What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)
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posted by Maurice Bernstein, M.D. @ 10:59:00 AM
174 comments
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174 Comments:
Good Afternoon:
H ave a new ltr to the editor I'm going to try & get posted. This time using major markets.
On average it is generally accepted that women live an average of seven years longer than men. The difference is attributed to men taking greater risks then women and they also tend to ignore their health more.
For decades, the federal government hasn’t seemed to want to close this gap as funding at the federal level for breast cancer research far out paces funding for prostate cancer research. Five-hundred forty-five million compared to two-hundred thirty-three million in 2017. The government also has offices within the federal system promoting women’s health but none exist promoting mens.
With the rise of feminism in American, women’s healthcare has become the priority while men’s healthcare has not been given much attention.
I’d like to explore another reason why some men are dying at a younger age.
The reason more men would rather let nature take its course than seek out medical care is due to the lack of Choice, Privacy, and Respect (CPR), afforded men by our medical system. This is especially true when gender specific intimate exams, tests, or procedures come into play.
Same gender caregivers are a subject whose time has come to talk about and solve by the healthcare system and the public they serve.
In America, we have men and women who choose to have opposite gender care during their medical treatment. As it is their choice, it should be respected by all.
By the same token, there are men and women who chose to have same gender caregivers during their medical care. This is especially true when the person is dealing with gender specific intimate issues. Their choice should also be respected by everyone and honored by the healthcare system without question.
For the most part, women don’t have a problem when they want same gender caregivers as the nursing and tech areas are mostly female and more and more women are becoming doctors every day.
Where the problem lies is when a male wants same gender care especially when dealing with ultrasound, reproductive and urological related issues.
The American healthcare community has swept this issue under the rug and kept it there for decades and it has to stop. Men are needlessly dying because the system which claims to be “patient-centered” won’t accommodate his need for same gender care.
Please understand, when dealing with a gender specific intimate related issue some men simply are not comfortable having a female healthcare worker(s) present much less helping him with his issue.
Many women are the same way and they are accommodated by the system without question. In fact, the medical community goes out of its way to accommodate her needs.
Therefore, in the name of equality, men should without question or excuse, receive the same consideration.
This scenario, is a problem for both men and the American healthcare system that must get resolved without any more excuses from any one sooner, rather than later to everyone’s mutual satisfaction not just the medical community and the only way to resolve it is to meet face to face and have open discussions on the matter until an answer is found.
When a human being goes to a medical facility for attention, it is the job of the healthcare community to see that that human being leaves the facility with the best possible outcome.
By denying a same gender care request from someone, you insure that the individual will not leave your facility with the best possible outcome because that individual will now have to worry about their exposure the whole time, they are there rather that devoting their full attention to getting better. So, you have failed this person twice. First to do no harm to the patient and second, give s/he the best possible outcome.
end part 1.
Regards,
NTT
Good Afternoon:
Part 2
When an intimate medical scenario comes up for a man and he asks for a male caregiver instead of the female nurse who is there to take care of him, the dynamics of the entire encounter change in an instant. She gets defensive because the “patient” asked for a male caregiver. That in turn changes her whole demeanor. If he wasn’t before he’s now looked upon as no more than an object.
A lot of times, standard statements to all male patients by female nurses are;
We have no male nurses, you’ve got me.
We have no modesty here.
You don’t have anything we haven’t seen hundreds of times before.
We’re all professionals here.
IF you were REAL professionals (which many aren’t these days), none of that crap would be told to a patient.
Back in 2016 a Mr. Robert Underhill wrote a superb article called “Why Men Patients are Forced to Man Up in the Medical Setting”. http://drlinda-md.com/2016/11/men-patients-forced-man-medical-setting/.
Still today, men are putting their stories of how the medical community ignores their dignity, privacy and disrespects them.
Another good place to read up on how men feel about this issue is on a blog called “Patient Dignity (Formerly: Patient Modesty)”. https://bioethicsdiscussion.blogspot.com/2019/02/patient-dignity-formerly-patient.html.
The blog is run by a Dr. Maurice Bernstein a physician and medical school teacher out in California. Currently, they are up to volume 95 on the subject.
Numerous other articles are out there, healthcare chooses to ignore it because men haven’t spoken up enough yet.
The naked patient: The modesty movement won't take it lying down
https://www.chicagotribune.com/lifestyles/health/sc-hlth-0513-patient-modesty-20150507-story.html
Why is it so offensive to ask for a male nurse? Reddit
https://www.reddit.com/r/nursing/comments/6pqi79/why_is_it_so_offensive_to_ask_for_a_male_nurse/
There is a Strange Nudist Colony in the Woods of Privatized Health Care.
http://drlinda-md.com/2018/09/guest-post-there-is-a-strange-nudist-colony-in-the-woods-of-privatized-health-care/
Why Funding for Men’s Health is Bizarrely Low Given Life Expectancies.
https://www.fatherly.com/health-science/men-die-younger-government-funding-womens-healthcare/
Male Patients Are Likelier To Bail On Female Doctors. The Question Is Why
https://www.wbur.org/commonhealth/2017/09/08/patient-doctor-female-male-bail
For a man who values his dignity and privacy to have to deal with female care givers for an intimate exam, test, and/or procedure will raise his anxiety level through the roof. The medical community’s answer to that is to just say “too bad, it is what it is”.
End part 2
NTT
Good Afternoon:
Part 3
So, what can be done to alleviate the unnecessary confrontations between male patients and female healthcare workers when male specific intimate issues are in play?
First and foremost, the industry has to let go of the dark ages stereotype they’ve branded on all men. A next step would be, stop thinking that a smile and/or a nice pair of legs will not distract men from the fact they are not comfortable with having female caregivers take care of their intimate issues because its just not true of many men.
For years, the industry has been telling men there are just not enough male nurses. What are you doing about it? Are you offering men incentives to go to and complete nursing or technical school then further incentives after graduation to enter areas like urology and ultrasound where male patients need them most?
In the meantime, when a male patient asks for a male nurse and he’s told one is not available, why aren’t you doing like other healthcare systems do and have a male hospitalist step in and fill the void or is that beneath the American healthcare system to do?
For male intimate related ultrasounds are you actively cross training male radiologists to step in when a man requests a male ultrasound technician or is that to beneath you also?
Your so good at using the bona fide occupational qualification exception (BFOQ), to exclude male nurses from labor and delivery and male radiologists from mammography, why not use the same exception to hire men in ultrasound and urology areas or is it that male lives just don’t matter as much?
Men are tired of having their medical needs ignored by the American healthcare system in favor of advancing women’s healthcare. It’s time to stop trading men’s lives for the almighty dollar and fix a dysfunctional healthcare system so that everyone is treated equally.
Every man in this country that’s had an intimate medical issue and needed to get medical attention knows the issue. The answer isn’t, it is what it is and you have to go with the flow.
The answer is just like women, WE have a voice. It’s time for all men to speak up loud and clear with that voice and put an end to this practice by our healthcare system.
If you don’t want to do it for yourself, think of your son(s), grandson(s), and their male children. Do you really want to see them suffer the agonies we suffer today at the hands of a compassionless healthcare system?
Men deserve the same level of Choice, Privacy, and Respect (CPR), that women have been given by the system for over 50 years now. Its time men got their due.
The American healthcare system has been allowed to run their operations under a veil of secrecy for decades. Now is time that the veil be lifted away permanently in favor of complete open transparency.
Change will only come when men all over this great country of ours stand up and say enough is enough. It’s time for change.
Talk to your local hospital administrations, your local, state, and federal elected officials and tell them our dysfunctional healthcare system needs fixing. Maybe its time congress mandated changes like hiring quotas so more men are hired.
The healthcare system has proven beyond any shadow of a doubt they are not going to make changes on their own so its time the public they serve step up and mandate changes to them.
It’s time for the medical community to put their broom away and start open talks with the male population of this country to solve this issue once and for all.
Together, we can rebuild a broken system using words you all know very well.
Do No Harm and CPR.
Choice to each client without always questioning why.
Privacy, given to the highest level no matter the circumstance.
Respect. Give every client the respect they deserve and you will get the same back.
Do No Harm and CPR go hand in hand. You can't have one without the other and successfully build a healthcare system everyone will be proud of.
End of ltr.
Regards,
NTT
NTT, an excellent presentation to start out Volume 96! The hopeful result would be a change in the way the Medical System responds. Instead of "When we want your opinion, we'll give it to you", the System following your presentation, will respond "When you want to give us your opinion, you can give it to us and we will listen, acknowledge, act on it and hopefully meet that opinion."
NTT, Thanks for referencing to this blog in your presentation. It would be of interest to myself and others if you could consider identifying here to which publications have received your commentary. And thanks for making your effort for dissemination of the story which includes what has been going on within this blog thread for all these years. ..Maurice.
Is there a documented difference in the number of males seeking medical care when there was plenty of male orderlys? Has the age of when men die changed since male orderlys became a rarity? JF
JR said:
Finally was able to figure out how to post screen shots of Consent Form to blog. So the first part of my articles on Informed Consent has been posted. Check it out and let me know your thoughts. I will be addressing in future blogs more about Informed Consent.
NTT,
You made some really good points in your article. If you don't mind, can I use some of your references? It is time for healthcare to give dignity of care to men. No one should be treated like they as a person, do not matter. JR
MODERATOR'S NOTE: Ray B posted the following on Volume 95 after the Volume's closure. Please note that Volume 95 is closed for Comments there. ..Maurice.
At Thursday, March 21, 2019 8:04:00 PM, Anonymous Ray B. said...
Ed T: On Monday, you told about being granted privacy when visiting a physician and his MA and concluded that “In all, a very civilized encounter.”
Let me ask you this: In retrospect, when the nurse first told you “that the doctor would be in shortly and that she would be assisting, do you recall having any negative emotional or physiological responses?* If so, can you tell me what they were? What about when she told you “that the doctor would require assistance and she was sorry if this would be an inconvenience.” -- Ray B.
* Negative emotions include but are not limited to: agitation, alarm, ambivalence, anger, anguish, annoyance, anxiety, bitterness, apprehension, confusion, depression, despair, disappointment, discontent, dismay, displeasure, doubt, dread, embarrassment, fear, frustration, gloom, helplessness, insecurity, irritation, panic, powerlessness, regret, resentment, shock, stress, tension uneasiness, unhappiness, and worry.
Negative physiological responses include but are not limited to: increase in respiration, burning feeling in your face/neck region (blushing/flushing), tightening of muscles, increase in pulse rate, pounding of the heart, increase in sweating, clenching of jaw, clenching of hands, increase in blood pressure [if taken], and sense that blood pressure probably increased if not taken.
Could somebody explain to me the reasoning behind this? I just spent four days in the hospital for the flu and pneumonia. Originally I just went to an insta-care facility for an IV after being unable to eat or drink for a week. They sent me to the emergency room for dangerously low sodium and they conned me into staying overnight. (which stretched into four days before I demanded to be released) A nurse walked into the room and told me that "the first thing we like to do is for two of us nurses to give you a full body skin check. Please remove your clothes." I politely declined (although I wanted to scream obscenities at her) and she said it was fine, it's optional. Can anyone explain this? Three days later she tried again and I again politely declined. Was there any point to that ridiculous examination? Was it simply for sexual gratification or their love for humiliation? I wonder how many suckers they've fooled into falling for that. My hospital stay confirmed my belief that hospitals are the biggest scam in America. DM
PJF here. Biker - thanks for the supporting words regarding my post of March 21 at the end of Volume 95 about the “ambush” I experienced at the urologist. This whole thing has been most humbling to me and still has me stressed mentally.
I believe you are correct about her being a college or medical student. She looked to be the right age in her early twenties. He did not introduce her as Dr. Xyz, but instead only by her first name. I do not recall a name tag. I believe she was introduced as a scribe in order to give her a reason to be present, although she never took notes. It is spring break where I live and many college students have off for a week – perfect time to shadow a doctor. If she was indeed a student, it is hard for me to comprehend how a doctor could think it is acceptable to bring her to the urology exam of an unknowing male. In fact it was downright unethical, particularly since he did not ask me if it was OK for her to be there.
Several lessons learned here for me and some advice for others. While my example is for a man seeking no female staff, the same advice would apply for a woman seeking no male staff.
First, I agree with Biker’s advice that I should have asked for male staff when I made my appointments. This request should have made its way to the urologist and he would not bring her to my exam (I hope). I knew in advance that I had not requested male staff, but I felt confident I could ask female staff to please leave the room if needed. But I could not get the words out. Even though it may be hard or embarrassing to ask for same gender staff when making an appointment, it is ten times (or more) harder if you have to speak up when in a small exam room surrounded by the doctor and their staff. You will not know if you can defend yourself in this situation until it occurs – and I found that I could not. If opposite gender staff should show up anyway, you can more comfortably start the conversation by first referring to your privacy request and then ask politely that they leave the room.
Second, I thought that I had made it safely through the system since I had a male ultrasound tech and a male urology nurse, the usual places to encounter modesty issues (as seen again and again in this blog). It was not until the male urologist, where I thought I would be safe, that the female showed up. I had let my guard down by that point and I was therefore more easily ambushed. You need to be prepared at any point to stand your ground right up until you are out the door of the facility.
Third and most importantly, if modesty is a personal issue for you and you do not take action and let it happen (as I did) you will regret it. At the time, in addition to thinking what to say to have her leave the room, I was in parallel thinking what’s the big deal and maybe I am making too much of this, so I let it happen. I am here a week later regretting that decision. I keep reliving the experience again and again - how I lost my privacy and wondering how I could have changed things. All negative thoughts. Had I spoken up, I would instead be proudly writing to this blog how I had confronted the system and won. All positive thoughts. Be brave, take a stand and you will not regret it.
Thanks again to Biker and others for their shared experiences and comments. And also thanks to Dr. Bernstein for this blog as it has made me feel better to get my story out and to provide some advice to others so that this does not happen to them.
PJF
Good Afternoon:
JF you asked about male life expectancy. In 1965 a man was estimated to live for 66.8 years.
Males born last year have a life expectancy of 76 years.
Regards,
NTT
Ray B
In answer to your question, YES, I had a very strong emotional response but I was prepared for the situation. Blood pressure, ears warming, etc all part of the feeling at the time but I think being emotionally prepared was very important.
I too, had an early experience much like PJF described with all of the emotional remorse after the fact. That is what started me on this journey of never letting that happen again. By rehearsing the scenario over and over and formulating a second nature response, it has become a natter of course when I need to respond. The situations that are described in this blog are very common for males. They happen all the time and they are traumatizing. Good luck in finding a medical person who is open to helping you deal with the trauma as most don't seem to think it is trauma in the first place. I will leave that topic for others.
For me, this blog has been a life saver in terms of letting me know that I am not alone and has encouraged me to speak up for myself and encourage others to find their voice as well.
My recent encounter was encouraging mainly because there was advance warning, which is very rare. I had a chance to respond without the added duress of everyone walking in unannounced. Knowing the magic word "consent" and how to use it was a great help in translating my intent to the MA. It would be nice if more practices gave more detail up front and I do plan to praise my physician on a follow up visit.
I encourage all on this blog to keep up the good work and to use their voices loudly and wisely.
Ed T
JR said:
PJF,
Thanks for sharing. You are not alone. My husband is still suffering from his experience of being naked and exposed for hours with various female nurses and who knows who else--sometimes 4 or more at a time. He was drugged to the point of only being able to think how humiliated and violated he felt but was unable to convey his thoughts to actions. Part of his PTSD is from, part is from having no choice in the medical decisions that they made for him, and part from other bad things that happened. I am not sure when or if the feeling will go away. He too feels like he should have done something but he was drugged and helpless like they like patient to be. Drugging patients is their way to gain complete control. I feel I should have done something even though he was kept isolated from us for hours. If only we could have a do-over...
Ray B.,
Here is a difference in how male and female patients are dealt with--how many times will a doctor tell a female patient to drop her pants and spread her legs for her gyn exam? I would imagine that most women would file a sexual harassment suit or walk out for such crude and rude treatment. Men are expected to strip their bottom half naked with an audience in attendance with their pants and underwear waded up on the dirty floor around their feet. Then they are expected to turn with their pants and underwear waded up at their feet making them in fact looking like clowns or naughty school boys bending over the principal's desk for discipline. Turn around and bend over is usually what is said. I keep waiting for them to bring out the paddle to finish the humiliation. I know I sit there shaking my head and I am personally outraged every time this happens. My husband says if they are made mad then they could make the dre really more painful. If what I described is not a demeaning picture then I really don't know what is. The uro exam could be done with a garment covering the areas and the dre could be done with the patient on the table laying on their side. Instead this appears to be a common practice. It seems to me that this custom of humiliating males patients should be stopped immediately. I cringe everytime I think about it. As I have been present with my husband when he has had these in the past, he picks up his pants, then turns, and lowers them again. The doctors does not like it but oh well...it is a matter of dignity and not really modesty. That they still put men through this ritual is unbelievable. I am not satisfied with this but it is better than the alternative. I have been quiet about challenging the doctor as my husband didn't want me to fully challenge them in the past but now he has totally changed his mind about challenging their abusive behaviors. He doesn't allow them to have even male tag alongs during this part of the exam. During a recent EKG, he was told to strip from the waist up. I wonder if they also tell women to strip from the waist up? Or do they instead say remove your clothing and put on this gown? Of course, he now knows he does not have to strip from the waist up for an EKG and now speaks up. He will continue to speak up until they drug him again to make him shut and be compliant/submissive with control issues. I think how a male uro exam is conducted says everything that needs to be said about how the medical community feels about male dignity. Again, I don't think of this as a modesty issue but rather an issue of dignity and respect. As an educator, I have had discussions with other educators about times of old and the drop your pants and bend over for the whacks was partly done to humiliate and humble the naughty child. The whacks themselves were just icing on the cake. The ritual used to receive the punishment was used to mentality humiliate the naughty child. Knowing what the punishment entailed and prolonging the actual punishment is often worse than the punishment itself. Could that be why they save the drop your pants bit till the end? Scarred into submission? JR
DM, others here who work in hospitals can speak more definitively but my understanding is that for new inpatients a full skin assessment is for purposes of identifying bruises, pressure sores, or anything that should be documented as occurring prior to admission. Subsequent skin exams would be for purposes of determining if pressure sores or ulcers are developing. This can be a big problem with the elderly. Because that wasn't your situation is probably why they didn't make it mandatory.
My wife's cousin's husband was recently admitted into a VA nursing home as an alzheimer's patient, and as soon as he got there they had him completely undress for a full skin exam.
I haven't been an inpatient since I was 11 years old and have not experienced any of this myself. A question for you. Were you allowed to shower by yourself without an audience?
Welcome to those visitors who are beginning to write their Comments here. I just wanted to let you all know that I posted a Comment on a medical education listserv to which I subscribe. It was about the medical profession's need to consider the concept of all patients to be considered as "patient mentors" for physicians and their staffs. I had brought up this subject and provided a link to Volume 95 for reference. So far, I have received several supportive comments from these medical educators and no comments implying that this patient function is unneeded or unnecessary or would be interruptive or distractive to the basic diagnostic and therapeutic function of these professionals. It is my opinion that every patient should be considered as a mentor-- a teacher for the physician, beyond indirectly as an example of how the pathology of a disease can be presented--but more directly as to the need for the professional to be informed regarding the emotional "needs" of the current patient mentor but also reminded to consider these needs in interactions with other patients. I hope some medical school professionals visit our Volumes and provide their views directly to "you all". ..Maurice.
Please read this article by a physician in Academic Medicine regarding "Patient Centered Care": https://journals.lww.com/academicmedicine/Fulltext/2016/03000/Giving_Voice_to_Patient_Centered_Care.1.aspx
You will find support to what is being written on our blog thread and my suggestion for patient-mentors of physicians and the others "in the room".
..Maurice.
JR said:
Maurice,
This is off topic from patient dignity in a way but also could be considered dignity/respect. Do you know if any of the bioethics boards cover the topic of patients receiving services that did not want and as a result have to live with an implanted device in their bodies they are constantly being reminded of when they were basically assaulted by a medical community? Is this a question of ethics when the medical community does not seek consent for a procedure and the patient has to live with an implanted device that forever reminds them of the experience and also causes adverse side effects which may be as deadly as the actual illness which first brought them to treatment?
Maurice,
Just read your post about the supportive comments--that is great! Even I know there a some medical people out there who are confident in their abilities as a healer that they are amendable to change. I just wish there were more of them but that is what this is all about. Thank you for helping getting information out there.
Biker,
I found nothing in my husband's recent hospitalization records where they examined him for skin issues prior to hospitalization although he was fully exposed long enough they would have been able to but there is no documentation. He does not remember any skin exams during his actual stay either. Also, there was no showering mentioned until the morning he left but he opted to wait until he was home because he had had enough sexual abuse but the one sexually abusive nurse did multiple perineal care for spectators. The nurse was again female the morning he left and he wasn't going chance anymore sexual abuse. After he became unsedated for the most part, the exposure stopped once the sexually abusive nurse went off duty. I can understand a nursing home doing it as there tends to be more issues with pressure point sores so they would want to verify they weren't pre-existing. It would be even more important if that person were diabetic. He had a male nurse after the sexual abusive female nurse left and the male nurse respected his personal dignity and he was allowed in the bathroom by himself. There was a big difference in the way the male nurses treated him verses the way the female nurses did. JR
PJF
Have you read RG's story AMBUSHED BY A CHAPERONE ? RG used to comment on this blog. If you haven't read it yet you can Google it up.
Also maybe request to know " studying surgery's" job title. Maybe complain to the medical board. Medical board needs to know that people avoid medical care because of this issue. Males even more than females.
JF
Ray B
I would be very concerned if a nurse just drove down the street to visit another facility to “ see how they do it.” Please let us know where
he/she works so when we see that facility we know to run like hell.
Secondly, I would never seek the advice/opinion of any nurse as you did because you will get a different opinion for each one that you
ask. You do recall that I asked you what your experience was in healthcare although I expect the answer to be zero as you did mention
that you’ve asked nurses a number of questions.
NTT
Here in Arizona a number of hospitals are being penalized by Medicare ( payments withheld) do to poor patient care as well as patient
satisfaction scores. One of the obvious signs you can glean from this is that hospitals, physicians etc don’t really work for the patient,
it seem. Rather, they all work for the insurance companies. I think it’s time Medicare should penalize medical facilities that do not hire
an equally mixed gender staff. Maybe that is where the letter writing should begin.
PT
One of our nursing home patients where I once worked , the patient was completely confused and helpless. She was sent to the hospital for AT LEAST a month. Probably closer to two months. She didn't appear to have been given one single shower or sponge bath. When I was in that same hospital for 8 days I had one. I did my own but I prefer it that way anyw.
Another city that I lived in when we would send our patients to the hospitals they would be returned to us dirty and with bedsores. I know that hospital had gotten rid of most of their CNA's because there was a story about it in the newspaper. They falsely stated that the care would not suffer because of it.
Thanks for the response Biker. On my second day a young nurse suggested five or six times that she could "help" me take a shower since I couldn't stand up more than a few minutes. I politely declined every time. She must have made it clear to the other nurses and none of them bothered me again. I ended up not bathing for four days. As I was leaving they gave me a "to go" bag and in it was a large package of disposable washcloths I could have used on myself. It would have been nice if they pointed those out to me earlier. By the way, there wasn't even a shower curtain in my bathroom until the fourth day. I can't imagine what that shower would have been like.
How do they normally "help" patients take showers? DM
JR said,
We sent Medicare a 30+ page document listing everything that happened along with corresponding documentation to back up our allegations. We had verbally spoke with them and they said they wanted everything in writing. They said they if once they review everything, they may demand payment back from the 2 hospitals and air ambulance. I really hope so as the bottom line is what is going to force these institutions to change along with bad public relations. As with any type of profession, those from the outside view it differently than those on the inside. As an educator, I often wondered why some "parents" chose to have children. Sometimes, when I met the parent(s), I knew immediately why the student had issues. However, being a parent myself, I could also see the issues with the educational system. I know things that some schools do that others would never dream of doing. For example, at my elementary, if buses were moving, then nothing else was allowed to be moving. Cars were allowed only so far and no parent would be able to skip the waiting and come into the building to pick up their student and cross into the bus area. All it takes is a split second of inattention. Any students not on buses had to be in the building supervised and stay until the buses were off the property. The elementary my kids attended let car riders and walkers out while the buses were loading and leaving. That was dangerous. A few years later, an elementary not in our system lost a student to a bus not seeing them. Someone then thought it was an original idea for no one to be moving when buses are moving. Apparently, some schools do things differently as some hospitals may do things differently. What we did for years at my elementary seemed like the most safe thing to do although we took a lot of criticism from parents for such a strict rule. I and others often times would visit other school systems to see how they were doing certain things. It was not uncommon. I know from reading on several sites that EMTs are encouraged to spend time in cath labs to watch what is being done. I have read on cath lab digest about cath labs observing other cath labs. Please keep in mind that generally when police interview witnesses to crimes, the police are usually not witness to the crime. They, however, must take the stories and sort out the facts. It is true that 2 people seeing the same event may view it differently. People working in an industry may view what happens differently. I am sure the females nurses who abused my husband see nothing wrong with what they did and will most likely continue. However, we viewed it as sexual abuse. While we can't be certain of the cath lab nurses' motives and maybe it was something like they treat all after hours male cases with the same lack of respect for personal dignity (and this certainly doesn't justify their behavior and it needs to change), we feel the ccu nurses especially his assigned care nurse to be a sexual abuser/predator. She was downright vicious in her actions. However, I am sure she would have a different story to tell if not just for self preservation. JR
Another connotation of "self-preservation", term used by JR: A patient's own written "self-preservation" (self or family-written description) of that patient's history may be, in many interactions within the medical system, a "life-saving" or "legal" action for the future. One can get that term definition by reading the experiences of experiences and reactions in a thread on my blog which has been written to by many visitors over many years. The title of the blog thread is "Dark Side of Medicine: Writing Lies into the Medical Records". I certainly have no argument against the patient or family keeping their own record. It may later turn out to be of pertinent value. ..Maurice.
Sometimes vehicles illegally pass school buses. One way around that is for the school bus to stop in the middle of the street so nobody can pass.
Dr. Bernstein, I read about half of that blog about medical records and now have a question. Are there two sets of records? By that I mean the visit notes available to the patient and then another set that may contain additional and likely more pertinent info that the patient isn't seeing?
Where I get all of my care now has a great online records system that I can access anytime. Each visit will generate two documents that I have access to. One is the After Visit Summary which is just a set of standard instructions, and which they give me a hard copy of before I leave. The other is the notes about the visit itself, what was done, results etc. That second document is definitely pre-programmed to include everything the risk management people want included should it become Exhibit A at some point.
That notes document always includes discussions about risks explained and consents received that never occurred. It might even include examinations that never occurred. I do get a chuckle when for matters involving intimate exposure the notes will include something about me consenting to the exposure, being properly draped, and tolerating it well. Some data is carried forward from prior visits and not necessarily even updated. That makes it obvious it is a stock document vs an original creation. With one exception I just ignore the inaccuracies on the basis they aren't anything I particularly care about. The one correction I went back on was something that did matter to me and concerned when I had a complaint about that 1st ever dermatology visit I had previously shared here.
Is there another set of records that I'm not seeing? I'm not talking surgery or inpatient matters but office visits and outpatient procedures. I'm guessing yes.
After my brouhaha with Dermatology a year and a half ago they couldn't have been more accommodating and polite this last time. I did see on the after visit note for my recent dermatology visit coded in red a statement that said "No Resident/Prefers Male Providers" but I wonder if there is also something in a master record that is hospital-wide.
With my recent urology visit my appt. notice indicated a 2nd unnamed person would be with the doctor. Its a teaching hospital and I assumed that meant a Resident or medical student would be accompanying him. Nobody accompanied him which left me wondering did he have a female Resident or medical student that day but saw how I was coded and had them stay out rather than even ask me.
I hope they do have me coded as a modest patient that prefers male caregivers for intimate matters. It'll save me having the same conversation again and again if they do. At the same time I do wonder what else the record might be saying, and whether it is true or not.
PJF. I’ve a question for you. I think the answer is an important one for putting your experience in perspective. If the physician and/or the “scribe” had asked for your consent before allowing her to be present, what would you have said, do you think? I’d like the answer to this question so I know what to write for my next post.
Maurice, what are your thoughts about PJF’s experiences? Did what he wrote make you reconsider or temper any of the recommendations you have made in the past? (You may have already done this while I was absent from the blog.) – Ray B.
With regard to PJF's described experience, I find it professionally unfortunate to hear that a physician lied to the patient relative to the female's role in the room. If she was described as a scribe and did no work as a scribe then the physician was lying. Then, by not asking the patient's permission for an individual, student or other, of either gender to watch simply is to ignore the need for patient's permission for that person to be observing. I have not tempered or reconsidered my advice to patients on this thread: "Speak up!" to the professional if disturbed about what you see or what you know or are told or what hasn't been explained.
Currently, we physicians are having resident physicians from a neighboring hospital attend the "free" medical clinic where I volunteer. Remember that the resident has a M.D. degree and is not a pre-med student. It is my policy to make the resident's presence and role permitted by the patient who expected to have me as his or her physician for the visit. So no reconsideration or tempering. ..Maurice.
PJF, I think what could have made it easier to speak up is if you would have came up with an excuse to cancel and then reschedule. Then you could have made your wishes known and it wouldn't have been face to face and the awkwardness and embarrassment would have been less.
JR said:
I am writing some of my opinion articles to see if I can get anything published. Our local newspaper has begged me for articles in the past. We'll see if their need of articles is greater then their need of advertising dollars from the local hospitals that are involved with our lawsuit. I am printing it here in segments:
Healthcare consumers in the United States are routinely encountering discriminatory and/or substandard care. To be more precise, it is male healthcare consumers. For males, how care is delivered has not grown better but progressively worse.
Fifty years ago, women were on the receiving end of poor healthcare services. With the rise of feminism in the 1970’s, how healthcare is delivered and treatments have greatly improved for women. Women live six years longer than men and men’s state of health in their last years is generally worse than women’s health. There are four widows for every one widower. There are seven federal agencies that deal with specifically with issues for women. Out of 50 states, 39 have an agency for women’s health; only 6 have one for men’s health.
Add to the above that over 90% of nurses are female and that overall; over 80% of healthcare workers are female. Furthermore, many of them are young especially those working in a hospital. When women are seeking intimate care, they have choices. The may choose from a pool of ob/gyns that now is made up of over 85% female. In addition, the office staff and nursing staff are overwhelming made up of females. For females seeking ultrasounds or mammograms, the techs will be female as hospitals rarely employ males for these positions.
For males, however, that is a different story. Although urologists are mainly males, their office staff, nurses, and techs are generally female. For prostate ultrasounds, the technicians are usually female. For ultrasound of the testicles, the female will usually be female.
It is the right of a patient to ask for same intimate care to be provided by same gender but hospitals are not obligated to comply. For women, it is easier to find same gender care. Most hospitals discourage or will not hire males to work in labor & delivery, mammograms, or other female specific care areas. There are even whole buildings dedicated to female care. There may be male physicians but the staff will most likely be entirely female.
Even how intimate care is delivered is very different. When a female goes in for her gyn exam, she’ll be lead to a room and told to change into a gown or large paper thing once the nurse leaves the room and closes the door. Lying on the table during exam, the doctor is careful not to expose areas not being examined. Even in the stirrups, the doctor uses great care not to expose her upper torso. The accompanying medical person—nurse or tech—is female. After the exam the doctor will usually arrange the drape to cover the patient, and say they will be back once the patient has had a chance to dress.
For males, it is quite different. The urologist and the female nurse enter the room of a fully dressed male. After doing some listening to the heart, etc. the doctor will usually say, “Drop your pants” as he/she dons gloves. So there the male is standing like a cartoon character with his pants and underwear around his feet. The nurse just looks on. When finished with the front, the urologist will say turn around and bend over the exam table. So if the humiliation of standing there with pants/underwear waded around your feet on the germy floor is not bad enough, somehow you have to turn without falling and bend over the exam table with all watching. When finished, you will be told to pull up your pants again with everyone still watching. There is not even the slightest bit of dignity allowed to the male patient during this exam. Females are not made to undress in front of the doctor, nurses, and/or techs. However, no consideration for personal dignity or respect is given to the male patient. JR
JR said: article cont.
When males have surgery, the prep will most likely be done by females. Furthermore, you may not even be aware of how the prep is done or who it is done by. The majority of hospitals like to give benzo class drugs or one called Versed to patients so they will have no memory and will be submissive during the prep. Oftentimes, the same care to reduce exposure is not given to male patients as females patients.
The cardiac catheterization procedure is particularly one procedure where exposure happens that should not. Most stories I have read from women talk about how they were only exposed briefly before being covered. With male patients, there seems to be a different story. A male might be left exposed or uncovered the entire time with no gown or blanket. He will be drugged and will probably be unable to defend or speak up for himself but he may be aware of how they are mistreating him. Cardiac cath. labs are staffed mainly by female nurses and techs. While they will keep a woman’s genital region covered while they shave, oftentimes they will not cover a male’s genital area while doing the shave and alcohol type prep. They may not cover a male until he is actually draped for the procedure. For females they will usually place a gown or blanket over her chest area after the probes and grounds are place but with a male they generally do not bother. After the procedure is over, for a male is suturing is to be done they can expect to have their genital region again exposed for whatever time the nurses choose. For females, they generally keep them covered.
During the cardiac cath process, a male patient who is drugged with Versed and Fentanyl is alone in a room with female nurses/techs numbering from 2 to 4 but could be more. The drugs usually render them incapable of defending themselves from inappropriate behavior. However, I can think of no hospital that would knowingly allow drugged and vulnerable females to be left alone with 2 or more male nurses/techs.
The news media is full of stories about how male nurses/techs molest female patients. But it is a rarity to hear about females nurses/techs molesting male patients. Is it because only males have more sexually aggressive characteristics or that females are all saints?
JR said: article cont.
Sexual abuse by female medical personnel does happen. Sexual abuse can take many forms. It can be the difference between keeping a female patient covered and a male patient uncovered or exposed. It could be that the use of drugs such as Versed and fentanyl makes patients submissive, less alert, and erases memories of events. Sexual abuse can occur when female nurses strip off the clothes of a male patient without consent even though the male was conscious and permission should have been sought. Sexual abuse can occur during a cardiac catheterization lab procedure when the female nurses do not use a gown or blanket to cover a male patient during the pre-cath time or after the procedure by again not using a gown or blanket. They are able to do this as they know the male patient cannot put into actions their distress because of the side effects of the drugs. Female nurses in Cardiac CCU may leave a male patient exposed during the secretive time after transfer from the cath lab to the time when a family is “allowed” to finally see the male patient. The female nurse may even force the male patient to use the bedside urinal and do perineal care in front of techs that have no reason to view the genital regions of the defenseless male patient. This type of behavior can and has gone on for hours as the nurse controls visitation access. Since the male patient was drugged, they may come and go out of sleep. Subconsciously they may remember parts of what happened but may never really remember the entire event. There also may be outright acts of sexual manipulation but again the drugged male patient may not have complete memory of the event because of the drugs. Nurses know this as they are fully aware of the effects of these drugs. For some men who become aware of what is happening, they may not voice their complaints are they are ashamed, afraid no one will believe them, don’t believe something like that could have really happened, or a host of other emotions or reasons. Sexual abuse upon women is also more likely to occur when they are drugged or severely ill. Sexual abuse by hospital personnel is a crime of control and power. Hospital administrators will protect and justify the actions of their employees. It is almost impossible to get them to really investigate a claim of sexual misconduct or abuse.
It is also sexually inappropriate for male patients to have to have additional females present when there is an intimate exam taking place. Males have the right to having same sex caregivers present. Oftentimes, male patients are “ambushed” by the presence of a female chaperone or scribe. Many times they only become aware of this ambush when they are already in the exam room and the doctor enters with the female in tow. At this point, many males freeze and are afraid that speaking up will cause issues. Later, many will have regrets that they allowed themselves to be violated in such a manner. How many times will a male doctor have a male nurse or scribe in tow when he enters a room to conduct an intimate exam on a female? Women have learned to speak up about this type of sexual abuse. JR
JR said: article cont.
Some males may decide not to seek medical treatment due to knowing there is no dignity/respect given to a male patient. Some males who have sought treatment and have encountered sexually abusive behavior may not have a smooth recovery period and their overall prognosis is diminished by their mental sufferings. They may fail to return for needed treatment out of fear of being abused once again by a system who has already failed them once. Many may suffer from Post-Traumatic Stress Syndrome (PTSD). The MadmanBanterings website and Twitter account has some great articles on PTSD and how it is related to hospitalization. It can also affect the family of the violated male patient.
There are many boards/blogs that deal with the issue of patient dignity or modesty. I will list some good resources following this article. I personally do not like the term of modesty. I wear blouses that do not show cleavage as I am modest. I demand personal/bodily dignity/respect because I am a human being. All human beings inherently have the right to be treated with dignity/respect without question or compromise especially those who are defenseless and at their most vulnerable during a time of illness. It is ethically and morally wrong for the medical field to think otherwise or that male dignity/respect issues are unimportant especially in a world dominated by female medical personnel.
http://bioethicsdiscussion.blogspot.com/2019/03/patient-dignity-formerlypatient-modesty.html#comments
http://patientmodesty.org/malemodesty.aspx
www.issues4thought.com
https://madmanbanterings.blogspot.com/
http://drlinda-md.com/2016/11/men-patients-forced-man-medical-setting/
https://www.kevinmd.com/blog/2018/11/how-urologists-can-be-more-sensitive-to-male-patients.html
https://www.chicagotribune.com/lifestyles/health/sc-hlth-0513-patient-modesty-20150507-story.html
http://www.martynemko.com/articles/should-we-pay-more-attention-mens-health_id1231
http://www.thesmokinggun.com/documents/nurse-patient-sex-lawsuit-785643
Good Evening:
JR if your newspaper contacts would like to publish the article I previewed here called "The American Healthcare System’s Ignorance Towards Men" just let me know who to send it to.
I've sent a copy of the final document to the HHS secretary & the Centers for Medicare & Medicaid Administrator.
Regards,
NTT
While I agree that male patients are treated badly, male doctors play a major role in causing it to happen!
He hires female staff or makes little to no effort to have enough male staff to accommodate.
He is either amused by the embarrassment and humiliation that he and his female staff creates or he just considers himself too godly to concern himself with something so utterly insignificant as a patient's emotional health.
I partly think it wouldn't be enough to get enough male staff because much of the embarrassment is desirable to them. ( sorry Dr B I don't mean you )
Good Morning Gang:
JF, I completely agree with you and it's up to the patient, to put him in his place if if does that to him. It's up to the patient to talk to the doctor on their very first visit with him to see if they are compatible and set boundaries that neither should cross.
If the patient/provider relationship starts out on the right foot then both will gain from the relationship and the type of issues that JR talks about would not rear its ugly head. If its toxic at the start, best find a new doc.
One of the problems with getting male doctors in doctors offices other than our Dr. Bernstein to make changes like get male personnel is many of them are older, set in their ways, and like looking at a pretty face and/or nice pair of legs all day rather than a male.
Many female docs won't have male personnel in their office because they feel threatened and don't want to have their authority challenged by "the big bad male nurses" and by having jut females surrounding her she can humiliate her male patients in front of an audience if she chooses and have fun doing it knowing that the "girls" won't say anything.
Regards,
NTT
JR said:
NTT
I am going to personally take my articles to the local newspaper office. I want to sit down face-to-face and have give my talk. Whereas my other articles are not controversial, I know these articles will be. The one argument I have perfected in order to have a local attorney search for someone to represent us is: "Do you remember when your wife was delivering? How many male nurses/techs were in the delivery room? Ask your wife how many male techs she has had to do a mammogram? Ask her how many times she has been told to drop her pants and bend over? When she has her intimate exam if she has a female doctor does the dr. bring in a male nurse to watch or does her male doctor bring in a male nurse?Now think about when you have had an intimate exam probably by a urologist? How is it done? Are you told to drop your pants, turn, and bend over? Are the nurses or techs female or male? When you visit a hospital, what sex is the majority of workers you see?" This is just part of my little speech. You should have seen his reaction when he realized what I said is true. He is now looking for us an attorney and I might add, free of charge as he now thinks are case could be a major one in terms of how care should not be given. Hopefully, another attorney will think so too. So when I talk with them, I will add that there are other articles like mine they could use too making. If you want to send me the corrected articles, I will just take it with me. The more articles, the more they will realize what is being said is not just isolated cases of disgruntled people.
JF,
I believe you have hit upon something with what you said. The lead doctor at Disability when I worked there reviewing cases, said something that had stuck with me for years. He said that having patients undress and exposed is done more for the state of control. Exposed patients are more compliant and less likely to argue with a fully dressed doctor in a white coat that represents power. Add in the female nurses/techs, and for many men whether they are willing to admit it or not, being exposed to the opposite makes them question their maleness so they remain quiet and submissive. I am not saying there is anything wrong with their malesness but it makes them unsure and that would appear to be the goal of the exposure and audience. Males are usually perceived to be more of a threat to power and control than females. I think male doctors may enjoy being able to manipulate his male patients in front of his female audience. It certainly is a power trip for them as they may have some issues with their maleness.
As for females who expose male patients, I think many of them do it for power and control. They also may do it as payback for the condescending attitudes of the male doctors they work with so they take it out on vulnerable males that are defenseless. Some may do it as they really don't care about personal dignity, just doing the job with the less amount of "bother" and time. Some may do it because they are sexually disturbed like my husband's CCU nurse. Others may go along with it because they don't want to make the others turn on them as they have witnessed how vicious they can be. And make no mistake, groups of women can be very vicious. I know this from a school atmosphere where the overwhelming majority is female. Most will only care if it they need care and it happens to them or their loved one. I truly don't think most of them care about us mere mortals or that because of their cruel, callous, sexually abusive, and unnecessary actions that they damage many patients mentally even causing PTSD and further access to medical care. JR
Good Morning:
JR, male healthcare workers are treated the same as male patients by the medical community. That's why when a male healthcare worker violates a female patient or co-worker it makes the news because they want to embarrass him, then get rid of him.
They protect their female worker the best they can. Their goal is to keep all female violations out of the news media at all costs. They've had decades of practice at it & they are very good at it.
It's only been recently that stories about female teachers violating their male students have gotten out to the news media but once they did, now its become common place to hear about the stories.
The same thing will happen to the predatory nurses soon. They they will be forced to do what they do with male healthcare workers.
Regards,
NTT
Hello,
I sent the following letter to Karen Jackson, administrator at CMS, asking her to forward it to Seema Verma, CMS Director. (Ms Jackson's e-mail is the only one available at CMS leadership). To date I have received no response. I implore everyone to keep "hammering" CMS on this topic. CMS controls the purse AND the policy.
Part 1
1 Mar 19
Hello Ms Verma,
I read with interest your CMS Blog dated 1 March 2019 regarding Empowering Patients and Unleashing Innovation …. I applaud your desire for innovation and your positive view of seniors (contra Kaiser Health News). I’d like to invite you to consider another innovation – equal treatment of men in the health care system.
Let me explain the above with a personal anecdote. My wife is in her 70’s and requires a walker for movement. I accompany her everywhere she goes. At her recent mammography appointment, she was greeted by a female receptionist and escorted to the exam room by a female tech. Along the way the tech asked me, “Are you necessary?” I responded, “Yes.” and assisted my wife during the procedure. At each step during her visit, my wife was given same gender care and concern for her dignity, even to the possible exclusion from the room of her husband of 50 years – “Are you necessary?”
Consider the scenario of my wife accompanying me to a urological exam. I am NOT greeted by a same gender individual. The nurse who prepares me for the exam is female. When the urologist enters he DOES NOT ask my wife, “Are you necessary?”
These two scenarios demonstrate the disparity in the health care between men and women. Women are afforded utmost concern for their dignity and modesty. Men are, consciously or unconsciously, assumed to have no regard for their own dignity or modesty. Women can assume that they will receive same gender care from nurses and medical techs. If a male is to be present, women will be asked if this is acceptable to them. Men will usually NOT be afforded this consideration. A man can assume that a testicular exam will be performed by a male; but, in all probability, a female will perform the exam. The placement of an extremely personal urethral catheter will also, usually, be done by a female.
If a man requests same gender care for these procedures, he is often met with criticism, ridicule or extreme embarrassment. He can expect to encounter statements like, “You don’t have anything we haven’t seen before.”, “Get over it.”, “We can’t change our procedures to accommodate your neurosis.”, etc. These encounters probably do not rise to the level of an actionable tort; and, would probably not be considered blatant discrimination. Nevertheless, they are subtle forms of discrimination and indignity. Although the doctor may be male, because nurses, medical techs, CNA’s and chaperones are female, men are NOT receiving same gender care. Furthermore, when men realize that same gender care (via nurse, medical techs, etc.) is not an option for them, they eschew needed health care because they don’t want the embarrassment or ridicule for trying to “buck the system”.
End of Part 1
Rwginald
Part 2 Ltr to CMS
I believe that there is a simple solution to the inequity I’ve portrayed above. Place a bullet point on P89 of Medicare & You 2020 which reads “Same gender care will be offered (and provided, if desired) before any Medical Procedure”. (An asterisk may indicate that “same gender” applies to all medical staff members involved in the procedure, not just the physician.) This will alert medical providers to the full meaning of same gender care; and, that same gender care must be offered and provided, if the patient so desires. Furthermore, the patient will not be required to endure the embarrassment of having to ask first.
“I’ve learned that with any improvement you try to make, there will always be naysayers.” (Your statement in the 1 Mar 19 blog) When hand disinfectant was advocated for each hospital room, critics predicted financial ruin. Hand sanitizers now appear in each hospital room; and, they’re mandated for use by all caregivers upon entering the room. Similarly, when wheelchair accessibility was mandated in public places, some thought compliance was impossible. Today, virtually all public buildings in the US are handicapped accessible.
Hospitals and medical offices will exclaim that male RN’s and techs are not available. The retort is, “Encourage your feeder schools to recruit more males”. The UK has been successful in attracting males to nursing. Over 10% of their nursing staff is male. (See http://www.dailymail.co.uk/health/article-145183/More-men-work-hospital-nurses.html#ixzz4ugrFCTbL.)
CMS could be in the forefront of a similar US program.
CMS initiated the Bundled Payments Initiative to assist beneficiaries with health costs. Your new eMedicare with apps is another worthy innovation. Surely, a similar initiative can be instituted for truly same gender care for men.
As a final point, I’d like to emphasize that I DO NOT feel that female health care professionals are inferior or unqualified. I have no “axe to grind” with the health care industry. I do, however, feel that men are entitled to the same dignity and modesty afforded women beneficiaries of CMS by receiving same gender accommodations at every phase of their care. Additionally, I am not alone in my desires for same gender nurse and tech care. I would be happy to have my acquaintances, from around the country, e-mail you with their “stories” – some are extremely painful. Please let me know if it is possible for CMS to advocate for the accommodations I’ve presented above and/or, if you’d like other individuals to express their feelings on same gender care.
End of Ltr to CMS
Reginald
PS P89 of Medicare and You lists "Know your Rights...." in this order: Be treated with dignity & respect, Be protected from Discrimination,... Participate in treatment decisions....
Good Afternoon:
For anyone that wants them:
Alex M. Azar II
Secretary U.S. Department of Health & Human Services
HHS Office of the Secretary
E-mail Address: Secretary@HHS.gov
Phone Number: 202-690-7000
Ms. Seema Verma
Administrator
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-8013
e-mail: Seema.Verma@cms.hhs.gov
Regards,
NTT
Excellent letter Reginald! It states the issue clearly and in a reasoned professional manner. It does not come across as angry or as a rant. Good job!
JR said:
Reginald,
Great article! Knowing Your Rights is why I sent an over 30 page document to CMS for review. I wanted them to see exactly what happened from our point of view and to be able to back it up with facts. The medical records are so full of lies that the lies are not consistent--in other words they can't keep their story straight. The federally mandated Patient Bill of Rights lists no exclusions so they also breached many areas in that contract. I, again contend, that in order to get around dignity, consent, discrimination they use the drugs like fentanyl and versed that allow them to act as they please. The victim patient is often rendered unable to defend themselves. They lay there knowing and seeing but unable to protect themselves. And then they have the uncertainty of not knowing what happened when they were sleeping if they remember what happened when they were awake. Yes, I know those drugs may have a valid use but it is their abusive usage that concerns me. It is like a gun--guns are only bad when the wrong person is in control of them. Knives only stab people when used by the wrong people. I will at some time put on my website this 30+ page document. The full story is very shocking but it needs to be out there so others can be aware. Office patients being ambushed or even if they know in advance of women being present, may feel intimidated, humiliated, and angry at themselves for what happened. They will certainly feel violated and trust was broken. No patient seeking medical help should have to deal with such issues from insensitive, callous, and unprofessional medical personnel. You might also send a copy to Hank Azar. I did. I also sent one to Trump and Pence. JR
GREAT COMMENTS AND GREAT EFFORTS TO PUBLICLY AND MORE EFFECTIVELY "SPREAD THE WORD" OF THE ERRORS AND DEFICIENCIES OF THE MEDICAL SYSTEM! I hope this starts some change in the system.
Now on a different matter regarding this blog system. Some of the commenters here are still writing to Volume 95 despite my last statement on that Volume that there would be no further Comments published there. I don't have the time to copy the text and republish it on this Volume 96. All your Comments are desired but WRITE THEM HERE ON 96 AND NOT 95. ..Maurice.
That was me Dr B and it was accidentally. I meant to comment on this volume. I will as soon as I remember what I wanted to say.
PJF Welcome to the site. I am the same age as you are and in all my decades of seeing doctors have never dealt with a scribe. It could be that they don't have them in Pennsylvania. I really couldn't say. I have dealt with doctors who sometimes have a sidekick, usually a physician's assistant, and sometimes don't. I can take it either way. But when an intimate exam is involved the patient should be asked first if the sidekick's presence is acceptable arguably even if the sidekick is the same gender as the patient. Patients come in to see a doctor not their sidekick. I suspect that this doctor had a female sidekick on behalf of his female patients in order to keep the session gender neutral but he should take into consideration his male patients as well. You say you couldn't find your voice then. Find it now. If the doctor worked in a hospital then contact the hospital and file a complaint. If the doctor as it appears works in private practice then write the doctor a letter saying the same things you wrote in your initial post and say you didn't appreciate this. If he fails to write a letter back then phone the office.
PA
Good Morning:
This morning sent my lack of choice letter off to the Atlanta Journal Constitution. They did a big series awhile back on the healthcare industry so I asked them about doing something on men's healthcare in America or lack of it.
We'll see what happens.
Regards,
NTT
Ed T. – Sorry I’m so late responding to your March 22 post. I’ve had a lot of things going on. I do thank you for your response. The question I asked you to answer regarding emotions and physiological responses had to do with my research interests. I studied under a sociologist by the name of Robert Leonard when I was in a Ph.D. program at the University of Arizona some years ago. His research interest was in Medical Sociology. We studied how physiological responses could be used to measure variables such as level of anxiety, level of sexual interest, and the like. Measures of physiological variables were sometimes validated using other measures of the same variable such as the State section of the State-Trait Anxiety Scale. One experiment conducted by Leonard and several nurses looked at the effects of types of approaches to new mothers (formal approach versus informal approach – the independent variable) on their babies’ level of anxiety (dependent variable) as measured via fecal return, emesis, respiration, etc.
Your physiological responses were probably also indicators of anxiety. I have good reason to believe that it is more common for males than females to, ceteris paribus, experience anxiety when they visit a healthcare provider, especially when intrusive examinations are anticipated. That anxiety, and the physiological symptoms that accompany it, may be dismissed by providers as due to the proverbial “white coat effect” when, in fact, it is due to the fear that one will have to relinquish his dignity or act to protect it, neither of which is a particularly palatable situation in which to find oneself.
You can tell me if I’m wrong, but I’m guessing that you were a little anxious before you were ever ushered by the MA into an examination room. I surmise from what you wrote that your anxiety and the concomitant physiological indicators became worse as the MA ushered you into an examination room and then jumped again when she confirmed the cause of your anxiety by saying, before exiting the room, that “the doctor would be in shortly and that she would be assisting.” – Ray B.
Beginning of part 2
You then made a demand, based on the hope that she was capable of empathy and was cognizant of the norms of common decency, by telling her that you were a modest man. I suspect your anxiety and negative physiological responses reached their peak when she told you something that was patently untrue – that the physician required her assistance – and then trivialized her planned assault on your dignity as a mere “inconvenience.”* Imagine now that the physician ignored your demand and, as some have done, entered the examination room with the MA and proceeded ritualistically with his examination as though your demand was never made. Imagine what action you would have taken, if any, were that to have happened. Also imagine, if you will, what your level of anxiety would have been. Would you have experienced tachypnea, tachypnea, hypertension, tachycardia, heart palpitations, abdominal rigidity, fight-or-flight sensations, an unusually high level of diaphoresis, and the like – all signs of something that may have gone amiss in an exchange? Had this latter scenario transpired, and it often does, the physician and MA would have made a mockery of the Hippocratic maxim of, “First, do no harm.” As it was, the MA and the physician who permitted (and possibly instructed) her to behave as she did, failed to do the oath justice. What stress and concomitant physiological symptoms you experienced as a consequence of the MA’s ritualistic commitment to standard operational procedures was wholly unnecessary. This may be a bold statement given that the outcome of your ordeal was more favorable than what you might have experienced at another facility. However, it is founded on some years of studying and teaching about the ethics of healthcare delivery to, among other students, those in premed, nursing, and health and exercise science.
Prior to teaching the courses, I studied many documents that enumerated the rights of human beings including, but not limited to, the Belmont Report, the Universal Declaration of Human Rights, the Geneva Conventions (esp., the 2nd and 3rd Conventions), the AMA’s Code of Medical Ethics, the ANA’s Code of Nursing Ethics, the AHA Patient Bill of Rights, the U.S. Constitution (esp. the penumbra privacy amendments, First, Third, Fourth, Fifth, and Ninth), some state constitutions, and case law in which ethical principles were addressed. From these documents along with reading and studying the writings of ethicists, I conceptualized “human rights” and created a model of ethical healthcare delivery based on that conceptualization. I can’t go into detail, but will provide an overview. – Ray B.
* I have found that there is a social norm inherent in the healthcare institution that legitimizes expressions of contempt, including dismissiveness and trivializing the loss of dignity, directed – both overtly and covertly – by providers and their enablers outside of healthcare, at patients who try to protect their dignity. This norm is a curious reversal of the norm inherent in “polite” society. After all, isn’t this like a murderer showing contempt for his target because his target takes action to protect his life? Isn’t this like a robber condemning his intended victim for taking action to protect his property? Isn’t this like the polluter taking aim at those who breathe in his carcinogenic by-products because they bring suit to protect their health? And, isn’t it true that for many, if not all, dignity is reciprocally related to one’s health and quality of life? If so, then who is the deviant and who the conformist, the patient who deigns to follow a norm requiring him to unnecessarily relinquish his dignity or the provider who attempts to compel, cajole, or convince the patient to conform to that norm?
End of part 2
Beginning of part 3
First, here’s a considerably truncated conceptualization of a human right: A human right exists within a person by virtue of that person being a human being. A human right, in other words, is inherent in each person and consequently can neither be granted nor relinquished, voluntarily or involuntarily. Even when someone ignores or violates another’s right the right remains. A human right cannot be purchased, earned, demanded, or requested. If an actor is required by another to exercise his/her rights via purchase, earning, demand, or request, the right is not treated as a right but as a privilege.
If a person gives another person permission to violate his/her rights (including signing a contract), s/he may rescind that permission at any time. If the other person in any way pressures (via force, threat of force, cajoling, persuasion, etc.) an actor to permit him to violate his right, then that other person is not treating the right as a right.
Human rights, as codified, take the form of general abstract principles. Consequently, their operationalizations may be somewhat dependent on variations in cultural idiosyncrasies or, more specifically, cultural mores (morally important rules governing human behavior). For example, if a human right includes the right to bodily integrity, this right would be understood differently among the South American Yanomamo who wear no clothing than among citizens of some Middle Eastern nations where women cover themselves from head to toe. Finally, conformity to and violations of human rights are matters of degree; they cannot be dichotomized.
Ethical documents are, in part, founded on this conceptualization of “human rights.” Accordingly, there are a number of principles that are among the cornerstones of ethical research and practice. They include the principles of beneficence and respect for persons. The principle of beneficence may be divided into two general rules including “1) do not harm and 2) maximize possible benefits and minimize possible harms.” The principle of respect for persons “incorporates at least two ethical convictions” one of which is “that individuals should be treated as autonomous agents” (Belmont). Autonomous agents have a right to be treated with dignity. They have the right to informed consent, voluntary participation, and privacy pertaining to their papers, homes, and persons. It is ethically obligatory to clearly inform individuals of risks and possible benefits they may accrue from their participation in research or practice. “Even when some direct benefit to them is anticipated, [they] should understand clearly the range of risk and the voluntary nature of participation. They must be allowed to ask questions and to withdraw at any time from participation.” Voluntary participation requires that participants not be subject to coercion or unjustifiable pressures. “Coercion occurs when an overt threat of harm is intentionally presented by one person to another in order to obtain compliance . . . Unjustifiable pressures usually occur when persons in positions of authority or commanding influence . . . urge a course of action for [an individual].” Ray B.
End of part 3
Beginning of part 4
Ed T., you concluded your entry with, “In all, a very civilized encounter.” Some folks treat civilized encounters and conformity to ethical standards as dichotomies rather than matters of degree; they are, in fact, maters of degree. I submit that it is true by definition (rather than a proposition) that the greater the conformity to ethical standards, the more civilized the encounter. A fully civilized encounter would conform to each pertinent ethical maxim I have summarized above. I’d say that the physician and MA did a pretty good job, but they certainly did not conform to all the ethical criteria I’ve identified.
But before I conduct an assessment, I need to establish that a patient has a right to receive intimate care from same-sex providers. That means I must first establish that same-sex intimate care is consistent with a mos (singular of mores) of “polite society” or of the greater society and opposite-sex care violates that mos. Some of that evidence has been presented in Maurice’s blog in the form of research that asks people whether they prefer same-sex intimate care, opposite-sex care, or it doesn’t matter to them. Anywhere between a sizable minority to a majority of both men and women report that they prefer same-sex providers. I also found, from research I and students conducted, that the overwhelming majority of women and better than half the men surveyed indicated that they preferred same-sex providers. I went further than the other studies by asking respondents why they had a preference. Several response options were given to them, they could choose all to none of those options, and they could add other reasons not listed in a space provided for that purpose. Overwhelmingly, both male and female respondents who preferred same-sex providers for intimate care responded that their preference was based on their desire to protect their privacy and their dignity; they indicated that opposite-sex providers would cause them anxiety, embarrassment, and/or humiliation. Their preference had nothing to do with prejudice, a belief that opposite-sex providers were in some way inferior or less competent than same-sex providers.
Another indicator that same-sex care is consistent with social mores in the U.S. is by looking at what and how many major social institutions, other than healthcare, legitimize putting naked Americans, without their invitation and consent, on display for the scrutiny and/or ministrations of opposite-sex strangers. One can’t say that such behavior is institutionalized in the family. Nor is it institutionalized in the aggregate of law enforcement organizations, though it could be and does happen occasionally. The government and courts don’t approve of it. Businesses would be in deep dodo if they were to do such a thing; so too would the school. That this practice is not institutionalized in any major social institution other than healthcare suggests that it violates the social mores of our society. There is one social institution, though not a major one, where human beings are put on display for the scrutiny and ministrations of opposite-sex strangers; the sex industry or, more precisely, the sex-slave industry. But there’s an irony in this; it is the slave (a metaphoric parallel to the patient) who is the victim while the customer (a metaphoric parallel to the provider) offends the mos. Ray B.
End of part 4
Beginning of part 5
Now it must be established that Americans have a right to same-sex care. To do this, a link must be made between the practice of same-sex care and one or more of the ethical maxims that have been identified (e.g., rights to dignity, informed consent, voluntary participation, privacy, etc.). For this evidence we can turn to U.S. courts; they have done the best job at making the necessary link and they have frequently done so very cogently and forcefully.
In York v. Story (1963) the Court proclaimed that a person’s “body involves the most sacred and meaningful of all privacy rights . . . We cannot conceive of a more basic subject of privacy than the naked body. The desire to shield one’s unclothed figure from view of strangers, and particularly strangers of the opposite sex, is impelled by elementary self-respect and personal dignity.”
The Court in Gregory Backus v. Baptist Medical Center (1981) disagreed with Backus’ plea that he was subjected to illegal discrimination when he was rejected for employment in labor and delivery due to his sex and agreed with Baptist Medical that the constitutional right to privacy would be violated if male nurses were allowed to perform intimate procedures on OB/GYN patients. The Court concluded that Baptist Medical acted within the law when, to protect the privacy interests of patients, it considered being female a bone fide occupational qualification (BFOQ) for working in its labor and delivery department. It concluded that the right of patients’ to privacy trumped Backus’ right not to be subjected to discrimination based on his sex.
The Court in City of Philadelphia v. Pennsylvania Human Relations Commission (1973) “recognized a constitutional right to privacy” when it decided in favor of a youth center’s policy to hire only “supervisory personnel . . . who were of the same sex as the inmates” in order to protect the privacy interests of inmates when they showered and underwent body searches. The Court defended its use of the penumbra privacy Amendments of the U.S. Constitution by citing their origins in Griswold v. Connecticut (1965) which concluded, “Having one’s body inspected by members of the opposite sex may invade that individual’s most fundamental privacy right, the right of privacy of one’s own body.” According to the Backus Court, the City of Philadelphia Court “was persuaded that intimate contact by those of the opposite sex could cause a ‘traumatic condition’ and ‘irreparable harm to [a] psyche and concluded: “Laws forbidding discrimination in hiring on the basis of sex do not purport to erase all differences between the sexes. These laws recognize that there are jobs for which one sex is inherently and biologically more qualified than those of the opposite sex. The biological difference between men and women which in turn produce psychological differences are the facts that justify limiting personal contact under intimate circumstances to those of the same sex.’” – Ray B.
End of part 5
Beginning of part 6
In City of Philadelphia and Fesel v. Masonic Home of Delaware (1979) the plaintiffs argued that hospitals cannot legally cater to “customer preferences” for same sex providers by discriminating against either sex in hiring and promotion. A. Larson, Employment Discrimination Sex dealt effectively with this issue: “Giving respect to deep-seated feeling of personal privacy involving one’s own genital area is quite a different matter from catering to the desire of some male airline passenger to have . . . an attractive stewardess. The correct simulation of this type of case is to the personal restroom attendant example. After all, one could with equal logic say that the decision not to be stared at by a member of the opposite sex while urinating is only a matter of customer preference. Indeed the degree of invasion of personal privacy is far greater in the hospital case. . . It would be a strange doctrine that would decree that the sanctity of the right to privacy in the performance of excretory functions, fully respected in a public restroom, is forfeited by the fact of falling ill and becoming hospitalized.”
In Iowa Department of Social Services v. Iowa Merit Employment Department (1977), the Court concluded that it would be a violation of the “constitutional right to privacy” were women employed as guards and then fulfilled their job requirements of watching men bathe and conducting pat downs. “It is apparent, and is undisputed,” it wrote, “there would be a constitutional violation of inmates’ rights if the guards were women . . . Continuous surveillance by one of the opposite sex violates a right of personal privacy.
The Backus Court notes: “In re Long (1976), in which guards maintained a constant watch over inmates, the court found that intimate exposures were in clear conflict with the guarantees found within the Bill of Rights and held: ‘Thus, an accretion of decisional law recognizes that privacy, in both its tort and constitutional manifestations, encompasses the individual’s regard for his own dignity; his resistance to humiliation and embarrassment; his privilege against unwarranted exposure of his nude body and bodily function. The latter kind of exposure assumes particular poignance when it occurs within the perceptive range of strangers of the opposite sex. At that point the exposure clashes with a deeply held social, moral and emotional bias pervading western culture.’ In this area of the law the courts focus not on the employee’s competence, but rather on the obvious bodily intrusions which will result. The fact that the plaintiff is a health care professional does not eliminate the fact that he is an unselected individual who is intruding on the obstetrical patient’s right to privacy. The male nurse’s situation is not analogous to that of the male doctor who has been selected by the patient. It follows that requiring labor and delivery nurses to be female is a bona fide occupational qualification (BFOQ) which is ‘reasonably necessary to the normal operation of [its] particular business or enterprise.” Ray B.
End of part 6
Beginning of part 7
Hinds General Hospital experienced a drop in patient census to which it accommodated by laying off staff. Nurse assistant Pamela Jones was one of those laid off. She filed suit for gender discrimination against Hinds (1987) because female assistants were laid off but no male orderlies were laid off. The hospital argued that “none of its orderlies were laid off . . . because at least one orderly was required to be in the hospital at all times in order to protect the privacy interests of defendant’s male patients. Various functions performed by nurse assistants or orderlies entail the manipulation of exposure of patients’ genitalia or other private areas of their bodies. To preserve its male patients’ interests in privacy and dignity, defendant asserts it was necessary to retain all orderlies who were on the staff at the time of the layoff.” The Court recognized the virtue of Hinds Hospital’s argument and decided in its favor.**
Of significant import to Maurice’s Blog was the Backus Court’s distinction between the purpose of the Civil Rights Act in banning employment discrimination and some hospitals’ policies designed to protect patient rights: “It is necessary at this point to stress that the purpose of the sex provisions of the Civil Rights Act is to eliminate sex discrimination in employment, not to make over the accepted mores and personal sensitivities of the American people in the more uninhibited image favored by any particular commission or court or commentator.”
This statement was a harbinger of what was to come. What the court picked up on was the efforts of some healthcare providers to compel resistant Americans to define the world in a manner that violates long lived and deeply entrenched social mores regarding dignity and privacy; to compel resistant Americans to truckle to providers’ pressures to relinquish control of their bodies to those providers, no matter the harm. What it picked up on, in other words, was the efforts of some healthcare providers to convince us, through the courts, to turn our social mores upside down by labeling as deviant hospitals’ efforts and patients’ efforts to protect their dignity, their privacy, their self-esteem, and, in general, the integrity of their bodies, and to define as socially normative and desirable providers’ increasingly successful efforts to strip these rights to their core. Yet, it is undeniable that our mores of the past regarding opposite-sex surveillance and ministrations are our mores of the present. – Ray B;
** Not all courts have found in favor of hospitals that have engaged in gender discrimination in order to meet the privacy needs of patients. However, this is not because the judges involved reject the notion that patients’ right to privacy includes having same-sex providers conduct intimate procedures but because the defendant hospitals failed to do their homework. For a hospital to prevail, it must prove to the satisfaction of a court that 1) a substantial number of patients of a particular sex would object to getting intimate procedures done by an opposite-sex provider, 2) all or substantially all of those whose sex is the same as the plaintiff’s would not be able to perform the duties of the job without intruding on the privacy of opposite-sex patients, and 3) the hospital would not be able to “rearrange job responsibilities in a way that would eliminate the clash between the privacy interests of patients and the employment opportunities of the plaintiff.” Not all hospitals have been able to prove that all three of these conditions applied.
End of part 7
Beginning of part 8
The courts clearly established that, in the U.S., same-sex intimate care is a right. They established this by linking this practice to the ethical maxim of do no harm. They also clearly linked same-sex intimate care to privacy and dignity rights, and through these rights to the rights of autonomy, and through this right the right to be treated with respect. Thus, the violation of a patient’s rights to privacy and dignity by assigning opposite-sex providers to conduct intimate procedures also violates patients’ rights to autonomy and to be treated with respect.
The rights enumerated by the courts are the rights of each individual patient, per se, to respect, autonomy, dignity, and privacy made possible by the assignment of same-sex providers for intimate care. The rights enumerated by the courts are not the rights of hospitals, per se, to assign men to men and women to women for intimate care. The Backus Court reasoned that the right of Baptist Medical Center to assign men to men and women to women exists only through the rights, per se, of patients. That is what the Backus Court meant when it wrote: “The Court notes that the patients’ rights have become intertwined with the rights of the Medical Center . . . When a close relationship exists . . ., rights become intertwined and the relationship itself entitled one [the hospital] to litigate on behalf of the other [the patient].” This fact should parry the wrongheaded argument that the courts were enumerating the rights of hospitals to discriminate not the right of individual patients to discriminate and therefore, patients don’t have a right to same-sex providers for intimate care. That’s nonsense. It would be a strange doctrine and, indeed, a highly paternalistic doctrine that would allow hospitals to protect patients’ privacy rights but not allow patients to protect their own privacy rights. But it seems that some hospitals have latched on to that interpretation. Consequently, when people exercise their right to privacy by requesting a same-sex caregiver for intimate procedures, the response is, “We are not a BFOQ hospital,” meaning that they will not accommodate patients’ legally recognized privacy and dignity rights by pairing them with same-sex providers when intimate care is involved.
Given what I’ve written is true, how might one determine if Ed T.’s MA was more a hero or more a villain?
Informed Consent, Voluntary Participation, and Respect for Patient: I have no reason to disagree with Ed; the MA adequately addressed the technical dimension of the planned examination. But she was largely remiss in her discussion of the human dimension – the dimension associated with patients’ affective responses to what was to take place – except to say (probably dispassionately or in a mater-of-fact manner) that she would be assisting the physician.
If one assumes that the M.A.’s presence was necessary for Ed’s health or healthcare, and if one assumes that same-sex care is an action that, if violated, undermines patients’ rights to privacy and dignity which could, in return, cause the patient humiliation and shame, then it was obligatory that the M.A. address the likely advantages and possible drawbacks (e.g., embarrassment caused by exposure of the genitals) of her participation in the examination and how the patient’s privacy right would be accommodated (e.g., “I will step behind a drape during the intimate part of the examination.”). Ray B.
End of part 8
Beginning of part 9
The M.A.’s presence, however, was, in fact, not essential to Ed’s health or healthcare; the doctor did not “require” her assistance as she claimed; her claim was false as evidenced by the fact that the physician completed the examination without her presence let alone her assistance. In this case, if it is true that opposite-sex care violates a person’s privacy right, then it was ethically incumbent on the M.A. to get Ed’s consent to be present; it was not incumbent on Ed to get the physician’s consent that she be absent. That Ed had to exercise his privacy right before it was honored is prima facie evidence that 1) neither the M.A. nor the physician considered the unnecessary participation of the M.A. as being a violation of Ed’s privacy right and 2) considered their willingness to excuse him from being scrutinized by the M.A.’s a privilege.
As soon as Ed voiced his objection to the M.A.’s presence, she was, without argument, ethically required to inform the physician that she would be absent from the examination. Instead she told Ed “that the doctor would require assistance and she was sorry if this would be an inconvenience.”
An M.A. and others who answer to and are subordinate to a physician are vicariously imbued with the physician’s authority. It follows that when the M.A. rejected Ed’s demand that she be absent during the examination, she was putting unjustifiable pressure on him in order to get his compliance; she was urging “a course of action” that he said violated his sensibilities and, implicitly, his peace of mind. Moreover, her response to his reasonable demand that she not be present during the examination was a show of disrespect and a direct threat to his right to voluntary participation. Her disrespect was augmented by her disingenuous apology and when she debunked one of his laudable character traits (modesty) by trivializing her intention to undermine it and calling it an “inconvenience” as though his plea was no more than a mere expression of preference rather than a demand that his privacy and dignity rights be respected.
In The Sociology of Health course I intermittently instructed, I sometimes included a section on the ethical delivery of healthcare. The test over this section included scenarios of the sort given by Ed T. Students were to judge how closely healthcare characters in the scenario conformed to certain ethical criteria. Were Ed T.’s MA to take the course and were she to judge her performance and other similar performances favorably, she would have probably earned a “D” on that section of the exam. – Ray B.
END: Sorry about the length of this piece.
Reginald: On March 25, you wrote, "Place a bullet point on P89 of Medicare & You 2020 which reads “Same gender care will be offered (and provided, if desired) before any Medical Procedure”. (An asterisk may indicate that “same gender” applies to all medical staff members involved in the procedure, not just the physician.)" Where did you get a copy of the 2020 Medicare and You booklet? I was told it is not out yet. The 2019 version does not have anything about same gender care. -- Ray B.
I think you might be reading into Ed T's MA more than what is there. It's more Ed T's doctor who is/was at fault.
With th MA she was following her job description possibly the best way she knew how. Maybe a patient had never even required her to not be there before her encounter with Ed.
But if a male patient wants a male doctor when exposer is going to occur and the doctor includes female staff to be assisting, he's deliberately misunderstanding.
It seems to me that once she realized she was doing something wrong , she immediately stopped.
It turned out the doctor was able to do the job by himself.
JF, I disagree concerning the MA that Ed encountered. She was dismissive of his concern as evidenced by her use of the word inconvenience. That trivialized his concern. Imposition would have been a far better choice of words.
Ray B., it was long but very informative. “We are not a BFOQ hospital” are the exact words my local hospital used in a response to a letter I wrote to the President of the hospital. I decided that was my last attempt to nudge them into being more respectful of male patients and finished shifting all of my care to a large teaching hospital 75 miles from here. I will not do any scheduled surgery, exam or procedures locally. Their ER is the only local option, though even then it is that larger teaching hospital that serves as the region's Level I Trauma Center for the most serious emergencies and where anyone needing cardiac caths get sent.
Though I have moved away from them I will defend the local hospital in one respect. It isn't that they are rejecting males looking for nursing jobs. They can't find enough nurses to fill all of the openings. There is only one urologist in this area and he has one female NP in his practice. He wants to retire and the hospital hasn't been able to recruit a new urologist. If a female urologist comes along, they will surely hire her to replace him regardless of the impact on male patients because the alternative will be no urologist at all. Another small hospital about an hour from here went a year or two without a dermatologist until a female dermatologist came along.
Limited choices in rural areas may be a reality but it doesn't preclude the adoption of protocols designed to minimize exposure, maximize dignity, and address very simple matters such as requiring informed consent for student observers that includes clearly stating their educational status (9th grader vs college senior vs medical school vs nursing school etc).
Ray,
An excellent academic piece as always. I see you are back to your old research prowess.
I would like to expand on a point that you open the door to with the rulings of same gender violation of bodily integrity, that observance and performance of treatment by the opposite gender may create an assaultive situation towards the patient, even that of the same gender may creative an assaultive experience for the patient.
It is clear that the presence of the intimate area lends itself to the trauma of the experience MORE than that of the gender of the provider. If that were the case, we would see issues about examination of benign body parts such as the wrists by members of the opposite gender.
We need to begin with the question of what additional information the intimate exam adds as part of PLANNING with the patient of their GOALS for HEALTHCARE SERVICES that they are receiving. This then goes to the primary focus of completely transparent, fully informed consent (sans coercion).
This is where the problem truly lies. Read the justifications by DOCTORS AND MEDICAL STUDENTS for Pelvic Exams On Anesthetized Women Without Consent.
The lack of conscience is truly disturbing.
-- Banterings
Ray B
Sorry to have neglected one important question that you asked. What would I have done if the doctor and MA both entered for the exam?
This scenario has been well rehearsed.
I would have stated calmly that I did not consent for her to be in the room. That it had nothing to do with her level of expertise but everything to do with my personal modesty (dignity). If the doctor refused to have her leave, I would have said no thank you and left. Chances are that he would have relented at that point but if not, so be it.
Again, a well rehearsed plan of action if needed.
Thanks again for very interesting and informative response.
Ed T
Though I never intended to be a surgeon (and I never was one), I am very pleased with the "dissection" of the complex issues of professional behavior (or misbehavior) which is currently being discussed here.
To me it is important to "uncover", by dissection, pathology in order to have some valid direction toward a cure. And I think we are all looking forward toward "a cure" and so what is being presented here and the recent Volumes is going in the productive direction.
..Maurice.
Thanks for your response Ed T. Your's is good instruction and you probably correct about the likelihood of the physician relenting. It’s unfortunate that patients must instruct some providers about how to behave, but c’est la vie, c’est la guerre, c’est la merde.
There is another option that I prefer but seldom implement and that is to prevent events such as the one you experienced from occurring in the first place. Upon first meeting a healthcare provider, I inform him or her how I expect to be treated and offer to the provider a legal/ethical justification for my expectations if s/he wants it in the naïve hope that s/he will decide to treat everyone in a manner consistent with social mores. One of the things I expect is that only those people who are essential to my health or healthcare will be in the exam room with me and the physician and that before that person enters his/her essential role will be explained to me to my satisfaction. I will also have to be convinced that my right to privacy cannot be accommodated without the presence of that third person.
The right not to have anyone but essential healthcare providers in an exam room without the patient’s consent was, in my lifetime, first articulated in the original American Hospital Association’s (AHA) Patient Bill of Rights. This clause was taken out some years later. I phoned the AHA’s office to find out why, but nobody to whom I spoke knew it had been in there in the first place let alone why it had been dropped. I figure that the AHA thought it had the authority to reduce the autonomy of patients and increase the autonomy of physicians. Of course, we still have the ethical right to decide who participates in our health care whether or not the AHA wants to recognize that right.
If a physician refused my demand and told me not to return until I was willing to change my attitude, I would (and have) filed a complaint with the state medical board. The worst it will do is write up the physician for not following the proper protocol for terminating a patient. Were an attorney to terminate a client without following proper protocol, he or she would more likely than the physician to end up in deep dodo.
When I’ve exercised my rights, I’ve been accused of being “too controlling.” Of course, if that attack comes from someone who wishes to undermine my rights, it is a pure case of projection – attributing to others the foibles in oneself (usually without recognizing them in oneself). I would expect anyone whose life, health, property, or dignity is under attack to make an effort to parry that attack. By what cerebral legerdemain can one laud the first three and condemn the last, especially given their reciprocal effects on each other? -- Ray
Hello Ray B,
I do NOT have a copy of Medicare & You 2020. My letter to CMS included the proposal to list same-gender care in the 2020 edition when that edition is compiled.
Reginald
JF: One can certainly make an argument in support of your belief that “it’s more Ed T’s doctor [than the MA] who is/was at fault” And you’re probably correct that the MA “was following her job description possibly the best way she knew how.” She may have also been following the physician’s orders. However, it does not follow that the MA did not violate legal/ethical principles nor that she was not legally/ethically obligated to behave differently, no matter what her motives. If the MA was following the physician’s dictum, then they were both responsible for what Ed experienced, although the burden of responsibility may have fallen more on the shoulders of the physician than on the MA’s shoulders. She can no more be absolved of her actions, though some may think she should be, than the Eichmann’s of society, who attribute their actions to the orders of superiors, can be absolved of their actions.
I recently read a piece written by an ex-scribe. It was about how he participated in defrauding the government by debundling at the orders of physicians at the clinic where he worked. Had there been a raid on the facility, it is unlikely he would have been absolved of legal culpability for his actions and not held to account. Indeed, there is a good likelihood that he would have been, rightly or wrongly, the “fall guy.”
There’s a theory of deviance called neutralization theory that has consistently received empirical support. It posits that before an individual engages in deviant behavior s/he will neutralize internal controls (e.g., conscience) and external controls (e.g., being fired). Once these controls are neutralized, the person is free to engage in deviant behavior. The aspiring deviant learns from others (e.g., physicians) certain techniques for neutralizing controls. These neutralization techniques are justifications learned in advance of the commission of deviant acts. One of these techniques is called denial of responsibility which includes, but is not limited to defending the deviance with, “I was just following orders,” “I was just doing what my job description tells me to do,” “I was just following standard operational procedures.” Those who wish to reduce certain forms of deviance (such as the unjustifiable intrusion on a person’s privacy) recommend strongly that these a priori defenses be debunked not legitimized. -- Ray
Biker.
Could be you are right. And inconvenience WAS the wrong word to use. Convenience for the doctor was what SHE was there for. I like that she explained in advance what the examination was going to be like. If she did that on her own without the doctor telling her to do it , that is to her credit. If the doctor instructed her to do that, then HE is to be commended. I think I sometimes criticize doctors too much. We need them so much. I just feel so strong about our issue.
Reginald: Thanks for the clarification. Don’t hold your breath. On the other hand, if each of us could enlist 100,000 people to sign a petition, maybe we’d have half a chance. Then, again, maybe those who have the authority to make the change need the impetus of legal/moral justification for such a change.
Thanks Banterings. But I’m a little disappointed. I wished my piece to be viewed as something more than an academic exercise. I was hoping anyone who didn’t fall asleep before reading the whole paper, especially good folks such as PJF, saw it as an affirmation of the position we take on the issues of opposite-sex care and unnecessary attacks on patients’ dignity, privacy, and self-respect via unnecessary and unjustifiable exposures of their nether regions and women’s breasts. Knowing and having evidence that social mores, interpretations of ethical codes, and legal precedence are on our side should make more facile the otherwise difficult decision to inform providers about how we expect to be treated, to challenge them when they deviate from the norms of common decency, and to parry the ad hominem attacks on our character when we “lay down the law.”
Wayward Provider: “I treat everyone the same. I don’t see why I should treat you special.”
Response: “I don’t expect you to treat me as though I were special. I expect you to treat everyone with dignity and respect, including me.
Wayward Provider: “Your behavior is immature and childish.”
Response: “If so, I’m in good company. It includes judges and ethicists who agree with me. They wonder why so many providers don’t think it is childish for patients to protect their lives, health, and property but think it’s childish for them to protect their dignity.
Maurice has for years recommended that we “SPEAK UP,” but I don’t know if he has provided the social, moral, and legal defense for doing so, since I’ve been “off the air” for so long. After all these years and all the input on the subject he’s received, including many references to pertinent scientific research, he must know what the social and psychological (sometimes insurmountable) barriers are to speaking up. Having evidence that one is in the right may help.
Banterings, you suggest that we read “the justifications by DOCTORS AND MEDICAL STUDENTS for Pelvic Exams On Anesthetized Women Without Consent.” I just came across the article a week or so ago. As I read it I began to have a sense of dejuvue think that it sounded familiar. When I got to the end, I realized why. In 2004, the major author of this piece Robin Fretwell Wilson published an article “Using Tort Law to Secure Patient Dignity” in which she provides the legal justification for defining pelvic exams on unconscious women as being illegal. Any woman who read this piece and had been the least bit reticent to speak up and out against this treatment, would probably have experienced a loosened tongue.
Wilson writes that 5 states made the act illegal (though the battery laws were already present to sanction it but they were not being employed). Now, wonder if women wanted to get the same laws passed in other states, what might they do? I suspect if this were the 60’s or 70’s, women would organize (probably with sympathetic men) and as an aggregate refuse to participate as teaching tools or visual aides for the benefit of students until hospitals changed their ways and legislators outlawed the practice. And if providers thought they could outmaneuver unconscious boycotters by just staying mum about their actions, they should be made aware of the fact that were they to conduct nonconsensual pelvic exams on women without their consent, it might lead to civil action at worst; doing so over the explicit objection of the patient could be prosecuted as a criminal act. -- Ray
A rather interesting 2002 study hospitalized healthy second-year medical students for around 24-30 hours so they could experience health care from a patient’s perspective. While the students commented positively about the care they received from nurses, they “were particularly upset about the distance and coldness they felt from the medical staff.” This contrast was seen as something that might lead to positive changes in the students’ interactions with patients moving forward.
it is interesting to note that:
Among key themes expressed by student participants were the following: they felt a profound loss of privacy; they found the nursing staff to be caring, attentive and professional, and repeatedly commented about how much time the nurses took to talk and listen to them and to take a complete history; in contrast they were particularly upset about the distance and coldness they felt from the medical staff; they expect this experience to affect their own future practice as physicians. When asked how this might change their attitudes in the future, students' comments generally reflected a primary concern with improving the human aspects of the patient experience.
I think this should be SOP for ALL med students. The experience should include catheterization by opposite gender and repeated genital exams by medical students...
-- Banterings
Banterings, I am not aware of such a program for our second year medical students and I certainly wouldn't approve of clinically unnecessary catheterization with its trauma or infection risks or clinically unnecessary genital examination performed by either gender on either gender, whether a medical student or a clinical patient. Short of that, it may be of education value experiencing the medical environment being presented to patients when hospitalized to have second year students within a hospital environment as a "bed patient" for an overnight stay.
I may have mentioned this before, but I know years ago first year residents from a Long Beach California hospital were required to all have such a "inpatient" experience.
..Maurice.
p.s.-
This kinda doesn't go with what is being discussed most recently but since nobody has said anything for awhile, here goes.
More of the medical world than not, are like the rest of us.
Sometimes they have to get up and go to work when they'd rather stay in bed. Often they have to see and be around coworkers they dislike. Otherwise there may be things going on outside of work that they need or desire to attend to but they go to work instead. Just like most of us most of their friendships are surface friendships, nothing more. They aren't gonna come to the patients defense when Twana Sparks and Larry Nascar's show up and do their thing. Why? It endangers what they have going on.
PJF here.
I decided the only way to put my awful experience to rest and move on is to send a letter to the doctor who ambushed me by bringing a young female observer to my urology exam. My original story appears at the end of Volume 95.
What happened to me cannot be undone, so my goal is to prevent the same from happening to other men by informing this doctor how his insensitive actions affected me. Who knows how many men got ambushed that week and perhaps more to come. I cringe thinking about this happening to other men so I owe it to them to try to get it stopped. In fact this bothers me about the same as my own grief over the incident. His thoughtless approach to male modesty needs to get called out. Hopefully some good will come from this.
It is a concise one page polite letter, describing how I was shocked when he entered the room with her and how I froze and was unable to ask her to leave. How he only vaguely described who she was and her purpose. I stated my biggest concern is that he did not ask for consent – and had he asked, I would have requested her to leave for the intimate part of the exam. I requested that in the future, for male and female patients alike, that he always ask for consent for opposite gender exams/procedures or for student observers. I concluded by requesting the name, title and purpose of the female at the exam as the vagueness still bothers me. I provided my address, email and phone for a response providing multiple ways to contact me. I sent the letter to him only, marked private. I would like to get it resolved between us and not have to take this to a higher level such as the hospital associated with his practice.
He should have received the letter a few days ago. It felt good writing and mailing the letter, but now I am nervous and anxious waiting for a reply. Will he be apologetic and lesson learned? Or “surprised” at my letter since I did not speak-up (hint to him – that’s why he needs to ask for consent)? Or question my story and claim he certainly ask me for consent (a CYA move)? Or the medical community needs to teach students and your not helping (actually had I asked her to leave then that would have been a valuable lesson on male modesty - that he is not teaching)? Or irritated, giving me a lecture on manning-up since nobody else complained about her observing? If it is a phone call, I have developed a series of responses least I get tongue tied or just nervously shut up (which got me into this mess in the first place). Ideas on how to reply to these types of comments would be helpful!
I will provide an update once he responds (assuming he does) and hopefully this will help close my issue.
PJF
Bureaucracies are usually amusing if you're not affected. Medical institutions are no exceptions.
Recently I spent six days in hospital. I'll skip moaning and groaning about the lack of integrity in the medical community and relate something I found amusing.
I broke my hip. The first two days in hospital the staff extolled the importance of a swipe [their word] bath twice a day [AM & PM]. During the first baths, two young female healthcare assistants discussed the importance of swipe baths [no attempt to expose my genitals, old male, wearing shorts]. The skit was obviously for my benefit since the words were so unnatural and poorly acted that it bordered on camp. You're right, why would they spend the effort? But I can still recall the big smile on my face during the performance.
After surgery, I spent four days two floors away from the pre-surgery floor. Never once during the four days were bath, swipe, wipe, shower, cleanliness, sanitation, germs, etc. mentioned. Water was mentioned as in drinking water. Unless it was too subtle for me, I don't think there was any intent for the 20 oz. of water in the water pitcher to be used for a bath.
Why would I expect consistency in different fiefdoms in the same bureaucracy?
BJTNT
Anyone else here on this blog get the impression that there are multiple personalities ( one poster using different names),WHY?
"One poster using different names" I suppose that argument is a possibility since anonymity is virtually universal here except for myself I have no way of knowing if that possibility is or has been occurring. If the value of this thread over the years has been to discuss various aspects of the "malpractice" carried out in the maintaining patient dignity or modesty, then I suppose it is possible that multiple views and approaches to change could be generated by a single contributor and still be of value to those who read this blog thread. However, to maintain a logical discussion, hopefully each pseudonym remains consistent with a statement or view or if changed that pseudonym individual expresses that change.. otherwise chaos in any discussion. But again, as long as no writer here clearly abandons anonymity, yes, it certainly is possible there might be "one poster using different names". I think it is worthy to bring up the possibility and discuss whether such behavior is harmful for what we hope will be "productive" discussions. Oh, by the way, you didn't identify yourself with your pseudonym. ..Maurice.
Anonymous
I have sometimes not signed my initials because my phone was trying to make me use my real name. That's something I REALLY don't want to do. Then verification pictures were making it very difficult to get on this blog at all.
I haven't used any other name than JF and I haven't noticed anybody else seeming like they were using different names or initials either. I can often guess who certain posters are before it gets to the initial part of the comment.
PJF. Maybe you should turn that piece of shit uroligist in to the state medical board. It would have been better to stab him a couple of times but that would have gotten YOU in trouble.
Hello Dr. B, it's been sometime since I've tapped into this forum, especially following my (2) life events (major surgeries) with modesty violations and recent cardio scare. I had just came across the following link, which I wasn't sure if you had ever seen before? I thought it relevant to share:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772755/
Thanks, H.
Maurice,
I must do this in 2 parts:
Part 1
What I referenced was a study where 2nd year students were "hospitalized" to see what their view (as a medical professional) was of the experience.
Your response to me regarding the peer PEs lacked hindsight. Indeed there was a time (that you should remember when this was SOP in a medical education. The osteopaths still practice this in many of their schools.
These practices that you call clinically unnecessary occur regularly in healthcare. Let me start with the continued practice of PEs on anesthetized women without explicit consent. Being that the practice is illegal in Cali (one of only 5 states), let me ask the following question of you Maurice, regarding the Keck school of medicine's program:
Does Keck's program explicitly teach it's students that any intimate exam under anesthesia to ant gender, WITHOUT EXPLICIT CONSENT is an assault, a battery, immoral, unethical, and a VIOLATION of HUMAN RIGHTS?
...or do they simply teach that in Cali and 4 other states you need explicit consent for PEs on women?
Even worse is what is done (especially at teaching hospitals) to children with DSD:
Disorders of Sex Development: Pediatric Psychology and the Genital Exam
The Intersex Society of North America
End Part 1
-- Banterings
Part 2:
The medical gaze and children with DSD
The medical gaze and children with DSD
This last article hits the nail on the head:
...A second resident objected. “This was supposed to be a teaching hospital, after all. If we want to have doctors who are trained to manage DSD in the future, we have to allow residents to learn about these cases.”
...Another suggested they could use existing photographs rather than exams for educational purposes. One questioned whether there was an element of voyeurism underlying the urge to find a justification for the exam. “Everyone wants to see an interesting case,” she said.
There is a lack of conscience, empathy, and/or care in healthcare about what is patient-centered, dignified treatment. Just look at the issue of gender concurrent care. What do patients get? Excuses or "this is the way we do things here..."
Finally, in relationship to DSD, this 2017 study notes that boys are more likely to have GEs from female physicians.
How often are clinicians performing genital exams in children with disorders of sex development?
So what has this issue done to me? I do not see healthcare providers as human, they are sociopathic, sexual predators. I am indifferent when I read the woes they cry on sites like KMD or when there are stories of burnout or suicide. I assume that their sociopathic behaviors have lead what conscience they have left to burnout or suicide and they are only getting what they deserve.
I support corporate medicine that espouses customer service and has turned physicians into WalMart employees. I direct thousands of patients to these facilities professionally when setting up provider networks for my clients. I find that there is a better grievance process for patients, employers, and insurers when the complaints are handled by a customer service department that is made up of people who are NOT medical providers but rather customer care specialists.
These organizations are quick to throw a seasoned professional "under the bus" for providing care that is truly NOT patient centered.
I await the day that the R. Lee Ermey types (that quietly and stoically man up) in senior positions of law enforcement are replaced by the touchy-feely, emotionally delicate The “Participation Trophy” generation AND the long overdue witch hunt in healthcare begins.
-- Banterings
As a follow up to my previous 2 part comment, when patients become fully protected by society, the same administrators who have come up with the policy to use patients as teaching props will find fresh meat in the medical student body. The medical educational industrial complex will eat this new resource up. This phenomenon is well documented in the nursing profession: NETY (nurses eat their young).
High school and college students will no longer shadow physicians, instead they will offer their bodies as teaching props to 1st and 2nd year med students as a symbol of their commitment to the admissions department of the medical school of their choice. 1st and 2nd year med students will be offered up to 3rd and 4th year med students, 3rd and 4th year med students will offered up to residents and become teaching props for patient education (the tables turned).
This will all come in the wake of IBM's Watson leading the diagnosis of disease and robots and nanobots performing arthroscopic surgery on patients who remain fully clothed.
A small trend will arise in medical students and be sensationalized, after having children or preserving their reproductive cells (sperm, eggs), they will voluntarily remove their breasts and genitals (under the guise of cancer prevention) essentially rendering Barbie and Ken dolls having nothing of clinical educational value. The scarring will be the excuse to avoid anal exams.
For the next 200 years, these future generations will pay for the sins committed against patients from the time of James Marion Sims.
Plastic surgeons will thrive and become the dominant surgical provider due to their commitment to the patient's comfort with the surgical experience.
This is the trend in healthcare my research points to.
-- Banterings
BJTNT, your recent hospital experience speaks to an issue I've noted in the past. There are not universal standards for much of what goes on in healthcare as concerns procedural protocols or what constitutes dignity and respect.
I have not been an inpatient since I was 11 years old but based on your report and that of others it does not seem there is any norm as concerns patient bathing or skin exams or general approach to patient modesty/dignity. I would love to hear from those who work in healthcare as to why this is the case.
Banterings
It's probably not the worst offenders committing suicide. Mean abusive people hardly ever do.
I remember once a patients wife took him out of our nursing home and they got hit by a train and died. The male CNA that was working there said " It was completely accidental because mean people don't kill themselves. Right now she is someplace madder than Hell because she can't bitch!"
I know you can't stab the urologist or punch his female assistant in her face ( as much as that needs to happen ) Maybe in that kind of circumstance when you're unable to talk to the doctor first to deter something like that from happening, just leave your undershorts on until you know and can request no anbush/female assistant.
JR said:
This has been a bad week for PTSD. I have been writing a lot. I have several new articles on my site Issues4Thought.com and several more started. All relate to dignity of care.
I don't know if someone is using 2 separate blog identifiers or not but what does it matter? If they have a story to tell or facts to present, then that should be all that matters.
The medical world I have dealt with is not like me. I would not purposely abuse or demean people in my care. To be clear, all take some sort of oath to protect, do no harm, preserve dignity and respect each patient. If they don't do so, they are being abusive in my estimation. No excuses. For me, doing the right thing may not be the easiest avenue but I have gladly walked that avenue alone because in the end, I am at peace with my actions. Medical people know about patient dignity but they do not consider it part of giving good care. That is the issue. How care is delivered certainly affects the overall outcome. For people who have had a heart attack and they are told by medical people to avoid stress then should they not also avoid doctors and medical care as they may be a major stressor especially to the patient who has suffered abuse?
As for not reporting abuse when they see it happening does not excuse others behavior. If a child is abused and you know it and do nothing, then you are charged as being party to the abuse. Why would it be acceptable to excuse their behavior especially since the patient is an innocent, vulnerable victim much like a child? I am sorry but I do not agree in excusing their behavior. It does not matter if the abuse happens because a patient is ambushed in a doctor's office or while they are drugged on a table.
Because of their behavior and the excuses the hospital has made, we now have PTSD. Neither of us either dreamed we would have something like this. PTSD was an extra illness foisted upon us by them because of their actions. Actions do have consequences so people who deal with others especially others who are vulnerable and dependent on their care, need to be mature enough to put aside their outside life and totally concentrate on the duties at hand. If not, then find another job. There is never any excuse to violate and abuse patients.
Our attempted apology by the doctor was, "He was sorry if we offended you." Sorry "if" we "offended" you. That apology in itself offended us. There was no if about it. We weren't offended. We were abused and violated by their very real actions that certainly occurred. Unnecessary exposure of the genital region is sexual abuse. Sorry doesn't fix it but actually admitting he and the cath lab had treated my husband in a manner unfit for anyone and he was rude, unprofessional, etc. would have been a good start to dialogue to fix things. Also, committing assault and battery by forcing a procedure on a man without consent doesn't make it just an iffy, offensive action. His apology rung hollow. I know that as far as they are concerned, nothing was learned and nothing will change. If the hospital had taken a different action, they we wouldn't been left with all the feelings we now have. All we wanted was to feel they were truly sorry for their actions by having them work on making sure that no one else has to endure what happened to us. It seemed pretty reasonable and simple. All of those in the medical community know about patient dignity and respect. It should not be the duty of the patient to make them do their job properly. It is like pulling a cop who is speeding because he can and telling him to slow down. The cop knows the rules because he is in charge of making sure the rules are followed. How well would that turn out for the private citizen? JR
Ray B
I’m waiting for you to divulge to us your vast experience in healthcare, particularly the surgical suite. Or, do you just ask nurses for their opinions, some of which don’t work in this country.
PT
Ray B
On volume 95 you posted
Negative emotions include but are not limited to : agitation,alarm,ambivalence, anger,anguish, anexity and etc etc...
In regards to the nurse stating that the Doctor will be in shortly and she will be assisting.
You know Ray, you just might be on to something. These are the very emotions I’ve experienced when I learned that most
registered nurses in this country cannot perform a proper blood pressure.
Can you elaborate to us what you have learned after your interrogation of nurses from another country and how did it
contribute to your current knowledge base of how medicine is carried out in this country.
PT
Banterings
Nobody is going to volunteer to have their breasts or genitals removed. If nursing and medical students want to volunteer to replace involuntary patients , at least it's being done VOLUNTARILY. That's the whole point. SOME PATIENTS volunteer. It's when it's forced on patients that wouldn't agree to it that is so extra wrong and traumatizing.
JR
When I said more medical staff is like us I deliberately didn't say MOST. More could be 51/49 but I don't know the ratio. Just like you I believe modesty violations are sexual abuse and often done for the same reason. I also believe it's an accusation that wouldn't likely hold up. SOME of the modesty violations are unintentional because somebody is too accustomed to nudity and is working too many hours and maybe in a rush to get things done.
Medical staff working too many hours or being made to come.into work sick is a bad problem. It's not just because of dignity violations either.
I know when I'm tired , attention to details suffer. Surgeons often work long hours. Does their job performance suffer for it? My guess would be yes!
Think about this. A physician wrote in the current issue of the New England Journal of Medicine N Engl J Med 2019; 380:1197-1199 about the way the medical system is currently run..there is not enough time available for a physician to THINK.
In the pressurized world of contemporary outpatient medicine, there is simply no time to think. With every patient, we race to cover the bare minimum, sprinting in subsistence-level intellectual mode because that’s all that’s sustainable. We harbor a fear of anything “atypical” popping up. I dread symptoms that don’t add up, test results that are contradictory, patients who bring in a bagful of herbal supplements with instructions to “ask your doctor.” If I can’t spring to a conclusion in a minute flat, I’ll never keep up. God help me if the medical history includes Sturge–Weber syndrome or anything with ANCA.
If it requires thinking, I’m sunk.
This is an embarrassing admission for a field that prides itself on intellectual rigor. But with the frenetic pace of medicine today, there’s no time or space (or reimbursement) for cogitation. We end up over-ordering tests because it feels more workable in the moment. We over-refer to specialists because we don’t have the mental bandwidth to integrate confounding data. Beyond the financial waste, modern medical practice is a petri dish for medical error, patient harm, and physician burnout. There’s no surer way of grinding down committed clinicians than forcing them to practice the cookbook medicine we’ve always derided.
Remember, if there isn't time to think, there isn't time to behave the way you would like your physician to respond to you, the patient. This surely applies to nursing staff too since I am sure they work under "time spent with one patient" pressure.
I am not saying that I am ignoring the gross misbehavior published about doctors and nurses but unless you are in an active medical/surgical practice, you really don't know the pressure of current medical system expectations upon them. And I hope we all take this reality into consideration in formulating a working response. ..Maurice.
Much of the problem is definitional. I am not picking on you JF but rather am just using you as an example given you have worked as a CNA I believe. You are very aware of modesty/dignity issues and no doubt do your best to minimize patient exposure and treat both men and women with total respect. That said it is fully possible a patient might think his modesty/dignity wasn't respected by you simply because you as a woman were the one to bath him for example. That wouldn't mean you did anything wrong but rather you did the job you were assigned in the most respectful manner you could. That it didn't met his definition isn't a reflection on you but rather on the system that doesn't offer male CNA's for male patients who would prefer a male for intimate matters.
Our problem as patients is that whereas our version of what constitutes respecting a patient's modesty/dignity is likely going to be aligned with JF's, other healthcare workers may also be thinking they are respecting patient modesty/dignity when they are not even close to doing it the way JF does it. The problem is healthcare has little to nothing in the manner of specific standards when it comes to patient modesty/dignity. Healthcare workers have great leeway in interpreting what "respect patient dignity" means. For the most part it seems to be interpreted simply as "be polite".
JR said:
Still there is no excuse. I agree they are working long hours and that needs to be addressed as with them being in total control of whether a patient lives or dies, is maimed or not is too important. They also know what the standards are for patient dignity. They need to adhere to no matter what. We all know pressure from our field of work. There is never enough time for most to get things done. In IT, if you don't get things done in the time span a customer wants it, they find a new IT person. Violating or sexual abuse because you don't feel you have the extra seconds to make sure you are doing what is ethically and guaranteed in the Patient Bill Rights is totally unacceptable. How a patient views how they have been treated will affect their overall physical state of health. In my husband's case, there were 4 nurses in the cath. lab. I don't believe for a second that none of them did not have a second to cover him up. Not only did they violate his guaranteed right of personal dignity as stated in their hospital's Patient Bill of Rights but they compromised his health by allowing him to become cold to the point of severe trembling/shaking. They are very aware that a cath lab is kept cold but they were dressed so they just didn't care. He was an old man (in his 60's) that kept them at the hospital on a Saturday night and was gay to boot or so they thought. He also at his age was not yet on the medical go-around. It was as if they were trying to punish him for being naughty. If you saw his medical records and what they said, then you would agree. Medical people are responsible for their patients period. They are assigned to the care. They agree to this by cashing a paycheck. If they are not able to handle all aspects of the job then get another one. I am sure you are right that some of the violations may be unintentional but it really doesn't matter if you are the one getting exposed. It still damages. I don't believe in our case it was unintentional. I realize that not all medical people are bad but at this point after being so used and abuse, we longer trust our judgment so they all are bad. It is a result of the abuse. I apologize JF and Dr. B. if I came on strong. I am in no way trying to devalue your opinion(s). JR
Not enough time to think probably equates to not enough time to do a quality job. One root cause is medical school is too expensive and not enough people are becoming doctors. WHY does medical school cost so much? I know whoever is teaching needs to be paid but is it maybe possible that they're being paid too much?
JR said:
Biker brought up a good point that some may be offended by a bath given by the opposite sex even if the bath was done properly. I would say many people do not know they can request same gender care or can say no. If you say no and they still do it, then it becomes more than just suffering discomfort. My husband knew to say no, however; they know how to get around that and that is by drugging what they term as an "emergent" patient although he had time and had family available. Because he knew what was happening and they had rendered him defenseless by their secretive actions, he remembers suffering the humiliation and shame. It was no an accident or because they did not have time. This was a cold, calculated action by both the cath lab and the ccu nurses. It was done to him by the nurse who was in direct contact with the cath lab nurses. All involved knew how drugged he was and that he was thought of as being gay. As for not having time, they in fact, wasted time due to their mistakes. They were counting on the amount of versed and fentanyl that he would not have any memories.
He has had prostate ultrasounds done by female techs to which he agreed to and they did what they needed to preserve his dignity. There is a difference. Yes, he would have felt better with a male tech but the female respected his dignity. Sometimes you have to have intimate exams and it is not for most, a fun time but you deal with it. He no longer feels like any of them are professional because of what happened. I have had male doctors that made me uncomfortable and I have ended the exam and association. I have had male doctors that have been respectful.
I think that probably with JF, her patients recognize she is respectful and although it may be uncomfortable, they deal with it. I imagine she explains and asks for permission. Permission is a big factor. Knowing ahead of time and not being ambushed is another. Lastly, if you don't want different gender care, then your wish should be respected without any issue. There are garments that can be used to protect your dignity while being bathed. If only facilities care more about their clients than about their profits. However, what they don't value or respect is patient input or autonomy. The care thing also goes back to it being "acceptable" that female healthcare workers can bathe males but it is not acceptable if publicly known, for a male healthcare worker to bathe a female unless it is done without anyone but the medical facility knowing.
As you med. school being expensive, yes it is but they also make a lot of money. I have spent time looking through different hospital's doctors and have found a lot of them being of foreign background with their education from a foreign country. The doctor who started this quack diagnosis of my husband being diabetic, high cholesterol, and high blood pressure graduated from a foreign school of dentistry and medicine (notice dentistry came first). In the real world, he has had none of those ailments ever. However, they wanted him to have it. It looked better for their bad decisions. The doctor in the cath lab whom is actually responsible for the lack of consent and treated me in such a sexist manner is also educated from a foreign school. His home country's culture is not pro-American. This was not something that I had ever came face to face with before but with this experience I do believe there is a difference. Maybe with these doctors being so sexist the nurses take out their abuses on male patients but still it does not give them the right to be abusive. JR
JR
I don't take it that you're being hard on me but I think you misunderstood that I was defending modesty violations. I wasn't defending. I was criticizing ( although not necessarily the medical staff ) I think working long hours in surgery is a HUGE mistake and shouldn't happen. Surgeons need to be well rested and eat in a timely manner and take care of their outside of work life to.
SOMEBODY decides how much the cost of their schooling should be! How many years they have to study and WHAT ALL they have to learn. Is some of the information unnecessary and unused? Is it an obstacle to limit how many people get to be doctors?
Is physician fatigue a common cause of unnecessary patient injury? I have constantly said I think most intimate care/exams shouldn't be happening at all. No physician should be so used to nudity that he/she absent mindedly leaves open doors. No nurse should be either ( or any other staff )
Maurice
That’s the most lame excuse I’ve ever heard, to busy to think. The pace is so frenetic there is no time for cognition. I disagree because
I know better and I could write thousands and thousands of examples as to why. So, let me name a few, arrogance, greed,disassociation,
lack of advocation, sexual perversion etc.
The Denver 5 sure had plenty of time to leer at the deceased man in a body bag, plenty of time for laughter with Dr Sparks and her crew
as well as the large crowd gathered in the operating room to view a surgical case. I’ve forgot more derogatory comment made by medical
staff towards patients than all the posts on this blog made in the last 10 years and Maurice, that is no exaggeration.
Wouldn’t it be nice, a breath of fresh air if everyone came clean about this issue and worked toward a resolution. It’s NOT our responsibility nor will it ever be to find a solution to this problem. It’s an ethical issue on a grand scale funded annually with $4 Trillion
Fuc&ing dollars of patients money and this is how people are treated when seeking healthcare, the lowest point in a persons life, when
they are ill.
It’s pointless to get anyone’s attention on this matter in healthcare for it ranks equally well right along with all the other problems that
exist in the healthcare industry. Laziness, greed, fraud, perversion, assault, sexual assault, diversion, boundary diversions, medical
malpractice, arrogance, Medicare fraud, Stark law violations, overbooking, lack of transparency.
PT
PT, if I thought that all my 30 plus years of first and second year medical school student teaching really was ending up with "arrogance, greed,disassociation,
lack of advocation, sexual perversion etc." sooner or later as a universal part of virtually every student's future "behavior in the profession", I would say I wasted the time I spent. But, I don't believe I wasted my time because I believe the vast majority of physicians are trying to "do good" for the patient and not trying to use patients to "get rich" or "get sexually stimulated". Yes, there are some physicians are using their "profession" for their own self-interest or worse and examples are "press worthy" disclosures but I am writing about "some" and not "all". And "some" I think and from my years of observation and as a patient myself (no VIP treatment either), that "some" is a very, very small percentage of physicians.
I have continued this thread all these 13 or so years because, after reading what has been written here by those who have experienced the patient-doctor relationship again and again, I feel that even if the writers are represented as "statistical outliers" the impact of their observations and experiences on themselves and potentially on others is worthy of dissemination and discussion with the goal to lower this statistic even further. And I think that "speaking up" both to me and the medical profession and government is the correct beginning approach.
I also wish there was a way to anticipate in the first two years of medical education which students will be prone to misbehave when they move out of medical school and that there was an easy legal way to get them out of the profession. Any suggestions? ..Maurice.
Maurice: The hypothesis that can be derived from your post is, the busier a facility, the greater the likelihood that events of the sort discussed on this blog will take place. I’m from Missouri, you’ll have to show me. Indeed, one can make a reasoned argument that the reverse is true.
The only data on the issue with which I am familiar are anecdotal and they are described as occurring in both high and low pressure healthcare environments. An anecdote is poor evidence of a general pattern. But an aggregate of anecdotes (which social research often entails) in which patterns can be found can be good evidence. Were we to take all the anecdotes shared by contributors to this blog, what percent of them occurred in frenetic, high pressure healthcare environments and what percent in low-pressure environments? We could analyze the data, but what a job it would be.
My only experience as a patient or as a patient advocate is in low-pressure environments; I have seen and experienced more than my share of violations of social mores some of which undercut patients’ dignity. All of these violations occurred in low-pressure environments. For example, a blood clot developed in my leg that forced me into an ER on a Sunday morning. The ER was sizable and had two rows of cubicles each with a curtain. When I was shown into the ER, I was the only patient; all of the cubicles were open.
After waiting for a physician for about ½ hour, a young lady, her friend (I later found out) and a physician walked into the room and took a cubicle across from me and one cubicle up. By the time the physician was done getting the patient’s personal history, I knew her name and her friend’s name, I knew where she lived, I knew she was a junior in a local high school, I knew she was sexually active, I knew the name of her boyfriend (a senior at the same school), I knew she had unprotected sex with him the weekend before, I knew she had been sexually active for more than a year, and I knew that she had never used contraceptives. Four other intrusions occurred during the 5 days I was there for observation and none were during busy times. Indeed, one occurred in the dead of night; it was as still as a morgue.
I should say that, except in the case of one nurse, the nursing care there was so good, I sent a letter of commendation to the CEO along with flowers and candy to the nurse’s station. I also wrote a letter outlining the improprieties that occurred while I was there. I received no reply to my first letter and show of appreciation but did receive a phone call in response to the second letter. Regarding the breach of confidentiality, the administrator asked, “What do you expect me to do, change the architecture.” I told him that I didn’t think such an extreme measure would have to be employed. The physician could have moved three cubicles up from where he met with the ladies. And, in the future, he could install “white noise” technology in the ER.
If you can find a report on a study that has been done on the relationship between low/high pressure healthcare environments and actions of the sort that have been described in this blog, please reference it for me, Maurice. I've given up looking for it. – Ray
After over 10 years of posting on this blog I’m happy to announce two very distinctive awards that I’d like to give. I’ve put quite a bit of thought into this for this joyous occasion. I want to give the Lamest excuse award to the physician who posted in the New England journal of medicine that he just dosen’t have time to think. I wish him well in his endeavors.
The second award I want to hand out is well, it is the award of all awards and this award goes to our illustrious poster who takes advice from nurses who don’t even work in our country and believes female college students who state that she saw a room full of nude men being prepped for surgery. My only advice, cut back on the Ambien and of course stay within the recommended prescription guidelines of your prescribing physician.
PT
PT, while I truly appreciate your years of writing to this blog and not only to this thread and I mean it!!!...nevertheless watch out for strictly ad hominem discourse. ..Maurice.
PT
Why do you want to put that doctor in the wrong? He admitted a problem most would just cover up!
At some of my nursing home jobs it was OFTEN unsafe to report to the nurse being unable to complete our assignments. Our options was report it to the nurse and being shouted at or written up or just go ahead and falsely document that the care was done.
Also some days back I talked about a scribe acting as an assistant/chaperone and you insisted it couldn't be true. It was true though. I requested to be told her name and job title and the name and title of the person who did the exam ( plus my diagnosis ) I pulled her up on Facebook and it was her. No nurse was present. That was one of your arguments. You said she wouldn't know a proper exam but she was in her 40's so she definitely would. If you have to have proof before you'll believe , Google "Are scribes ever used as chaperones?"
JR said:
I would have to agree. It doesn't matter how busy because violations do happen. As I mentioned, my husband's cubicle was open the entire time and the curtain never drawn. The ER was not overly busy. No one was in a rush as evidenced by them allowing him to just sit and wait over an hour for the most expensive mode of transport when a ground ambulance from the county EMS on the corner w/ the hospital was available and could have gotten him and I there together in less than 30 minutes. Everyone in that ER knew his business and in fact, commented to me about his condition at one point or another. There was absolutely no privacy or any effort to provide it. The staff never moved in what appeared to be a rush. So much for time is muscle unless counting time is muscle provides them with the excuse of what they want to do.
At the other hospital, the chaplain and the cath lab repeatedly gave his name and information in a public hallway so strangers could hear but away from us. I take their philosophy as better strangers know than family. They, too, never drew the curtain even though his room was directly in front of double doors leading to the waiting room. It wasn't their first rodeo--they knew what and how to act but just didn't care. He was her only patient that was why she was able to constantly abuse him.
I have learned patient names, their illnesses, their test, and other personal information from just sitting in doctor's offices. I have been sitting in the waiting room and have seen patients in rooms in various states of activities. It seems to me there is no real attempt to provide patient privacy of the body or of information.
Until recently, we provided HIPAA compliance assessments for medical providers. We have cut that from our business as it is just too stressful to deal with these monsters. However, it was like pulling all the teeth of a monster to make them realize that by law they are required to be compliant and show proof they are. It went beyond impossible that if we found issues, to get them to remediate those issues. They simply didn't care and would rather take their chances that issues would never materialize. I think this attitude covers all the other areas they deal with in patient care. They don't care because they know even if they get caught, getting something done is next to impossible. If a patient becomes disgruntled or overly abused, there is always another to take their place. This is especially true in the way doctors now work for doctor corporations to put in simply. The hospital makes sure they have an ample supply of victims. There is no accountability.
Of course, for us mere mortals, they are very condemning if we don't visit them for at least yearly checkups. They are downright awful if you don't follow their rules of care. It seems they think only their opinion matters because they are professionals. No one else doing their job are entitled to that right. JR
JR said:
JF,
I agree about the long hours. There is no way anyone in the medical field should be working such long hours. I think the long hours take their toll upon them. My son's college costs were ridiculous. His studies were also state dictated. He had to take many courses that were unnecessary. He went to work for a poor school corporation so he will have student debt for many years to come. However, like doctors, he chose his profession and knew it would be costly. In the long run, he will never get wealthy by being a teacher. That, too, was his choice. I think the whole educational process for everyone needs to be seriously re-evaluated.
From my days spending time with kids, when I would have them talk and then write about what they want to be when they grew up, I found some of their answers to be enlightening.
This Dr. B., could shed some light on who should be in the medical field or not. Some had parents whom were medical providers. Even as 3rd-5th graders (I dealt with both over achieving and under achieving students), they were aware of the perks. Some wanted to be like their parents because of their jobs they had nice houses, cars, and vacations. Some liked telling people what to do. (I was shocked!) Others whose parents weren't in the field also knew about making lots of money. It seemed the kids whose parents were poor and they simply didn't have the grades to become a doctor or nurse were the ones who wanted to become one to help people. Some of the kids who had been sick a lot also wanted to become a doctor/nurse to help people. Those kids always made me a little sad because I knew the kids who truly had the caring feeling would never become that doctor or nurse. I always inwardly cringed of the others said they wanted to become a doctor or nurse because at that time, being privy to how they acted and reacted, I knew they would not be a caring medical provider. I imagine if you go back into the childhood of some these offenders, you would find why they should not be a doctor or nurse. JR
JR said:
I still argue that the privacy violations primarily happen because they don't care and know they can get away with it. Bodily privacy violations don't seem to happen to female patients as often as males. So that tells me there is a thought process being used. There is also a shortage of male nurses/techs. I do think it is ingrained into medical students to take charge of the situation so therefore that makes them more likely to deny individuals their basic rights such as choice and privacy. Us mere mortals have been taught that medical people are above us and we must submit and accept their directives.
For our cases, I have done some social media investigating. The nurses who were involved in his care, their social media sites say a lot about them. We as educators were cautioned about our sites and that we would be subject to scrutiny but I think medical people know they are protected so therefore they are invincible. I know the very abusive nurse that her site was very graphic with comments and her love of drinking. She has since taken down a lot of it but too bad for her that we had already screen hunted it and included it in our nursing board complaint.
Since there are not enough males in the nursing/tech fields, male patients usually can count on having their personal privacy violated during a hospital encounter. However, how this encounter is conducted by the female nurse(s)/tech(s) is what determines how badly it is viewed by the patient. Permission should always be asked and if permission is not given, then they must find an alternative. Intimate care should be given in a manner as to not humiliate, violate, or abuse. When prepping for procedures, the genital region should be kept covered. If access to the genital region is needed such as a foley catheter, permission and how it is to be done should be discussed with the patient. In any case, providing the most privacy to the patient should be at the top of the list.
In heart cath cases, they is no reason the genital area needs to be exposed if a foley is not involved. The Covr should be standard issue. A blue towel should be place before the gown is lifted and removed. The blue towel should not be removed until the gown is back in place and covering. These types of care administrations go a long way in the overall health of a patient. The trauma of not suffering what amounts to sexual abuse makes recovery so much better. In other types of procedures, the same attention to privacy can also be maintained if they only cared and weren't on a power and control trip.
Found an article on Outpatient Surgery entitled Cell Phones in the OR about surgeons using their personal cell phones to takes patient pictures during procedures. WOW! Those people are really clueless and have no boundaries.
I know for a fact that nurses document care they do not give. We have page after page of lies of care that was not given. It is also a fact that screw ups are not documented. The sexually abusive nurse failed to hook up his equipment in a timely manner and required the help of about 6 o7 others including other nurses and techs. None of this documented. Doctors who ask about side effects but choose not to write them down because of some sort of unethical motive. There is care that should have been documented but is not like 2 IV insertions but then abusive nurse verified she had been present at another hospital 35 minutes away when the other hospital inserted 2 of the 4 IVs he had in his arms the entire time. The other 2 were never accounted for. Medicines given that were not listed even though there is a place to list but they choose to say none. It would seem medical records are works of fiction and it is just page after page of self preservation materials and not actually documentation of patient care. The automated systems make this kind of lying easier as they only have to pick and choose.JR
JF
If you want to document care that was not done, then that’s on you. Furthermore, her age has nothing to do with her competency and finally scribes are not allowed to act independently, they are considered an unlicensed medical worker. For any physician, nurse or licensed medical employee who says “ I’m so busy I’ve no time to think. “
Appreciate that this physician was speaking from the perspective of an outpatient environment. Think about waiting an hour and 45 minutes past your scheduled appointment time. Most physician offices are closed anywhere from an hour to two hours every day for lunch and is it the patient’s fault if they overbook? Why do patient’s that have an appointment at their physicians office have to wait anywhere from 30 minutes to two hours after their scheduled appointment time?
Quite frankly I would not want to see what this physician says if he had to work in a level 1 trauma center, outside of the confines of his cushy office. There is at least in this country $4 Trillion dollars spent annually that they can afford to hire a scribe, medical assistants,an office manager, receptionists etc. The complaining never ends.
PT
Maurice,
Here are people decide to become doctors.
Some doctors do it for the money.
-- Banterings
Banterings, I fully agree that the vast majority of physicians, from the 3rd year of medical school to residency are indeed "scutmonkeys" and while they expect the "scut" to terminate when they graduate into the professional life beyond, they find in many ways the "scut" has not or never will end. The overriding pressures from an attending physician may be gone but the daily "dirty work" of day in and day out "doctorhood" is now "scutted" with the daily, taxing requirements of HMOs and other insurance programs and government and others in control of the medical system and its duties and responsibilities. I think that this destruction of the illusion of what being a doctor and what one can accomplish in medical practice contributes to the way physicians behave toward their patients and which leads to disillusion and final "burnout" of the doctor. Maybe nurses too end up as "just another job" rather than "another job" or "scutmonkeys" and, in reaction, turning to their own misbehavior to patients which has been amply described on these threads. Thanks. Banterings, for links to those two articles. ..Maurice.
Latest news:
San Diego: Cameras secretly recorded women in Sharp Grossmont Hospital delivery rooms.
Maybe this will spur change finally....
-- Banterings
Banterings, all I can say is that such hospital administrative and police behavior is ethically "sickening". There cannot be and should not be any excuses. ..Maurice.
PJF: On March 30 you wrote, “I decided the only way to put my awful experience to rest and move on is to send a letter to the doctor who ambushed me by bringing a young female observer to my urology exam.”
You do have another option. 1) If the physician did indeed give you the impression that the young woman who accompanied him was going to act as a scribe, 2) if a reasonable person would have gotten this impression, and 3) if she did not behave in a way that a reasonable person would think a scribe should behave, then what she and the doctor did might be construed as tortious and, as such, subject to civil litigation. Or, you might also prevail given #1 and #2 plus you were ignorant of a scribe’s role and found out only later that she did not conform to that role.
On-point case law goes back to 1881 in the Supreme Court of Michigan case of John H. De May and Alfred B. Scattergood v. Alvira Roberts. (https://faculty.uml.edu/sgallagher/DeMay.htm). “A physician took an unprofessional friend with him to attend a case of confinement when there was no emergency requiring the latter’s presence. The physician told the patient’s husband that he had brought a friend with him to help him carry his things, and he was accordingly admitted. The patient, on afterwards discovering the facts, sued both in damages.” The three (I think it was three) judge panel unanimously agreed “that the plaintiff and her husband had a right to presume that the outsider was a medical associate; that in obtaining admission without disclosing his true character, the defendants were guilty of deceit.”
De May and Scattergood defended their action with, “the night was a dark and stormy one, the roads over which they had to travel in getting to the house of the plaintiff were so bad that a horse could not be ridden or driven over them; that the doctor was sick and very much fatigued from overwork, and therefore asked the defendant Scattergood to accompany and assist him in carrying a lantern, umbrella and certain articles deemed necessary upon such occasions, that upon arriving at the house of [Roberts] the doctor knocked, and when the door was opened by the husband . . . De May said to him, ‘that I had fetched a friend along to help carry my things;’ he, [the]husband, said ‘all right’ and seemed to be perfectly satisfied. They were bidden to enter, treated kindly and no objection whatever made to the presence of . . . Scattergood. That while there Scattergood, at Dr. De May’s request, took hold of plaintiff’s hand and held her during a paroxysm of pain, and that both of the defendants in all respects throughout acted in a proper and becoming manner actuated by a sense of duty and kindness.” – Ray
End Part 1
Beginning of Part 3
In Inderbitzen et al. v. Lane Hospital (1932), Julia L. Inderbitzen and her husband accused providers at Lane Hospital in California of “tortious conduct in their treatment of the appellant wife” during the period of her labor and delivery. The plaintiffs claimed, and there was apparently no dispute about the facts of the case, that Mrs. Inderbitzen was shown into a room where she was undressed and examined by a young man whom she took to be a medical student, and, upon her demanding a doctor, the young man left the room and returned with an older man, who subjected her to a rectal and vaginal examination . . . ; that she was then subjected to a similar examination by the young man . . .; that she was taken to the delivery room, where she was examined intimately two or three times each by ten or twelve young men whom she took to be students; that there she was rolled over and prodded and poked about her body several times; that she was put on the delivery table and forcibly given gas . . . There was also evidence that, when she protested against the treatment above related, she was laughed at and told to shut up and otherwise treated with discourtesy.”
The Supreme Court of California decided against the Inderbitzens. Implicit in the decision was the belief that the plaintiffs could have won. Although they referenced the De May case, they did not claim, as did Mrs. Roberts, that Mrs. Inderbitzen experienced “shame and mortification” because of the way she was treated. Implicit in the Court’s decision was that had Inderbitzen but added that she experienced “shame and mortification” at her treatment, she may have prevailed. – Ray
There may be other cases that cite De May and Inderbitzen that are on-point and provide the foundation for a civil suit against the physician and “scribe” who were responsible for your “shame and mortification.”
An alternative to dropping the matter is to seek redress in a court of law. The first thing to do is secure information about other cases (if any) that are on-point. If these cases show a pattern of reasoning by judges favorable to your situation, you can take the next step. For $35 (more or less) you can call an attorney referral line and tell the person who answers what the basis is for your desired suit. Get a referral out of the area. (Physicians and attorneys often belong to the same civic clubs --in my experience Rotary – and the latter do not always reveal their conflicts of interest when agreeing to do business with a client.) If the referral cannot or will not take your case, you can phone the referral agency back and get another referral. In the past, you could continue doing this until you find someone. I don’t know if you will receive reimbursement if nobody can be found. If you do find an attorney, you might discover that s/he is open to receiving information about cases from you. If they feel threatened by your knowledge, run the other way. If you find that your efforts are for naught, small claims court is an option. – Just a thought, for what it’s worth. – Ray
End of Part 3
Beginning of Part 4
The rub is that evidence that your version of what happened is true is necessary because the physician and “scribe” are probably going to have a different version of what happened. You’ll also need evidence that you experienced “shame and mortification.” Receiving counseling because of your experience can be taken as shaky evidence of both. You wrote that after years of reading this blog, it was your experience that provided the impetus to finally participate. That’s evidence. Your letters of appeal to the physician and his response or refusal to respond can be used as evidence. Evidence from this blog suggesting that what happened to you is institutionalized across healthcare organizations or, if you will, the norm can be introduced and so on ad infinitum. Research suggests that arguing a case before a judge is better for the plaintiff than going before a jury. It’s a judge who decides the fates of plaintiffs in small claims courts. (Some small claims courts, however, will not hear cases that have no economic damages. Some will.) Juries tend to be wowed by high status individuals; judges are more likely than juries to see through the pomposity of high-status individuals who try to defend the indefensible. – Just another thought, for what it’s worth.
Two cases have been published in the media of patients using audio surveillance technology to surreptitiously tape interactions with healthcare providers. One, as I noted in a past post, was awarded ½ million dollars (probably reduced on appeal) as a consequence of his experience. The legislators in some states have outlawed this practice to protect people of power and authority like themselves. Most states, I believe, do not outlaw unauthorized audio surveillance as long as one person in an exchange of two or more people approves of it. That would, of course, include the one who conducts the surveillance. You can purchase audio surveillance technology at “Spy Guy” Spy Guy
Audio Surveillance https://www.spyguy.com/collections/audio-surveillance
– Just a hint, for what it’s worth. – Ray
Dr. Bernstein, one wonders what could they possibly have been thinking, both the hospital staff and the legal authorities. This is going to cost the hospital big time in dollars and reputation. That the hospital didn't even have an airtight control system for the storage and handling of the videos speaks to the whole operation being amateurish. No doubt the films were reviewed by low level administrative and security staff who are not otherwise entitled to be viewing patients intimately.
What this tells us is that patient privacy/dignity is barely on the radar for those who run this hospital. This would never have occurred in the way it did otherwise. I have no idea how L&D rooms are physically set up or function but how could it not have occurred to them to make sure the video didn't capture naked patients?
If they thought this was an acceptable solution in L&D, have they done it in other OR's or maybe the ER? Hopefully there are hospitals out there reviewing their filming and drug diversion investigative protocols as a result of this.
In a nutshell I find it horrifying that the hospital thought this was OK to do to these women, forever scarring what should have been a joyous event.
Good morning All:
Banterings, in regard to the women being secretly being filmed I doubt anything with change as the hospital has pulled out another card from their deck.
"The hospital indicated patients consented to the video recordings through a generic patient admissions agreement since the issue involved patient safety".
Should make for a good fight at least.
Update on the letter I've sent out, not a one of the major newspapers has had the guts to publish it or my shortened version as of today.
I'll keep trying though.
Regards,
NTT
If you read the article you would see that the police were not involved in the recordings. But wait, this is nothing new. Many hospitals
secretly record all trauma patients without their knowledge.
PT
JR said:
I don't think things will change. With the rise of smart phones and apps, the taking of inappropriate photos and videos will grow. Technology advances makes abuse easier and more likely to happen. The articles I mentioned yesterday clearly illustrates that surgeons think they have the "right" to do whatever they want. Even if the OR team may not agree, they will most likely not speak up due to fear of ridicule or losing their job. Patient privacy & protection is not a main concern. Doctors feel entitled to do want they want because of their long years of education (by their choice) and ultimate status of the food chain of the hospital. Patients, of course, are the ones that can be ate by all hospital staff because that food source is never ending.
The way medical records are now done electronically also adds a layer of protection. Since everything is automated, the chance of gleaming info about the procedure in someone's own words thus giving clues of what happened, is gone. This was done as an added protection bonus to the medical staff.
Not to mention, the medical community have the "justice" system on their side. It offers them protection. Trying to prove medical assault and battery is not very possible. They know it. That is why that do it because they know they don't have to care and can also get away with it. If they knew their were concrete consequences for their actions, then things would change. Although most hospitals have Patient Bill of Rights, they in essence mean nothing. Hospitals will defend abuse and violations committed by their staff. The Patient Bill of Rights is merely a fiction novel to read and should be considered a fluff piece of reading. The patient may care but sadly no one else does. Being told they respect your rights when in reality it is just a bunch of lies makes the abuse that much harder to accept and get past.
Both my husband and I have reached the conclusion that neither of us will ever have hospital intervention again in the form of ER or a voluntary procedure. This means we will die younger than we might have but what has happened has made this decision. At least, we can make this decision because once you enter their doors all rights such your ability to make decisions about your life are stolen from you as well as personal dignity.
A few days ago, a friend of our son, her father died. This man of 68 yrs.evidently knew he was experiencing heart issues but said nothing. He, in that time before his death, finished up projects and put his affairs in order like going through his wallet and papers the night he actually died. This type of death preparation is what the medical community and their ability to inflict collateral harm has resulted in doing. I hope they can live with the results. Stories like this should make the medical community so proud of their success of do any type of collateral harm in when providing "treatment". Here's to what comes around, goes around. JR
JR:
"Both my husband and I have reached the conclusion that neither of us will ever have hospital intervention again in the form of ER or a voluntary procedure. This means we will die younger than we might have . . ."
Take heart; it might mean that, and this is a recurring claim by contributors here, but I'm skeptical. Where is the proof that those with a history of trailing in for medical appointments are living longer/better? (Sure there could be a simultaneity issue but a good study could filter that out.) It seems to me that just about everyone now knows someone that was killed by their doctor.
The article linked by Banterings indicates that hospitals have a big problem in that many workers (doctors; other staff) are thieves. I'm skeptical that thieves will ever treat anyone with dignity or be good at dispensing procedures. Of course, doctors don't have time to think (unless employed as the USC Med School Dean); fortunately, no other profession is in that position :>) . BTW, where will the MD in the article sell the stolen propofol? Is it sent to another country? I wouldn't think it would have in street value in the US.
REL
I have a question regarding a comparison of moral and ethical similarity between the medical contrasting with the legal profession which really hasn't been discussed here, as yet.
In terms of professional behavior and its effect on the dignity (all components) of the "subjects" of the professional relationship, what do you see as major differences and do see significant similarities?
Are any violations of a "client"/"patient" relationships in the either of the professions similar? Are they or can they become of equal degree of damaging effect on one's personhood or life (such as PTSD attached to the medical profession consequence or in the case of law penalties such as monetary or imprisonment)?
Oh.. and what about the providers of religion to the public including the children or youths? How about in terms of those who provide not medical, not legal but religious service to the public.. it seems from the news over the years that there is damaging consequences to the intrinsic dignity of those "subjects" of the profession of religion.
Is there something intrinsically unique about the medical profession which overrides any misbehaviors disclosed in the legal or religious professions? Does anyone know of published comparisons of my question? ..Maurice.
JR said:
From a completely layperson's perspective, I can tell you about experience. I know my answers are simple but it is from real life experience.
Part of my husband's PTSD & mine is due to the chaplain's invasion of privacy. For me, it was that he wouldn't go away even though I asked him twice and told him once. He refused. He was privy to info he had no right to have. His mere presence was invasive and both my son and I felt stifled by his presence as well as viewing him as a warden. He also ignored all federal, state, and even more to the point--patient trust when he broadcasted my husband's name and information in a public hallway on a speakerphone not once but 3 times. He filled me with rage, helplessness, and fear. For my husband, not only did the chaplain invade his private health information but the chaplain also invaded his bodily privacy. The hospital allowed that man to be present when my husband's genitals were completely exposed for the extended period of time. My husband did not want a chaplain and had no need of a chaplain as he was drugged out of his mind and couldn't function even to ask who that man lurking in the shadows was, why he there, and to leave which no doubt, he would not have. He felt violated like he was a prisoner of war, stripped, and put on display for the victors to torment & torture. This catholic hospital had no regard for my husband's privacy. Mary, Queen of Scots, told Henry Darnley--her husband who had just stabbed her secretary, David Rizzio, in her presence that, "She could forgive him but never forget." We can do neither. For us, the wounds are too deep and too many. For us, the crimes they committed were done and sanctioned in the name of religion. It is frightening that an institution that advertises that it is compassionate, gives shelter to those in need, and heals is in fact an institution of torture and abuse.
As for clergy, in general, it is easy to understand how they might inflict PTSD. Catholic priest have been protected by the Catholic church even to this day, for the molestion of especially young boys. Maybe they continue this pattern into their hospital system for the sexual abuse of adult males? Could very well be the answer. Why else would they have purposely done one or two or three things to my husband but a long list of abuses? Other clergy have made headlines especially youth ministers about inappropriate sexual contact or molesting of minors both boys and girls. And forget the taking advantage of vulnerable women who are going through a divorce or the loss of a spouse.
As for attorneys, we did offer HIPAA assessments to them also. If they have Private Health Information (PHI), then under HIPAA, they too must guarantee it to be secure. They have certain guidelines to follow. Like doctors, they don't. As long as it is not their info., they seemingly do not care. Also, attorneys add to the protection of the medical community by not taking cases where change could come about for all involved. For attorneys, it is about money and their greed. If the case is not easy, they don't want it unless you have an open and large checkbook of which they will take full advantage. They could add to PTSD by not helping people with issues involving medical malpractice as those people are unable to get even legal relief. They also acknowledge, here in Indiana, how tough the malpractice laws are and their lobbying organization does nothing to bring about change. I have read some articles about doctors mistreating lawyers so hopefully what comes around will keep going around. JR
JR said:
REL,
If I am not mistaken, Michael Jackson died of Propofol and Benzodiazepine intoxication. His drug deal was a doctor if I remember correctly. Fentanyl is also another drug that is stolen a lot. This one was from my place of where evil occurs:
https://billingsgazette.com/lifestyles/health-med-fit/billings-clinic-dismisses-nurse-for-stealing-drugs-m
Here's another nurse who stole fentanyl:
https://local12.com/news/local/nurse-steals-deadly-drug-from-local-hospital
Again, another nurse from the cath lab. No wonder the one cath lab nurse who was part of the crime committed against my husband couldn't remember what procedure they had done on him 2 minutes after it ended.
Another drug, Versed which is in the benzo. class, is also used as a date rape drug. Why? Because it has properties that molesters really like: it erases memory, it makes victims submissive and more compliant, and it makes them less inhibited. Favorite drug of hospitals to use on cath lab and OR victims.
Not only are these drugs valuable on the street, some in the medical community need them to feed their own addictions. You never know if the person involved in your surgery is high or just coming down from a high. They ask you but you don't have a clue about the people who literally hold your life or death, and if you survive, your quality of life. There should be mandatory drug testing by an independent entity for every shift and some surprise testing during shifts. They should never know when it is going to be done. Let them feel how it is to have no say in having something done to your body. Make them pee into a bottle in front of the tester. After all, everyone has the same bodily functions or would that be violating their rights? Everyone should worry about the quality of care on a Saturday night when a cath lab team has been called in? What were they doing before the call? Did they steal a little shot of fentanyl meant for the patient? Is that why he felt pain and the cath lab nurse didn't know what procedure had been done?
I have said it before and I will say it again and stand by it: Too many in the medical field are drug dealers. There is too many pain killers being used and handed as if they are nothing. Here is a great article about the difference in drug usage in Europe in the cath lab vs. the US: https://academic.oup.com/eurheartj/article/39/8/642/4833993
I think the primary reason doctors here use this particular cocktail of fentanyl and versed is not for patient benefit but because of the memory erasing, submissiveness, and putting the patient asleep unless needed. Ethically, I think no one has the right to decide for another individual what memories they have and don't have and to make that person submissive and/or compliant to their commands. Why do we allow this to happen in hospitals? We don't even allow this in prisons. Does this mean that patients and their dignity/respect are less important than a committed murderer or child molester? Think about it. Cruel, unusual punishment, and torture was outlawed years ago on prisoners. However, hospitals still practice torture in the form of isolation, forced nudity, partial explanations of what the drugs they use really do, keeping families wondering for hours about a patient, doing procedures without consent, lack of sleep, bright lights, etc. JR
I'm apologize, Maurice. I'm having trouble with my computer -- can't get directly to Vol 96; I have to go through 95. So last night I failed to go to 96 and posted the following on 95 instead. What a screw-up.
Beginning Part 2
Maurice ended what I consider – to be blunt – a myopic explanation for why physicians can’t (rather than won’t) meet the privacy/dignity needs of patients with, “And I hope we all take this reality into consideration in formulating a working response.” Ironically, the three courts (the first with a jury) in 1881 provided that “working response.” The Supreme Court of Michigan deemed that the “reality” in which De May and Scattergood found themselves absolved them of neither responsibility nor accountability for their duplicity leading to an illegal intrusion – not the dark and stormy night, not the muddy roads over which “a horse could not be ridden or driven over them” (although De May and Scattergood managed to do so), not Dr. De May’s sickness and fatigue from overwork, not Dr. De May’s purported need to get help to tote things, and not even De May and Scattergood’s good intentions.
The Court’s summary and conclusion was presented thusly: “Dr. De May therefore took an unprofessional young unmarried man with him, introduced and permitted him to remain in the house of the plaintiff, when it was apparent that he could hear at least, if not see all that was said and done, and as the jury must have found [in the first trial], under the instructions given, without either the plaintiff or her husband having any knowledge or reason to believe the true character of such third party. It would be shocking to our sense of right, justice and propriety to doubt even but that for such an act the law would afford an ample remedy. To the plaintiff the occasion was a most sacred one and no one had a right to intrude unless invited or because of some real and pressing necessity which it is not pretended existed in this case. The plaintiff had a legal right to the privacy of her apartment at such a time, and the law secures to her this right by requiring others to observe it, and to abstain from it violation. The fact that at the time, she consented to the presence of Scattergood supposing him to be a physician, does not preclude her from maintaining an action and recovering substantial damages upon afterwards ascertaining his true character. In obtaining admission at such a time and under such circumstances without fully disclosing its true character, both parties were guilty of deceit, and the wrong thus done entitles the injured party to recover the damages afterwards sustained, from shame and mortification upon discovering the true character of the defendants.” – Ray
End of Part 2
In a video, John Cihomsky, VP of PR and Communications Sharp [Grossmont] Healthcare presents inculpatory evidence of the hospital’s bad faith. He is quoted as follows: “We sincerely regret that our efforts to ensure medication security may have caused any distress for those we serve.” This statement is inculpatory because it is an admission that catching a single thief took precedence over as many as 1800 patients’ rights to privacy. Also, one would think that even people whose moral compass was so corrupted that they too believed that to catch a thief was top priority would find it reprehensible that unauthorized videos (allegedly) continued for two months after the thief was caught. Use of the word “distress” is euphemistic when compared to the mortification, humiliation, shame, and fear (that the videos will end up in the public domain) that the victims must feel. Hopefully, the jury will see through the use of “sincerely” and recognize Cihomsky’s statement as highly disingenuous. The statement is a direct insult to the victims because it assumes incorrectly that they are “distressed” at the hospital’s “efforts to insure medication security” rather than its failure to protect patients’ rights. Finally, I don’t think I have ever heard or seen a statement so seeped in paternalism. Cihomsky may as well have said, “We are the heroes in this matter; we know best how to serve you and we decided in our wisdom that we could serve you best by catching a thief.” I shudder to think what some husbands whose wives were victims would do if Cihomsky had the temerity to repeat his apology to their faces. -- Ray
Maurice,
People do NOT only become doctors for the money, some become nurses.
Read Nurses that “only do it for the money”
-- Banterings
I think over the years on this blog thread I have periodically as Moderator informed or reminded the visitors here about the content and purpose of this thread. So I will present
my view at this time. I look at this series of Volumes as a place for visitors to express, in an anonymous context, their own upsetting experiences as patients since clinically I feel self- ventilation can be therapeutic. In addition, this should be a place for presentation and discussion back and forth of the visitors' understanding of the problems of being a patient in the current medical system environment, personally and in general and make suggestions of what changes need to be made and how to initiate and carry out attempts to promote such changes. All of these suggestions then are open to further discussion including debate, if such debate occurs but always aware that criticism of the writer rather than of the view (ad hominem) is not acceptable in constructive discussion. Anyway this is my reminder for my "old" visitors and explanation for those new visitors who would like to contribute their experiences, understandings and suggestions. ..Maurice.
Ray B, I hope your computer or Blogspot "straightens out". I have deleted your "Part 2" from Volume 95. Readers can read your "Part 2" dated today 7:22pm above and the narrative will follow "Part 1" published here yesterday at 10:44pm. ..Maurice.
Banterings I read that nurses in it for the money thread not being sure what I'd see. Becoming a nurse strictly for the money doesn't bother me. What would bother me is becoming a nurse for the intimate access to patients. None of the 19 pages I read on that thread even hinted at that which I found interesting, though I doubt they'd ever openly admit it even on an anonymous forum. .
JR said:
Ray B., great series. It is too bad that in today's world the legal system seems to disregard patient's rights. What is worse, is that the medical industry appears to make no attempt to not trample on the rights of patients. While it is true there might be some exceptions, respecting rights should be the rule and not the exception. For anyone who has any contact at all with a medical provider, read the entire privacy form before signing it. Recently, the doctor's offices around here have changed their forms. It now has in there they may photo or video any part of the office visit. If you sign that form, you are agreeing even though verbally they may tell you otherwise. We left an appointment because of this. After pulling several more people to the front, and making us endure a lengthy discussion in the public waiting room full of people (how is that for privacy?) they said they do not photo or video. We countered they could and the signature would be our agreement and it would be a he said/she said type of disagreement. We said in the signature line my husband could say no photos or video. Going back into the office and coming back into the waiting again, the manager said the form has to be signed with no additions or corrections. We then said goodbye.
To us, this was wrong. What would keep them from not filming or taking photos as the signature gave your acknowledgment and approval? We know that in today's world that verbal agreements do not usually hold up in court especially when a medical provider with all their attorneys are involved. This is coercion. It is also duplicity as most patients will not ask to read the privacy paper. They had one on a wall behind a plant but it was not the updated one. When the manager came up with one in hand, I realized the one she was reading from was different. She then had to go to get the correct one. The one the receptionist read from was not correct. It was a mess. The one on the electronic device would have been the updated one. Who really knew what was being agreed to and signed for. It would seem that HIPAA may be used against the patient. What is really bothersome is this doctor seemed to think he had free rein to commit invasions of patient privacy violations without real consent. It made us wonder if each exam room actually had a camera system in it despite their verbal statement.
All of this goes back to the way the medical industry operates in a veil of secrecy. It is as if they truly feel that once we enter their doors, we no longer have our basic rights as a human and as a citizen of the US. It is as if what they do is sacred that our only recourse is to accept what they do without question. We are treated worse than babies and this patronizing only grows worse as we age. I guess they think at least for a while they are immune to being treated as such by younger doctors. However, I doubt if younger doctors will respect them especially if they try to insert their own 1cents into the plan of care. JR
Biker,
The articles that I posted were in response to a comment Maurice made about the reason that people go into medicine is NOT for money. These 2 articles refute that point.
-- Banterings
A recent Gallup poll showed that 37% of Americans put off seeking healthcare for financial reasons. Do you think this is the only reason these potential patients have delayed their care? Are these Gallup polls accurate and what are the sampling rates? Is this the same company that wants you to believe that nurses are the most trusted profession? There is a lot of fake news out there, but them who pays for these surveys? Someone does.
PT
Maurice: I’ve finding it difficult to answer your questions because I’m not sure I understand what you are asking. Are you asking any of the following questions? If so, which one are they. Can you reword any of the other questions you have?
When people in positions of trust (e.g., clergy, attorneys, physicians) violate the rights of their “subjects” (e.g., parishioner, client, patient), do these violations have damaging effects on the “subjects”? If so, what are these damaging effects? How severe are these damaging effects? Does the severity of damaging effects vary according to the type of violation, the position of the violator, and the level of trust accorded to the violator? Is there an interaction effect among the three independent variable (type of violation, position of violator, and level of trust accorded to the violator) on the dependent variable (severity of damaging effect)? If so what is the interaction effect? (e.g., Does the severity of the damaging effect of a breach of confidentiality vary according to the position of the violator and the level of trust accorded to the violator?) What research studies have been conducted on this subject? – Ray
My phone does the same thing. Only I have to start from volume 94.
Ray, yes, yes, yes, yes, yes, yes, yes, yes!
Is there a common pathophysiology in the origins and consequences of these three professions? Is the commonality related to the dependence the victim has on each of the professionals presented in my posting? ..Maurice.
Though some might think the following issue is a bit "off topic", it does deal with a man's genitalia shortly after the patient has died. Not picture taking by a band of nurses. How about obtaining semen for use by wife, girlfriend or others (parents of patient want a grandchild)? If semen is obtained and the patient had not discussed or approved this possibility before death would this act be an in insult on the patient's posthumous dignity? Again, the insult might not be equivalent to the "picture taking" activity for "other's benefit" but still what is occurring is for "other's benefit". Ethically, this is as yet an unsettled issue but maybe our visitors here reading about maintaining "Patient Dignity" will still find this topic pertinent to discuss.
Benterings, as you see your expansion of this blog thread to "patient dignity" can take on a variety of possible issues and my impression was that this issues was one of them! ..Maurice.
I heard on a TV talk show one time that people judge how wrong certain actions are by the severity of the consequences. For instance if somebody parks in front of a fire hydrant and got sentenced to 20 years in prison soon people would think parking in front of a fire hydrant was an awful awful thing.
I sometimes think that we'll never get this issue resolved. If and when it gets resolved it'll be criminals retaliating in a criminal way. Giving his abusers their own medicine back to them ( and the hospital administration and their families families a taste of what they've been doing )
First I will say I have no idea how this is done, but my answer to sperm harvesting is "it depends". I do not see it as the same as staff voyeurism or sexual abuse. It is a medical procedure, however involuntary it might be.
Girlfriends? No. Spouse or parents? Maybe. I recently read of an Asian couple whose son was brain dead after a ski accident I think it was. He was the only chance they had of carrying on their family name which was extremely important to them. In their case I'd say yes. For spouses I'd say yes if for the right reasons, no for others. Yes if they had planned children or were trying to have children. No if it is financially based, an example being he had wealthy parents and she wanted to guarantee she gets to latch onto some of it. I assume here that the background situation would surface quickly enough so that the medical/legal ethicists involved could make a proper decision. It is neither an automatic no or yes.
After a person is deceased their modesty no longer matters but their dignity does. What the Denver 5 did was utterly disrepectful undignified voyeurism for which they should at a minimum have lost their jobs. Morgue workers & morticians as well as medical autopsy staff are simply doing necessary functions, though I imagine they too are subject to laws intended to respect the dignity of the deceased.
Maurice
Orchietomy, well organ donations happen all the time so this is nothing new. Just remember this pales in light of what happens in the land of the living.
PT
JR said:
PT,
Some good points that I hadn't thought about the polls. It is true that polls aren't always right. We seen this this last election cycle. It would be interesting to know how much money the healthcare field may be throwing in the direction of the polling companies. Something else I have thought about is how many in the US are employed by the healthcare industry and related fields. I think that would be an interesting piece of information.
Whenever my husband has had a healthcare encounter before the heart attack, they seemed not to believe him that at his age he was not already on a cabinet full of prescription meds. It seems to the goal of the healthcare industry to make sure every dollar older Americans have is spent on drugs. If only the drug companies spent as much on research as they do on advertising to convince us to ask the doctor who already doesn't listen to us for their medicine. There must be 10 or so advertisements in an hour long show on certain channels about getting a drug that the side effects may be worse than the ailment it is for and that is if it doesn't kill you first. Doctors should have to disclose any money/perks that receive from outside sources that may influence their treatment plans?
Healthcare is an extremely large business. They know just about everyone will have contact with them at some point. It seems to me that over the years, healthcare has become more controlling and listening less to the patient while maintaining everything they do is for the patient. I guess ambushing, unnecessary and prolong exposure, uninformed coercion for procedures, falsified and/or meaningless medical records, etc. are for our good? It seems their definition of transparency is to be able to hide their actions better. It seems their Patient Bill of Rights that guarantee personal privacy, visitation, being able to participate in your own care (why should I even have to be told they will ALLOW me to participate in my own care decision?), etc. is only done for surface effect and there is not one item that intend on keeping.
Again, healthcare seems to care nothing about the patient as being a person so why would they care about the manner in which care is delivered is in a respectful manner that accommodates personal dignity or privacy? If they were upfront then people like me would not have to second guess their motives. However, the secrecy and the manner in which they deliver their service of providing healthcare makes the consumer suspicious and not trusting them. Doctors to me have the same ethical standing as a used car salesman. Anything goes to make a sale or for a doctor/hospital to get money. Nurses may be even worse because of such bogus polls saying how trustworthy they are. They all should be able to do their job without doing additional harm. JR
JR said:
JF,
I would have to agree with you. If I wasn't so morally strong, I would consider giving back. But I have a family and animals that depend on me. I value my dogs and cats more than I value the lives of those scumbags who committed all these crimes. It is lucky for them this is true. Instead, I hope the air ambulance will crash with no patients on board. I hope for the sexually abusive nurses to suffer sexual abuse. My hopes for others is to be isolated from family members and to have to wonder what is happening. I hope is that are able to incur some of the suffering they have inflicted. Justice may not be on our side but fate does have a way of dealing. Here's to fate. I never would have thought a year ago that I would wish harm on others but....I agree, things will probably never change because they have no need to change. Any changes made is only lip service. If with all the changes made to how healthcare is delivered to women, women can still be abused. I have spent the morning on the phone bc of the hospital is billing for 2 rooms on 1 day. It seems they have no end to the harm they wish to inflict. They charged for a night he wasn't in a room. So instead they moved that room charge to another day that he was already being billed for a room. They don't see the problem. His co-pay is per room charge. They don't want to resubmit to the insurance and lose the money for the room he wasn't in but would rather commit fraud. So why would a hospital like this care about anything at all about protecting a patient's personal privacy and dignity or even doing a procedure with no harm? I don't think they care about anything but making money. JR
Once a male patient is deceased there are only 3 methods to extract semen of which 2 are usually not successful.
JR
I know for a fact that only certain patients were chosen for feedback to Press Ganey. How do I know this? I saw evaluations from Press
Ganey and read the reviews before releasing them for staff to read. I knew the patients were chosen, I saw it everyday for years. I
knew the questions Press Ganey would ask, I had them memorized. I place Press Ganey a few notches below the Joint Commission,
two absolutely worthless organizations, that patients pay for and recieve nothing in return. Yes, you the patient pays for this wether you
know it or not. It dosen’t show on your bill but it’s figured in. It dosen’t end with Press Ganey or the Joint Commission, it continues with
the ANA, AMA, big Pharma and countless other health agencies.
PT
JR said,
PT,
My husband received one of those surveys. The questions were really stupid so we wrote in additional comments. They must have messed up because, he received 2 of those surveys. They asked about the food which of course was terrible because they were controlling how a grown man ate and also he was stressed by the abuse he had encountered too. They wanted to know if the room was clean to which we said no there was blood on the blood for both days he was there. However, we added about the sexually abusive nurses and the doctor who didn't bother with getting any permission to perform a procedure. We talked about the lack of personal privacy both bodily and medical information wise. We gave them all kinds of information they neither asked for or wanted.
You're right. It is all stacked against us. They control everything. His bill for this mockery of medical treatment for this one facility in total with all the as-hole bills included was over $300,000. That was not including the 1st hospital and the air ambulance which was in fact slower than a county ground ambulance would have been. For the assault and battery he suffered by the air ambulance, it was over $55,000. A ground ambulance would have been a fraction of that. They know how to play the money game. They also know how to cover their tracks. The hospital from hell charged $91.00 for a glucose test strip because of the quack who wanted to make him a diabetic. They charged $28.00 for that poison they delight in giving--Brilanta. You should read the side effects on that particular piece of poison. You can almost bet you will get the side effects especially the shortness of breath and constant cough. They scolded him when he laid there naked, having a heart attack and was drugged for not getting his SOB checked out sooner but now the meds gives him SOB so he would be in the emergency room on a nightly basis because of the medicine induced SOB. It is very ironic but now he tells them about having the extreme shortness of breath, they ignore it as it is to the meds. It is no wonder that don't respect patient dignity/respect as they don't even care about the real physical harm they inflict or the money they steal. Hopefully the stress of their job and lifestyle will land some of them in a facility like this one with a heart attack or stroke. JR
"Perilously close to rape" a thought reviewed in a Journal of Medical Ethics 2002 article titled "Is Posthumous Semen Retrieval Ethically Permissable?"
Continuing on with my extension of "Patient Dignity" when dealing with an act performed after the patient has died.. how about the ethics of DNA testing (perhaps at the request of some family member) without the patient's permission, stated, of course, prior to death? Here is a <a href="https://bcgcertification.org/skillbuilding-the-ethics-of-dna-testing> 2015 article considering this topic</a>.
Doesn't the acts of semen retrieval or DNA testing of the deceased without prior permission, unless meeting some legal requirement, represent ethical challenges to the dignity of the deceased patient? ..Maurice
p.s.-If you think this subject is "off-topic" this is the blog (discussion) whose purpose is to not to sell something but to make the views of the readers known.
I somehow botched up the clickable link above to the second article..so just insert and click on the following internet address
https://bcgcertification.org/skillbuilding-the-ethics-of-dna-testing
..Maurice.
By the way, I don't think the following topic has been answered on our thread: Have you had experience with doctors of osteopathy (DO) and if so, comparing them to MDs, do you find them more "in tune" with the feelings and desires of patients and if a decision to obtain care from a DO vs MD, you would pick a DO? (including for surgery)? Today, I had a first year resident DO in the "free" clinic where I volunteer work with me and so this question was brought to my mind tonight. ..Maurice.
Maurice
I’ve known some outstanding DO’s. But getting back to your comments about semen extraction of the deceased, How does it differ from
being an organ donor say with a family member in a fatal motor vehicle accident and the family’s request to donate the organs? Come to think of it the family stands to gain the most with a family members semen vs kidneys, lung etc going to someone outside the family.
If you want to look at all of this from a standpoint of dignity, I’ve seen some sad situations of how a cadaver is handled once “ donated
to science”. I don’t think your questions are off topic but there is some relevance to this blog. There is considerable ignorance out there
in society regarding organ donation as I’ve seen some family members who after being distraught over their loved one being declared
brain dead asking the neurosurgeon about a possible brain transplant.
PT
Dr. Bernstein, the "Perilously Close To Rape" article is quite good. I see the organ donations and autopsies that society routinely allows families of the deceased to decide on as being far more invasive than sperm retrieval. That organ donations and autopsies benefit others does not make them any less invasive. On that basis I don't see the "invasive" aspect of sperm retrieval to be a pertinent factor in the decision-making.
Each case needs to be looked at on it's own merits addressing the circumstances of the deceased and his family.
As a humorous aside, if family oral histories and my great-grandfather's death certificate's agreement with that oral history are to be believed, this sperm retrieval and freezing technology has been around for quite a while. Researching the actual facts I learned my great grandfather was born fully 3 years after his "father" died back in the 1860's. I got a chuckle out of it even if some of my family didn't.
The DO who attended to me didn't protect my privacy AT ALL!
JR
$300000? That's HORRIBLE and inaccurate as ANYTHING! I once seen it said that one third of all patients don't pay their hospital bills.
Maybe more would if billing would be accurate about how much is actually owed.
I also seen that some blood testing is a $1000 charge. Somehow we need to get better laws voted in. I don't think medical care should be free. That doesn't mean people should be told they owe 10 to 20 times more than they actually do.
Medical overcharging is the cause of lots of death. I guarantee it!
Why all the ethical concern now, about extracting semen from this deceased man. The ethical dilemma it poses, the logistics of it all
and the concerns of consent and wether it’s valid and ethical consent to remove semen from his genitalia after he is deceased! One
would think there would be ethical considerations that take place on the access and viewing of his genitalia while he is AlIVE rather
then dead. Where is the concern for consent of the living? Or is this just fodder for ethicists to ponder? I think healthcare should focus
all their energies on the living first and foremost.
PT
Good Afternoon Everyone:
JF, funny you said we need better laws.
USA today ran an eposé recently about who actually writes the laws that those puppets in congress pass.
https://www.usatoday.com/in-depth/news/investigations/2019/04/03/abortion-gun-laws-stand-your-ground-model-bills-conservatives-liberal-corporate-influence-lobbyists/3162173002/
Seems the reason the average person doesn't get too much relief is because we elected people to write new laws. They’re letting corporations do it instead.
So for the most part the people in congress are just puppets for big business.
Sad.
Regards,
NTT
PT, there is generations and beyond genetic significance to use of a deceased's semen whereas there is no direct and generations long alteration by simple replacement to another party of the other organs of the deceased. It is just not the same and the ethical argument is that it should not be allowed if no specific permission was given by the man before his death.
PT et al, do you find some impact on a deceased patient's dignity for photographs taken, without any publicly informed personal identification, of bodily parts for professional education and medical professional documentation or professional criminal investigation taken to court in contrast to what seems to be accepted ignorance of deceased patient dignity by taking photographs for ones personal sexual or otherwise self-interest? ..Maurice.
Since we are on the subject of organ, semen donation I’ve a little story to tell, it’s a true story and I’ve recited it many years ago on this
blog. Anyone with some computer savvy can authenticate its truthfulness. In the mid 90’s an older male patient expired at a hospital
on one of the nursing floors. The funeral home, mortuary picked his body up from the hospital but, several hours later called the hospital
to speak with the house nursing supervisor.
The concern of the mortuary was that there were no organ donation papers that had accompanied the patient. The nursing supervisor
after reviewing the patient’s medical records on the computer told the representative at the mortuary that the patient was not an organ
donor. The mortuary then stated “ well he must have been because his penis was cut off and he was lying in a pool of blood.” The
nursing supervisor told the mortuary that you dont donate your penis. The police department was then notified and after a lengthy
investigation it was determined to be a homicide. The patient had his penis severed by someone in the hospital and it happened
on Halloween night.
To this day despite the family posting a $100,000 reward no evidence has surfaced on who had murdered this patient, he bled to
death. I’ve many stories like this and there seems to be much disinformation regarding tissue donation, wether it’s appropriate and
ethical. There is a lot of quarterbacking on these subjects after the fact. I’d much rather see the attention and all the ethical
innuendo ‘s spent on the living. Where are all the ethical considerations for the living or is it more harmless without possible
retribution when it involves the dead.
In the case for example of the Denver 5, it’s irrelevant, they were gawking before and after he died. It all boils down to this, if
dignity and respect are not shown to the dead, then what does that say about dignity and respect for the living. In many states now
children born after the death of the father are entitled to benefits. There is concern for the respect of the deceased man regarding
semen extraction, what about dignity and respect for the welfare of the potential unborn child that the semen donation would bring.
It’s been demonstrated that semen is viable within a dead male slightly beyond 48 hours. Typically, the wife of the deceased is
granted rights to semen of the deceased provided she waits 1 year after the grieving process which in my opinion is somewhat
obsurd. In the end something good can come out from semen extraction of the dead and in a small way perhaps help the grieving
process of those left behind.
PT
JR said:
I think there are 2 issues: 1. the respect of the male reproductive rights 2. the dignity/respect of him after death by the medical community.
As we know, women are in total control of their reproductive rights. Why not also ask if an egg can be taken from a woman or if a women in a coma should be able to be to be inseminated with donor sperm by authority of a boyfriend, husband, or parents? Women not have the right to abort a baby even if the father objects. Males don't have the right to abort a baby. If it is no for a female, then it should be no for a male. Equal rights for all. (I am not saying abortion is right or wrong.)
2. The medical community as a whole has issues with giving the living the dignity and respect they deserve as human beings. Do you really think that would treat a dead donor with any more dignity or respect. More likely in would all be done in a more disrespectful manner as they would be assured of no living patient witness.
As for photos to be taken for educational purposes, unless a consent was signed then that should be no. Just because a person is dead does not mean that still should not be afforded the dignity they should have had in life. But then, the medical community thinks everyone is put here for their use and abuse except them. Unfortunately, for criminal investigations the victims are exploited and abused through the use of the crime photos especially if the crime was sexual. I also don't think autopsy photos should be released and made public knowledge because it is really none of my business.
JF,
I added up his blood test for one night and it came to $1730. I do believe why he was not given Informed Consent or his basic right to choose his treatment was they saw dollars signs not a patient who has the right to decided their own treatment. They respect nothing about a patient and this comes from above and extends to how doctors and nurses treat patients. This also may lead techs and such to treat patients badly in the presence of the doctors and nurses. They gave him 2 equal doses of heparin. One cost $35.40 and the other cost 52.50. The price of inflation is faster than anyone ever imagined. I have documented of this and sent it to everyone such as HHS, CMS, and even the President. I think they are committing not only sexual crimes but outright robbery. Not to mention they know they are billing him for 2 rooms on 1 day and refuse to change it bc it is all about the money. We are getting ready to make the switch over to a natural doctor. Hopefully, they have a better attitude. JR
Please don't get upset if I am trying to extend the discussions of Patient Dignity beyond what was focused on the patient modesty issue all these years. Yes, maintenance of postmortem dignity which I shoved into the conversation was one aspect to consider. I have now another..but obviously not postmortem. How about an issue for a physician of either gender: "When is it OK to Date a Patient?" In my next posting is the discussion of the subject by the well-known ethicist Arthur Caplan. ..Maurice.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU School of Medicine. Medscape recently conducted a poll of more than 5000 physicians on a subject that [affects everyone], no matter your politics, your medical specialty, or your educational background: love and romance.[1]
This particular survey was [conducted to determine] when physicians feel that it is acceptable to date a patient. Roughly speaking, the answer came back that if there had been a 6-month time period where you hadn't treated the patient—a 6-month lapse in terms of doctor-patient interaction—it would be okay, at least to the poll respondents, relative to romantic interaction or efforts at romance.
I think that is a little bit of a surprise. It's probably different from what we might have seen years ago. My hunch is that more physicians might have said it's okay to date a patient; however, given the #MeToo movement, concerns about lawsuits, and concerns about misunderstanding when someone is in a doctor-patient relationship—even weakening of the doctors' prerogative to act or engage as they wish with a patient from 50 or 60 years ago—I think we're seeing a change in morals. We now see more doctors saying either don't do it at all or you have to have an interval before you [consider pursuing] a relationship.
I happen to think that the 6-month standard was completely arbitrary, completely random, and is not grounded in any social science, but it makes some common sense. Again, it's important to keep in mind that if you're treating someone who you're thinking about dating, you are dating, or who is a family member, you don't want to be doing that unless it's a minor kind of treatment. It may distort your ability to objectively assess a health problem if they're your [spouse or longtime partner]. It's better to have someone else treat them if possible.
If you're thinking about going out with someone, it's better to say, "Look, I'd like to have a chance at a romantic relationship. Maybe we need to look into having someone else provide your care." It is well established that romance or strong emotional feelings can distort judgment and that these feelings can get in the way of providing both the best diagnosis and the best possible care, and can even lead to [a physician] nagging the patient to comply and do what they ought to be doing if [the physician is] going to take on their particular illness or disease.
I think there should be a break between seeing a person and deciding that this is somebody you might want to have a romantic relationship with—6 months makes sense to me. It just seems intuitively long enough. Somebody for sure is going to say to me, "But if I just took a mole off somebody, you're telling me that I have to wait 6 months before I can ask them out?" ... Continued next posting. ..Maurice.
(Continued)
Well, I would say that some of this is case by case. There are minor medical interactions after which we are not likely to see the person again in the next week or two, much less in 6 months, because they came in for something trivial. Maybe, there, you could make the case that you wouldn't have to wait as long.
The general rule is, in a serious medical relationship, don't have a romantic interaction or a strong emotional connection—a family member or even a close personal friend—with the patient. Try, if it's possible, to have someone else deliver the care. I know it is not always possible. There are specialties where there's no one else around for hundreds of miles or where there are no doctors around except a rural practitioner—I understand all of that.
I understand how we may have to use common sense. Common sense also says, ethically and practically, don't get involved with someone for whom you're trying to provide care. It's bad medicine.
I'm Art Caplan from the Division of Medical Ethics at NYU Langone.
What is your opinion about this doctor-patient relationship? In whose best interest is this or is it all related to how it begins and how it ends? ..Maurice.
Oops! I forgot to give credit to the resource of the above presentation by Arthur Caplan. It was copied from the published article in the April 3 2019 issue of Medscape. ..Maurice.
JR
It seems like your husband was singled out because they thought he was gay. Maybe your lawyer could get a court order to see what other patient bills were who came in with the same symptoms.
Also maybe get in contact with the gays who have gone to that hospital for help and see if there is a difference in how they were treated.
I’ve always seen gay men mistreated in healthcare and I was always troubled over it. I’ve seen it go on in the early 90’s when a young male patient was HIV positive, the nurses ignored him at night. In the morning he was found dead in his room by one of the attendings. In the night the patient developed a tension pneumothorax. By morning he was dead and the nurses all female shunned him.
The hospital did nothing about it. I’ve also seen men come into the emergency roomwith an object lodged in his rectum and within minutes everyone in the hospital knew about it. Very very unprofessional.
PT
JR said:
JF,
We think that was why they did what they did too.
This would it explain why there are so many instances of patient exposure. They are checking out potential dates to make sure they have the physical attributes they want. So I guess I can expect the cath lab sexual abusers and the 2 cardiac care sexual abusers to ask my husband out on a date in about 6 months? They must have liked what they saw bc they kept him exposed unnecessarily and prolonged.
It is so wrong in so many ways. This is only adding proof that medical people are not all professional when they are exposing patients and especially when the exposure is unnecessary or prolonged. I guess a teacher should only have to wait for a student to grow up but it is okay to lust after the student while the student is still in school? I have been lied to that medical people didn't have sexual thoughts about their patients. Forgot the fluff questions on the dating site. Doctors and nurses can get right down to business bc they know all the patient's business. So now people should have this added worry if the pervert doctor or nurse will ask them out after thoroughly checking them out. I told my husband about this and as one who was sexually abused he was absolutely mortified at the thought of doctors and nurses thinking it was ever okay in dating a patient. They are not supposed to have sexual thoughts for any patients. Pre-checking out the genitals of a potential date is perverted. This concept would lead to more personal dignity/respect crimes. This is sick! JR
I continue to believe semen harvesting is OK under some circumstances and not others, and I'm comfortable with the medical/legal people involved making the determination.
As for dating patients, generally speaking I think it is a bad idea, but I accept that some healthcare staff can make it work without being inappropriate or unprofessional. Certainly there needs to be some time separation as Art Caplan's article suggests. I will note that the same issue exists with lawyer-client or other professional relationships too.
I also think whether it is appropriate and/or how much time has elapsed depends upon what exactly was the relationship. Was it coming into the ER with a sprained ankle or was it your GYN? Was it seeing your primary care for the flu or was it your dermatologist for full skin exams? The scenario matters which means any set of rules is going to be hard to define.
I will add that it isn't just doctor-patient. It can be any healthcare staff-patient at issue here.
Not stated in Art Caplan's article is the underlying reality that we have long discussed here is that healthcare staff are human and they are going to see patients in a sexual way. That doesn't mean they are attracted to any given patient nor does it mean they will act inappropriately, but it does refute the old "a penis is no different than an elbow to them" notion. That healthcare staff would see patients as someone they want to date as well affirms that donning a white jacket or a set of scrubs does not suppress basic human sexuality.
What should a doctor (male or female) do if he or she finds that he or she is falling in love with their patient of either gender? How can professional dignity as well as the dignity of the patient be preserved? I have a feeling that this professional problem is not a super rarity. Along the same lines what should a nurse do when as a care-giver is faced with the same dilemma? There must be appropriate advice that can and should come from the population of patients and not just from an ethicist or what is written in a professional organization document. How can a dignified doctor-patient relationship be maintained or properly terminated? Such help toward this subject should come from patients themselves. Do you think that most patients would feel comfortable discovering that their physician had a "personal" interest in them? Shouldn't all physicians have some "personal interest" in their patients--isn't that called empathy? What we are referring to here is actually a "nitty-gritty" aspect of maintenance of patient dignity. On the other hand, despite all the "bad" behavior of the various professionals in medicine, has anyone here developed a "love interest" in their physician, nurse or other medical attendant? Does this experience or even lack of experience shape your current views as written to this blog thread? ..Maurice. (p.s.-my personal response has been "no love interest as a patient and no love interest as a physician" even though my wife's profession ,as I have written here previously, was that of a nurse. ..Maurice.
The Code of Ethical Conduct at the hospital I get all of my care at includes:
"Do not have romantic or sexual relationships with patients; if such a relationship seems to be developing, seek guidance and terminate the professional relationship."
I like that they acknowledge it as a possibility and that they are clear it is not condoned.
Boundary violations are ignorance, exploitative behavior, moral weakness resulting in a position that loses sight of patient advocacy. It’s a hugh mistake to set a time limit for that just says it’s ok. It’s not ok! I’ve seen inappropriate relations go bad in short order and what does the ex-patient do, complain that they were taken advantage of and the physician, nurse are in trouble with the board.
I’m not going to any medical worker with the idea, concept of looking for love romance. Every second spent with the patient should be from the perspective of advocacy. Don’t waste patients time and money, $4 Trillion dollars is enough wasted money in efficiency as it is. The public is not looking runway walks and romance, we want to get well. Sounds like people need to stay out of the healthcare meat market and join a lonely hearts club. Pathetic!
PT
Hello,
Health Affairs has published an article on informed consent. (See URL below). They're pushing a slogan "Nothing about me without me." Their efforts are laudable; however, they may need some posters to give them some real-life stories. I placed a comment which hasn't yet been published. Maybe they won't publish other comments but, it may be worth a try.
Reginald
https://www.healthaffairs.org/do/10.1377/hblog20190403.965852/full/
I personally and as a professional agree with Biker and PT. I agree that setting a time limit when a romance with a patient is permitted is setting a moral wrong. Yes, doctors are humans and their patients are humans but both must realize that romance and marriage is not and should not be part of the relationship now or in 6 months. Or are we ignoring a human biologic interaction which setting standards of behavior (ok after 6 months or more free of professional interaction) is impossible to expect to be followed.
Set into words what I should teach my first year medical student of either gender specifically about this matter. ..Maurice.
Maurice: On April 1, you wrote, “I feel that even if the writers [to this blog] are represented as ‘statistical outliers. . .’” Now, I know you’re not insinuating that contributors to this blog are, in fact, statistical outliers because you preface your sentence with “even if.” However, there are many people who would, indeed, consider us statistical outliers. I too believe we are “statistical outliers,” but it’s not because we are bothered by unnecessary privacy intrusions and attacks on our dignity by healthcare providers while most males are not. It’s not because we prefer male over female providers for intrusive care. After all, research suggests that on average a sizable minority of men prefer male providers. I think we are statistical outliers because we deviate from the stereotype of the phlegmatic, stoic male who weathers the violation of human dignity without complaint. Unlike other males who experience status degradation ceremonies in healthcare facilities, we use this and other blogs to air our grievances. Some of us may bring our grievances home with us and to gatherings of friends and family. That may be how we are outliers.
But why don’t others join us; why don’t they speak out about the bad experiences they’ve had in healthcare facilities? We’ve already partially answered that question in this blog. Some male patients who are bothered by unnecessary status degradation ceremonies they experience in healthcare organizations don’t speak out because they are afraid of stigma and its consequences (e.g., ridicule, not getting needed healthcare). There are, no doubt, many other reasons one of which is pluralistic ignorance. Wikipedia actually does a pretty good job defining this concept (I’ll add a bit to it) – “a situation in which a majority of group members privately reject a norm [belief, value], but go along with it because they incorrectly assume that most [or all] others accept it.”
I have not infrequently spoken to men who exhibit bravado and sometimes even levity when describing their emasculating healthcare experiences. When I speak to each man in private, however, he will admit that the particular experience that seemed at first blush not to bother him in the least was, in fact, extremely humiliating. When I ask him why the show of bravado in front of his peers, he says that he didn’t want to give his buddies the impression that he was weak when, in fact, I know that at least some of his buddies feel the same way he does. So, now we can add another variable – viz., pluralistic ignorance – to the several we’ve already identified in this blog as explaining why men don’t speak out about their humiliating experiences in healthcare.
Success at changing a system that subjects men to unnecessary indignities requires, among other things, that we convince the sizable minority of men who feel as we do to join us in speaking out about their experiences. This is one way that outliers become the norm. – Ray
I wouldn't think a lot of women would their husbands to be gynecologists.
Pluralistic ignorance. I like that one Ray, and I am very guilt of it for most of my life until I finally found my voice with the help of this blog.
Back when I had my 1st bladder cancer surgery I afterwards made a huge joke with my buddies over what was really a traumatic experience. It was just the typical guy reaction that we all learned at a young age. Living in the rural countryside like I did I joked that word spread in Boston that they'd have a real man in surgery instead of the usual city boys and women were lining up to watch.
That was how I handled being ambushed by 5 medical students, 4 being female, and by the nurse mere seconds before she put me under saying in a decidedly sexual tone that she's "going to get to know me real well", and knowing that the prep and surgery had me spread eagle and that I was catheterized afterwards. Joking in a "I gave them all a real treat" manner in typical guy fashion was the only mechanism I knew of to deal with it. So yes pluralistic ignorance is a good phrase.
JR said:
JF,
You're right especially if they are literally looking for the mother of their next child.
PT,
It does make it sound like a dating service that goes way too far by one side being able to conduct secret intimate interviews. We all know that despite what the "professionals" are saying they are sexually active and have sexual feelings. However, it is unethical for them to act on this at any time. There would certainly be more crimes committed like what happened to my husband if this was behavior that became more widely accepted.
Reginald,
I am going to check out that article. I personally think Informed Consent should work for the patient too. As it is, the medical community has free rein on doing whatever, whenever, however, with whoever to a patient. There needs to be something that actually protects the patient.
Ray,
I think you are right. I think a lot of men feel they have been humiliated. My husband never spoke out before about the office abuse. He doesn't remember the OR experience during his prostate surgery but before and after I was there to protect him. However, this time he was alone and drugged in a hospital that treated him as if he was the victim of a gang bang activity. Being victimized in this way has made a lasting impression on him. You have to wonder how many other men who have had this procedure or another procedure that didn't really need genital exposure have been victimized in this same way and are struggling with what happened but who are remaining quiet? My husband is ashamed, humiliated, and quite frankly very traumatized. How many others are out there suffering from this? But how do we get the word out there? How do we become better organized? I don't think individual efforts will do it. JR
Perhaps men need a healthcare facility that resembles the Playboy Bunny Ranch. Nurses dressed in Benny Hill-esque uniforms, a flirtatious attitude that acknowledges a man's machismo. This acknowledges (at least as men PERCEIVE it) the sexual component of intimate care. Instead of ridicule, men are elevated.
This is why certain venues are popular with male clientele: strip clubs, casinos, etc. Furthermore, these businesses cater to men. It was common practice in the airline industry to exploit sexy stewardesses to sell more tickets.
-- Banterings
Hello JR, et al,
An article appeared in the Annals of Internal Medicine, Apr 19 ed., regarding informed consent for coronary angiography. A summary also appears in Medscape, 8 Apr 19 (https://www.medpagetoday.com/cardiology/pci/79086). The article advocates using a comic book type approach to explaining the procedure. A better approach is recommended (in the article) by Dr. Mehran who stated, "[A] short video of the process with the involved physicians in that hospital is much more user-friendly and informative for the patient," commented Roxana Mehran, MD, of Mount Sinai School of Medicine in New York City, who cautioned that the graphics used in the study were "not very realistic and may not give the right flavor of the procedure to the patient."
Before my hip replacement, I asked for the same video of the procedure and was told that that was too expensive. I could hardly restrain my indignation at such a lame excuse, especially since the hospital charged $78,000 for a 15 hour stay (no overnight). Fortunately, Medicare only paid $12,000.
I still feel that we should "encourage" CMS to advocate on our behalf for an overhaul of informed consent. Line-out items (such as pictures, etc.) should be allowed or the hospital receives no funds from CMS. This, along with a video of the procedure, would be a great step towards treating patients with ADULT dignity.
Reginald
I wanted to let everyone know that we have a new video, History of Gynecology & How To Prevent Sexual Abuse in Medical Settings up.
JF: We mentioned in this video that many women would not like it if their husbands were gynecologists.
We mentioned Dr. Sparks briefly near the end of this video.
Misty
JR, you wrote "My husband is ashamed, humiliated, and quite frankly very traumatized." I apologize to you if what I am about to ask you had been previously answered which I overlooked or didn't remember. But my question is why your husband is not himself writing to this blog thread and ventilating his descriptions of what he recalls, was told or what he read about how he was treated. I would think that this direct expression and this ventilation to others, especially to others here who could understand and support his concerns would be more therapeutic for him emotionally than having a wise, attentive and knowledgeable surrogate (yourself) communicate to our blog thread for him. My experience with emotional distress by a patient is that direct communication to sources of support is a more direct approach. We all certainly sense your concern, frustration and yes anger with those in the medical system who abused your husband but somehow as a physician it seems to me that direct ventilation here by your husband to this blog thread would be a better direct therapy. Again, if I missed an explanation along the way, I apologize.
..Maurice.
Golly, we are at 170 postings with this Comment and time to create another Volume. It seems that this is now occurring once a month. When I have time, I should be creating Volume 97. There is so much good written here an on previous volumes, it may be of value as supplementation to include in your upcoming Comments to the the new Volume referencing the reader with a specific link (obtained by clicking on the date of the old Comment and obtaining the resulting displayed link to copy to the current text) for easy referral of what you or others had previously written. There is so much valuable information in the past including links posted, that such referrals could be of value. Do you see that such referencing be of value as we continue? ..Maurice.
JR said:
Dr. B.,
That's a good question and one I have not addressed. There are several reasons. He's not much of a talker. When we talk to lawyers and others about this, he gets very emotional and usually asks me to continue the story. He'll usually leave the room. He doesn't want me to see and know how upset he gets. He says if he thinking and talking about it, he'll break and he says he cannot do that because. He feels guilty that because he was drugged and unable to care for me while I was being tormented. He feels ashamed and humiliated by what the nursing staff did. He feels angry that they did a procedure to him without his consent and gave him drugs without his consent. He feels like he should have known although there was no way he could have. But I know that saying this does nothing for the guilt and shame. He also knows I am on this board so he will not communicate on it as it doesn't want to upset me anymore than I am if he really lets it out. I know he needs to talk to someone who has been through what he has but there is no one. Every time he talks about what happens, his shortness of breath increases, his cough worsens, and he seems very subdued. He had to talk to Medicare about what happened this past Friday as they are looking into it. Friday night was really bad. Then came Saturday night which was even worse. He doesn't sleep. He may be a combination of the versed having messed up his sleep pattern brain waves or his nightmares from the experience. I also know there is more than he is telling but is afraid of upsetting me to the point of no return. I don't disagree with you and I tell him about what I read on here and what I say. He cannot talk to anyone in the medical field because they are the ones who completely broke his trust and mine. Neither of us expected such treatment. I have said this before, that my husband is the nicest man. Me, not so much. Right after the hypnosis session when he had finished telling his story from that time, he broke down and cried like I have never seen. He wants things to change for others and that is why we are pursuing what we are. It is not about the money but letting them know they cannot abuse and violate just because....JR
Dr B
I wanted to comment but held back because you weren't talking to me. You were talking to JR about her husband and I thought I should let her respond first.
What I thought about though was different times in my past, I have been super upset and somebody else trying to coax my story out of me before I was ready to talk. Only think that accomplished was to further enrage me.
Sometimes talking ( and feasting your mind on it ) is the worst possible thing to do.
Maurice,
Maybe the next installment should be about patients taking control (taking power away from the providers).
Patients take charge
Some highlights:
Doctors and healthcare experts say growing numbers of patients are becoming empowered—a term the World Health Organization defines as “a process through which people gain greater control over decisions and actions affecting their health.”
On an everyday level, an empowered patient is one who searches for health and wellness information on their own rather than waiting to get it from their doctor, then partners with their doctor in deciding the care they need, who should provide it, and where, explains Jan Oldenburg, a patient engagement consultant, blogger, and author of Participatory Healthcare: A Person-Centered Approach to Healthcare Transformation.
“Empowered patients are very clear that they have the ultimate responsibility for their own health and that the ultimate decision-making is in their hands,” Oldenburg explains. “They view doctors as advisers and resources rather than all-knowing authority figures.”
“The idea of a paternalistic medical culture doesn’t fit as well with people’s views of their lives as it did in the past,” Ganos says. “Patients understand that they know things that doctors don’t know about their lives and their health and have an expectation that they need to take an active role in their own healthcare.”
The fact that patients now have access to much of the same medical information as their doctors, and that more of them regard their doctors as partners rather than all-knowing authority figures has been difficult for some doctors to accept.
“When you have patients asking whether what you’re recommending is really the best treatment, bringing in their own information, it can feel threatening,” Oldenburg says.
Conolly acknowledges that winning the trust of an empowered patient sometimes requires extra effort on the doctor’s part, but says that few doctors will object to the effort if it results in better patient care. “And after these conversations lots of patients will say ‘thank you,’ and that feels pretty good. It’s why we became doctors.”
-- Banterings
AS OF APRIL 10 2019, NO FURTHER COMMENTS WILL BE PUBLISHED IN THIS VOLUME. COMMENTS CAN CONTINUE ON WRITING TO VOLUME 97. ..Maurice.
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