable. Our findings, however, suggest that the explanation may be more complicated than that. A reasonable hypothesis that may be induced from our findings is that men are more likely than women to balk at seeking care because they are more likely than women to be dehumanized. Put more broadly, the etiology of men's proclivity to eschew treatment may lie less in the character of men and more in the character of a healthcare system that requires men more so than women to weather the indignities of dehumanization. An even more chilling thought is that a pattern of unnecessary dehumanization of male patients may not only help explain why they delay seeking healthcare, it may also play some role in determining their mortality rate due to that delay, a rate that is consistently higher than that of women. Given the focus of researchers on describing and understanding the measurable discrimination against suspect groups (e.g., women and racial/ethnic minorities), tests of these latter two hypotheses may have to be put on hold.
Ray B
No, no and no. Patients are not left naked in masse while being prepped for surgery. That’s just fodder for people to read who have a fetish about that kind of thing. Consider the logistics of a surgical center, not all patients have their surgeries at the same time. You can only have so many surgeons, anesthiologists at one time. Each patient has to be prepped differently, not all patients are the same. Some patients will be intubated while some may have an epidural.
Honestly, that is one of the most ridiculous assertions I’ve ever read on this blog. Appreciate that I have over 40 years in healthcare with much experience in the OR. There are so many factors as to why this dosen’t happen and it would take pages and pages for me to explain why, so it’s not worth it.
PT
JF: I communicated only part of the story. I failed to write that the young woman's surgery was for complications associated with Crohns disease. She reported that she was wheeled in a gurney to the prep room along with a young man who was also going to be prepped for surgery. She said that they both saw what I described at about the same time, looked at each other and he shrugged. She said that she had never been more embarrassed in her life and the young man looked embarrassed too. She said that the young man remained in the prep. room as she was wheeled to a cubicle and the curtain closed. She was given a relaxant, prepped, and then anesthetized. Although I did not probe more, I suspect that there were several cubicles that were occupied and the overflow patients were prepped outside of the cubicles. I wish now that I had asked her how long she had to wait (which might signify that she was given the first cubicle that opened up, although there are other explanations), how many cubicles were there,if she had any indication of whether or not the other cubicles were occupied and she was given first dibs on the first opening for whatever reason, etc. It was remiss of me not to have asked these questions. Regarding the nurse's story, she was speaking of a hospital other than the one in which the young lady was treated. She also reported that when nurses at that facility needed surgery, they would generally go elsewhere so as to avoid being exposed to colleagues or they would ask a female colleague to accompany them and make sure that they were not exposed to anyone but those doing the preps. -- Ray
Biker: You write,"Somehow long ago the group-think in healthcare arrived at the conclusion that normal societal norms concerning privacy/modesty/dignity don't apply in healthcare settings."
You hit the nail on the head. If I live long enough, I aspire to write a book with the title "Because I Can" and use theories of crime, delinquency, and social deviance to explain the goings on in healthcare. One theory, which has considerable empirical support, is called neutralization theory. It posits that people learn to to violate social norms (folkways, mores, and laws) in the process of interacting with others. They learn (in deviant subcultures or subcultures of deviance), among other things, to neutralize in advance (before they commit their deviant behavior) internal controls (e.g., conscience) and external controls (e.g., the threat of informal and formal sanctions) that generally check deviance. Neutralization theorists posit that controls are neutralized after people learn certain techniques of neutralization. One of several neutralization techniques learned by many if not most healthcare providers can be dubbed "appeal to special status" whereby deviants learn in advance of their deviance that because of their special status, they are entitled to violate the norms of the greater society. Deviants drift in and out of situations which promote deviance. When the deviant provider is at work, s/he engages in her deviant behavior but when he goes home he now follows the straight and narrow.
The theory and the evidence suggests that these deviants are at least partially committed to the norms of the greater society. The fact that they drift in an out of deviance suggests that this is the case. But there are more specific examples including, 1) they would not want to be treated that way; 2) they wouldn't want their loved ones to be treated that way; 3) they will avoid circumstance where they would be treated that way (e.g., nurses employing nurse colleagues to keep them covered during preps; providers going to same-sex providers when they need intrusive procedures done); and they don't treat guests in their homes that way (e.g., they don't walk into bedrooms occupied by guests without first knocking).
Greater elaboration is needed on my part but I won't do that here. I can do it in the context of challenges to what I've written (which might require some elaboration). I hope what I've written engenders questions that require me to elaborate (e.g., a question regarding the significance of the proposed book's title). You might be inclined to fill in the blanks, give examples, come up with alternative explanations, etc. I look forward to that. -- Ray
NOTICE: As of today February 14 2019, there will NO FURTHER COMMENTS PUBLISHED ON THIS VOLUME. Comments can continue on VOLUME 95.
..Maurice.
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