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Patient Dignity (Formerly:Patient Modesty):Volume 98
So the "Rules of the Road" is a worthy presentation to each patient who comes to the physician for help but what is often missing is that the doctor needs to understand the "Rules of the Road" as taught by each patient. As you walk into the doctor's office you get a Welcome document from the doctor. What is missing often is the doctor doesn't get a "Its about me" instruction paper from the patient to educate the doctor regarding his or her rules as they both go down the same road with upcoming Stop signs, turnoffs and speed limits. One major issue within such a driving analogy is WHO FOLLOWS WHO? (physician paternalism vs patient autonomy). Can any of my visitors add to this road analogy? ..Maurice
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VOLUME 98. YOU CAN CONTINUE POSTING ON
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170 Comments:
As far as I'm personally concerned, I'm not willing anymore to let an MD have any authority over me. The moment I sense paternalism, I immediately request euthanasia. It's a knee-jerk reaction.
EO,
You hit the nail on the head. When my husband, who was 67 at the time, told them when they asked that he took no RX drugs, they were mortified. They are asked if he was sure like he was senile or something. When he told them he relied on naturals supplements but had not taken even them in over a year, they became angry, irritated. It seemed to us their main plan was to get another "old" person on the RX drug train. Even though his cholesterol levels were well within the normal ranges bordering on excellent, they prescribed the highest dosage of a statin. It seemed they wanted to make sure he would have other side effects needing procedures and more medicine. Immediately the statin did have side effects. The Brilanta has horrible side effects. The blood pressure medicine is the same as drinking gas from the pump bc it uses the same ingredients. (He didn't have high BP to start with but always had low pressure.) They gave him another one but at the moment all I can remember is it started w/ a L. The doctor told him to "suck it up" when he told him about the side effects. The BS way they defend statins is ridiculous. They know statins have the ability to damage muscles & probably will. What is the heart? It is a muscle but they say it does not attack the heart muscle. So if statins are so smart they will attack every muscle but the heart then why does it have any side effects at all? After all, it should be smart enough. They lie. Another doctor &I had a discussion about statins. He was actually a pharmacist too. He agreed that statins can potentially attack heart muscle. Well, anyhow, my husband has adjusted his forced drug doctrine w/o dr.'s knowledge w/ a routine of natural supplements. We have found the combination to help w/ the secret test score in cholesterol testing that one dr. wouldn't tell us that statins actually help and it is not the ones you would think. The average cholesterol test doesn't really give the info. needed & they know it. The test offers only false positive feelings as the generally tested results means nothing. By the way, the dr. thinks he is doing amazingly well. Since my husband's health information was violated by the hospital from hell sending his info to different organizations w/ his SSN so they could follow him forever (we are still working on getting it recalled but they seem to think they own his info although he did not sign a consent for this either), this really falsifies his results to these organizations as his results is not caused by the RX drugs but rather the natural ones. It is much more difficult to use natural supplements but worth it. We did the same after his prostate surgery. He had no chemo, radiation, or any type of RX. The morning after his surgery, he was released. He immediately started on his natural routine & has remained cancer free for 13 years. We hope all the radiation from the cath does not adversely affect him. He is taking natural supplements to protect him from that damage. They even gave him a lengthy lecture of about him needed to comply with RX drugs as he was lying naked, exposed on the cath lab. table according to their records. They did anything & everything they could to torture him bc they were mad they had an "old" person not yet on their drug gravy train.
I too believe it is the intent of the medical community to be in total control of everyone's life. After what we went through, and knowing how they treated and reacted to my husband, I have no doubt of this. As I have said before, it would be very interesting to see what the benefits are to the doctors and hospitals in payments, loot such as vacations,
They want to be in control of people's lives. Not in total control however.
They also have an understanding of what health and disease that is quite remote to what lay people understand as health and disease. And they do not tolerate dissent very much, ad they are pretty sure they have a more precise understanding of health issues than the patient does.
They simply see it as irresponsible of them not to do everything they can to make patients comply with the treatment.
On one hand, they tend to be right. On the other hand, they're completely blind to other issues that do not fit in their worldview. Seriously...
But they are not unaware of the issue. Check this out:
http://doctorskeptic.blogspot.com/2017/01/dont-treat-me-im-doctor.html?m=1
http://doctorskeptic.blogspot.com/2017/05/overcoming-cognitive-biases.html?m=1
http://doctorskeptic.blogspot.com/2017/08/prius-non-tempore-first-do-no-time.html?m=1
In regards to genital piercings, I consulted my friend up north who has dealings with people in that lifestyle. The following is what he explained to me:
Saying that they just want to show them off is like saying that a prostitute is a nymphomaniac by nature of her profession. Many women are pushed in to prostitution/escorting/stripping because there is no other option for them to earn an income that they can survive on. There are just as many single mothers as there are addicts in these professions. There was a woman in the greater Philadelphia area who put herself through law school by stripping After graduation and trying to get established as a lawyer, she went back to stripping because it was more lucrative.
Genital piercings are many times done for ones self. They may be shared with a partner, one that is also sharing themselves. Much of the modern body modification industry is a result of medicine's arrogance towards body mods. Just because medicine doesn't feel it is not necessary does not make it so. The body mod industry developed its own methods and technologies. This industry also has helped medicine in its shortcomings. The most notable example being nipple tattoos after women have undergone breast reconstruction surgery after cancer.
There has also been a lack of understanding of the mechanisms of the jewelry used in piercings by healthcare.
-- Banterings
From my perspective that road dead ends, it’s filled with hugh pot holes despite $4 Trillion dollars annually put in the coffers. Remember,
this isn’t just about physicians, it’s about nurses, techs and administration. There is plenty of blame to go around for the condition of that
road.
PT
Banterings, your link about nipple tatoos is broken.
Here is the link:
https://www.today.com/health/meet-tattoo-artist-making-breast-cancer-survivors-feel-whole-again-t48276
-- Banterings
Really fantastic work!
I know there was some argument in Volume 97 regarding discussion of religion as it impacted patient dignity. Nevertheless, religion is incorporated into medical system practice so it can't be ignored.
From today's California Medical Association bulletin:
The California Medical Association (CMA) recently submitted an amicus brief with the California Court of Appeal in Minton v. Dignity Health, a case involving discrimination against Evan Minton, a transgender man who was denied a hysterectomy at a Catholic hospital.
Mr. Minton filed a lawsuit against Dignity Health alleging that its actions violated California’s Unruh Civil Rights Act, which prohibits discrimination on the basis of sex - which includes a person’s gender, gender identity, and gender expression – in all business establishments and guarantees Californians full and equal “accommodations, advantages, facilities, privileges, or services” in business establishments the State.
Dignity Health filed a motion to dismiss the case, arguing that sterilization procedures are not provided at its Catholic hospitals in accordance with the Catholic Church’s Ethical and Religious Directives for Catholic Health Care Services (ERDs) and that its alleged conduct is protected by its constitutional amendments under the First Amendment. The trial court granted Dignity Health’s motion and dismissed the complaint. Mr. Minton is appealing the trial court’s order to dismiss his case in the California Court of Appeal.
CMA’s brief argues that Dignity Health’s adherence to the Catholic Church’s ERDs not only discriminates against transgender patients, but also adversely impacts patient access to care, interferes with physician clinical decision making and medical staff governance, and threatens California’s longstanding policies prohibiting the lay practice of medicine.
For me, this is a distinct example of a religion challenging state law and in effect damaging the dignity of a patient. Interestingly, the state law is to prevent sexual discrimination. However, on the other hand a January 7 2019 article in Daily Beast shows some Catholic wiggle room regarding hysterectomies. ..Maurice.
The amicus brief seems rather factual, though I do not get how the situation "threatens California’s longstanding policies prohibiting the lay practice of medicine."
What I do not get is why on earth would a transgender man ask a catholic hospital for a hysteroctomy. I'd instead run away as fast as I could and request the same procedure from a more secular institution.
I am not familiar with any religious affiliated hospitals and can thus only go on what I have read or heard. While Catholic hospitals in particular may have certain policies dealing with reproductive matters, based on comments made here and elsewhere it doesn't seem religious affiliated hospitals do anything any differently than other hospitals when it comes to patient modesty/dignity.
I have read that in days of old when small Catholic hospitals had nuns filling most nursing roles that male patient exposure was kept to absolute minimums by the nuns and that patient dignity was a core value, but that era is long gone.
JR said:
Women's health issues are not all they discriminate against. See this article:
https://www.americanprogress.org/issues/lgbt/reports/2018/03/07/447414/acas-lgbtq-nondiscrimination-regulations-prove-crucial/
https://www.aclu.org/cases/franciscan-alliance-v-burwell
So it is just not women's health issues the catholic hospitals have issues with. It seems they like think God has given them the ability to be both judge and jury. I don't know if other religiously affiliated hospitals operate w/ the same philosophy but I know the catholic hospital we dealt with had this attitude. They consider themselves morally superior and all knowing. However, their actual delivery of care does reconcile itself to their written philosophy of compassionate care. Between the control and power of the hospital administration and the medical staff, it is no wonder the patient has no rights and ends up getting abused and violated. I would say that the patient is least of their concern. The patients only pay them so they may continue on their quest for glory, power, control, and money. If we hadn't been in the position we had been in, we would have shopped around for a different hospital. We didn't know that going there made us give up all of our basic human rights bc their religious beliefs trumped basic human rights.
Religion should not be above the law. Sometimes, such as in emergency type cases, it may cause issues such as with a woman who had planned to have her tubes tied after delivery. A catholic hospital would refuse to do this thus causing the woman to have the procedure done later. Anyone seeking care at any religious affiliated hospital needs to use extra special caution as I can tell you from experience.
I will apologize beforehand if I offended anyone but I feel very strongly about this as our life-shattering experience happened mostly at a catholic hospital. To e sure, some started at a major teaching hospital's affiliate branch but the sexual abuse happened at a catholic facility. The lies, drugging started at the teaching hospital. We have great hate, anger, and a healthy dose of fear for both types of hospitals. JR
I read the thing about the ACLU and the lawsuit. Something beyond LGBTQ issues terrified the hell out of me:
"They seek an injunction that would permit health care providers to discriminate in health care, including by screening patients based on religious doctrine."
Remember: it's not only a question of non discrimination in access to healthcare. Some people are FORCED into healthcare. And the mere idea that a healthcare provider feels that he may be entitled to know about the religious beliefs of a person that he coerced into healthcare scares the shit out of me. He is NEVER entitled to know my religious or philosophical beliefs, EVEN LESS if the patient was coerced in medical care. That's an assault on freedom of conscience. If a patient chooses to voice his religious or philosophical concerns, it MUST be only of his own volition. And it must NEVER be consigned in his medical records without the patient's EXPLICIT approval. That would apply EVEN IF the patient is considered mentally incompetent.
Sorry for the capital letters, buf I feel very strongly about this specific issue.
Yes, there should be separation of Church and State (as outlined in the US Constitution) but in terms of the effect of religious teachings and rules as they apply to patients and their dignity, what do you think about the California Medical Association's argument that a church should not "interfere with physician clinical decision making, medical staff governance" and specifically the California Medical Association's brief to the Court states "long standing policies prohibiting the lay practice of medicine." Do you think the California Medical Association has a valid argument? ..Maurice.
I'd say that churches can legitimately have a voice in all public affairs, and that includes medical ethics. It's not because they have convictions that their claims are above scrutiny and criticisms.
As to the claims of the California Medical Association, I'd rather have access to a link expounding their position before making a specific judgement. I tend to intuitively agree with their position, but I cannot pronounce myself on its argumentation.
What follows may be a inadequately defined question but perhaps others can phrase it better than me.
Do you think that the medical profession as a whole has the professional, moral and ethical right and responsibility to reject the request of an individual (male or female) to remove a genetic present organ or tissue of his or her body simply in order to change sexual appearance or function but not because of any tissue pathology or dysfunction and not to enhance the genetic sexual appearance? If enhancing genetic sexual appears through cosmetic surgery is acceptable, shouldn't reversing sexual appearance and function also be an acceptable professional act? ..Maurice.
It’s ok to perform abortions, donate your kidneys therefore I don’t see why not.
PT
I've been hard pressed to think of how hypothetically such a situation could occur.
I believe that there is a right and a responsibility for doctors to oppose such type of surgeries on the basis of the consequences it may have.
However the lack of tissue pathology and the lack of cosmetic benefits do not constitute sufficient reasons to argue that the person making the request does not have a case.
As it stands, it seems to me that the patient is not disproven to have a case. Requiring the case of the patient to fall in the scope of tissue pathology or cosmetic benefit seems to me a way to restrict and thus frame the discussion to obfuscate the patient's case. Moreover, beyond framing the discussion in the aforementionned sense, it seems to argue that given the lack of perceived benefit, there are risks that ipso facto should predominate in the overall estimation. This is a nonsequitur. However, I do not dispute that there are risks in such surgery. As far as I see, medical professionals did not make a case for the existence of risks. The patient does not seem, either, to consider risks in his appraisal.
In this situation, no one really seems to know what they really aim at doing. This seems to me the only sensible ground to reject the request for surgery. But that does not mean either that the request is intrinsically unacceptable, as per to your wording, Maurice.
Maybe I am mistaken in what the question entails. Clarifications would help.
Is the question related to intersex adults who want to backtrack on surgeries they had as a child?
I was refering more to freedom of thought rather than freedom of conscience.
I'm also aware of ethical discussions pertaining to freedom of thought in a psychiatric setting, notably in delusions. I do not consider them wholly irrelevant, but I do consider them misguided.
JR said:
Wouldn't all of this be covered uncover the guise of cosmetic surgery? I think the need to reverse would be as important as the need to enhance especially if the individual thinks the original was done in error and most likely without their consent (probably by a parent). If I am not mistaken, doctors refuse all the time to do certain procedures and usually get out of it by delaying or referring to another provider.
Also, most hospitals always ask your religious affiliation so this is an invasion of privacy as they really do not need to know. The patient or the family will take initiate if any spiritual guidance is needed. This was done to my husband while he was still very drugged so he answered when normally he would not have. They have their bag of tricks they use. They also ask if you are physically, sexually, or mentality abused. This, too, was done when he was drugged. They continued with does he do laundry, grocery shopping, have a personal checking account, what type of house does he have, etc. This all was done while drugged and less than an hour after the PCI. He didn't know what he was doing or he would have refused. The next day the admitting clerk needed to know who he preferred to have with. He was still drugged then too as the effects last up to a week or more on him as far as mental functioning. He refused 2 times to have the follow up with him in one of their programs after release. However, using coercion, they told him they would be able to adjust his prison release to sooner than later if he cooperated and joined the program. He did and got paroled early. The first phone call he told them not to call back again. They did under the guise they had no note but he again told them not to call back and finally they complied.
The thing is he would have never known the extent of the information they were seeking if he had not looked at his medical records. They do it when drugged so patients cannot remember everything that is done. He remembers being asked questions but couldn't remember all the specifics as he remembers the more traumatic happenings. Since they gave him such high dosages of fentanyl and versed, it worked against what they were hoping would he happen. However, they almost killed him during the PCI due to the drugs decreasing his blood pressure and breathing rate and they refused to make note of this prior at the 1st hospital when we told them this would happen. JR
One of the issues overlooked by healthcare is the psychological side effects. For me, growing up I NEVER had any genital exams. I can only remember one when I was 5-6 years old, a hernia check in my 20's for employment physical, and having a lump checked on my right testicle ONLY in my 40's (this was only to placate my wife).
The risk of cancer or some other pathology was much less that the psychological trauma that such exams would have (still would) cause me. I knew the epididymal cyst )in my 40's) was NOT cancer, but the mental trauma my wife put me through, and (more importantly) my love for her, I had it checked. I still have flashbacks and somatization from the experience.
Philadelphia is like San Francisco here on the East Coast. I have many friends in the LGBTQ community. There are many stories of those who committed suicide rather than NOT live as the person that identify with mentally.
Among transgender adults, the lifetime prevalence of suicide attempts is 40%.
Suicide risk in LGBTQ people is thought to be highest during the teen years and early 20s. In 2015,
more than 4.5 times as many LGB-identified high school students reported attempting suicide in
the past 12 months compared to non-LGB students (29.4% vs 6.4%); 42.8% of LGB youth seriously
considered suicide. Source: The National LGBT Health Education Center (part of The Fenway Institute)
primum non nocere
I know many people that have survived and even prospered when they start living life as the person that they are. That being said, I have known many that ave made physical alterations to their body to affirm their gender. There is still much about gender that medicine does not understand. For instance, my best friend is a transwoman (male to female). She did NOT suffer from gender dysphoria, she is actually gender fluid. Basically (there is much more to the psychological aspect for this post), she got board with her male body. For HRT she takes testosterone because mentally, she is more male.
She, as many people have done (do), AND something that I ADVOCATE for, did much of her alterations outside the US healthcare system. True patient autonomy and customer service.
This type of BS is an excuse to justify paternalism. It is an exception like being an "emergency." I do about half of my lab work anomalously through Internet based providers. This is the universe's response to paternalism. The pendulum is swinging the other way. We are making providers irrelevant. We are making them retail employees.
LGBT issues have been described as the new Civil Rights movement. Let me demonstrate how absurd religious justification is:
See what Rev. Phil Snider says.
So when they continued asking him, he lifted up himself, and said unto them, He that is without sin among you, let him first cast a stone at her. John 8:7
I'm giving you a NEW commandment…to love one another. Just as I have loved you, you also should love one another. John 13:34
Teacher, which is the greatest commandment in the Law?” Jesus replied: “'Love the Lord your God with all your heart and with all your soul and with all your mind. This is the first and greatest commandment. And the second is like it: Love your neighbor as yourself. Matthew 22:36-40
Ethically, Jesus tells us love God first, then love our neighbor. That is it.
-- Banterings
PT
Not everybody thinks that abortions are OK. And the issue will never go away as long as this world as we know it continues.
Who's Jesus?
On the topic of LGBTQ issues, be very careful for what you wish for. I know that there's severe outspoken homophobia in the Americas (things are somehow smoother over here in France) and there's a need to tackle civil rights issue specifically in the US, but you should not make the mistake of alienating civil society: it may jeopardise the outcomes of LGBTQ medical rights. I say this because I do not consider someone like Jordan Peterson to be a marginal matter for LGBTQ people, and I know that I am myself often annoyed by some LGBTQ arguments. In an ideal world, I'd really advise LGBTQ activists to focus first on medical matters, and set aside their pet peeves to focus collectively and prioritarily on the most egregious issue. I believe intersex surgery to be a good candidate for the most egregious issue on which LGBTQ groups should prioritarily focus.
But you're right on one thing: LGBTQ issues are the current most pressing issue in the history of the civil rights movement.
Do not make too many mistakes. It may cost dearly not only to LGBTQ people but also to the other civil rights movement that are currently hiding in the shadow of the LGBTQ movement. When we'll stop worrying about who fucks who, other issues will indeed spring up to the front of popular consciousness.
I think that a discussion of the interaction between the religious or other excuse-rationales for physicians capable of performing abortions who refuse vs the requesting patient is an important conflict as we discuss patient dignity. Here is a specific discussion with visitor comments on this 2011 issue of Freakonomics and I would like to present here one visitor comment who adds a whole new dimension to this issue:
Julie August 24, 2011 @ 7:49pm
I sincerely hope that all those doctors who refuse to perform abortions (and the populace that agree with them) support socialized medicine (so the new babies can have proper medical care if the mothers have no insurance), daycares in high schools (so teenage mothers can finish their degrees), expanding the welfare system (so unemployed single mothers can take care of their children), and a full sex-ed curriculum in high school (so fewer teenagers are getting pregnant in the first place -- abstinence-only education doesn't work).
Also, I hope that they all have adopted children in their homes -- because if a mother is forced to have a child he or she doesn't want, SOMEONE has to take that child, and the foster-care system is laughable.
There is much to consider and fix in the way the medical system is currently playing out if social communities are eager to preserve patient dignity. ..Maurice.
F68.10, thanks for clearly identifying your current national residency. It is important and I have been repeatedly trying to encourage folks living in countries other than the United States to participate in discussions here.
I am glad that you brought up intersex surgery issue discussion to be an important issue in the LGBTQ communities since that correlates with the legal case example I brought up to the thread two days ago.
I have a feeling that the medical community is going to be faced more and more frequently with these issues since LGBTQ is, I think, not going away and is only going to be "coming out" more---why? Because of its biologic genetic basic origins. ..Maurice.
https://www.google.com/amp/s/www.ladepeche.fr/amp/article/2017/12/04/2697657-intersexe-une-plainte-contre-la-chirurgie-des-nouveau-nes.html
That's the first legal case concerning intersex surgery in France. (English translation)
Is there anything that strikes you as fundamentally different to the US situation, Maurice?
I agree Dr B
Anybody who opposes abortions should be willing to step up to the plate and help out or they are HYPOCRITICS!
Maybe they could be a babysitter ( unpaid if nessasary ) Maybe they could help the woman/ family pay their gas or electric bill or water. Even take this family into your home if need be.
Have I done these things? Yes, actually.
I DON'T think posted anti abortion posts accomplishes anything though. The only people who would listen are the people who already agree.
More people seeking to adopt should have their husbands/ boyfriends sign the birth certificates and uphold the woman through out her pregnancy. OK. I've said enough. I don't judge women who get abortions. It's just sad to me because I tried but could never get pregnant.
F68.10,
My point is that those who hide behind the Judeo Christian religion are hiding behind the Old Testament. That was violent, and the 600+ commandments were meant to keep the human race alive. At the time of Christ, the Greeks were developing modern math, the Romans developing public health, and the Egyptians modern medicine.
Once we did not need all these rules to keep mankind from going extinct, what do we need to do? Love God, and love each other.
If you want to apply ethics, then here it is: love each other.
Hatred is NOT a Christian value.
This is the hypocrisy of religion just like the hypocrisy of healthcare.
-- Banterings
Inacurate.
https://www.dominicanajournal.org/holy-hate/
(I was educated by Jesuits...)
I'm not particularly religious but many people are. That Catholic hospitals in particular might not want to perform certain procedures doesn't bother me at all. Few hospitals provide full services covering everything a patient might be seeking. Doctors specialize as well and people just need to seek out the doctors that do the kind of procedure they are seeking.
That said, all patients no matter their gender, race, ethnicity, religion, sexual orientation, age or disability should be treated with respect. This is the aspect of healthcare that should be universal, not services provided.
At a personal level I do my best to say yes to anything my doctors recommend and to follow their instructions. I am a very compliant patient in that regard, including with their staff. I try to be pleasant and polite to everyone no matter their role. If I buck the system it is over my refusing sedation and my wanting my privacy and modesty respected.
Discussions here have gone down numerous aspects of dignity that some see as not being well addressed by the healthcare system. My requests are very simple:
From the powers-that-be I want them to make an effort to hire a few males in key areas for male patients that would prefer male staff for intimate matters; urology, dermatology, & sonography in particular but also in inpatient areas for things like bathing, catheters and such. Just a couple token males would make a huge difference.
From the female staff I want them to show empathy to gender based requests rather than mocking or bullying the patient. They are not at fault if there aren't any males but how they handle the situation is entirely on them. Remember the difference between convenience and necessity. Close the door, pull the curtain, ask before bringing anyone else into the room, if you need to view the abdomen, put a towel or sheet down first and then lift the gown up from underneath. And so forth. Act as if the patient's privacy and modesty matter to you.
If healthcare would do these two things my needs would be met.
JR said:
About abortions--I agree that women have the right to decide what happens to their bodies but getting and using birth is so easy. Yes, I realize it is not 100%. Women can decide whether or not to have a child but men have no choice. Maybe a man might want to raise that baby even if the woman does not want the baby. However, a woman can choose to have the child and thus bind a man who didn't want a child to it at least financially forever. The absolutely foolproof method is not to have sex so being sexually active comes with responsibility. Maybe a little more responsibility in the beginning would bring about a different end. Abortion should not be used as a form of birth control.
The other thing I absolutely don't agree with is if a full term baby is aborted but born alive then they are wanting to be able to murder a fully viable human being. To me, that is murder pure and simple. On the other hand, medically assisted suicide is not acceptable when a person is terminal. So if people are so progressive they are willing to murder a baby then why won't they allow a terminal person who is probably on many drugs to die sooner than later? Could it be the progressive crowd is closely tied to big pharma? Exactly how progressive are you when you advocate murdering of babies who could survive on their own?
Banterings,
Upon reading your post about your wife wanting you to have the exam made me remember that I am the one responsible for making my husband seek treatment when I knew he was having symptoms of a heart attack. The guilt I live with because of the abuse that was suffered is almost unbearable. The what ifs are tremendous. The real hypocrisy of religion is that each religion believes that are they only ones in the right and their god is the only one. Some religions also still believe that killing a heretic is not a crime. Napoleon once said that religion is the social order...that keeps poor men from killing rich men as the afterlife makes all men equal. This was paraphrased from the The Mind of Napoleon written by J. Christopher Herold. There is nothing wrong with having religious beliefs as long as it is recognized that other people are equally entitled to have their religious beliefs. However, too many religious groups have decided to have their own beliefs such as making women wear blue jean skirts and their hair up. This doctrine to me is similar to Muslim women having to wear burkas. However, the men have little or no restrictions on their mode of dress. Religion itself is discriminatory in many ways so it is no wonder that a religious hospital practices discrimination.
Given that many doctors are condescending in their attitude towards staff, it is no small wonder that staff retaliate on selected patients. None of this is right or should be tolerated. At least here in the US, no one is forced to become a doctor so they need to get over themselves and the long years it takes to become one. It takes long years to become a lawyer or a school principal.
I read on one catholic site they say they can tolerate a person believing they are gay as long as they don't act upon it. (Although too many priests are not able to act upon their vow of no sex especially w/ boys.) Maybe bc my husband's papers said he was a gay married man is why they felt they had the right to abuse him? The hospital my husband had his prostate surgery had a Jewish affiliation complete w/ a Sabbath elevator. They respected his rights and personal dignity although the doctor himself had quite the attitude. JR
Is there any study of patients' wishes or suggestions in the US similar to the one that's recently been published in France?
https://qualitysafety.bmj.com/content/early/2019/04/17/bmjqs-2018-008593
JR: I have just one question for you. How do you know, and not simply believe, that abortion, or for that matter assisted suicide, should not be practiced? Because on such an important and controversial matter, I need to know what should be done, and not merely believe what I want to believe should be done.
What's your line of thought on this matter?
An important question to ask our group here which hasn't been fully considered is when does human dignity begin and end. We have discussed recently about the death of a formerly living patient and from the aspect of how to behave with the dead person from the time of death to burial or cremation. My experience is that attention to dignity continues during this period even during formal autopsy where I have never seen any "playing around" with the body being examined. Obviously the thoughts of the deceased's dignity through life may persist in the minds of the living after death.
The other aspect of "dignity" which hasn't really been discussed here as yet is about when does a person's dignity begin.. considering a fertilized ovum to an embryo to a fetus to a baby at term. This is an important issue if one is considering matters such as abortion. The question: Does the acceptance of an individual's dignity begin at the moment of birth but not before? Does the individual have to actually enter and face the outside world for human dignity in all of its aspects to be a valid attachment to the physical and behavioral body? Does a religious dictum against abortion or even contraception operate on the philosophical concept that dignity arises even from the gamete stage of reproduction? And finally, is there a concept that those who agree with abortion are themselves "undignified"? These are some issues to consider here on "Patient Dignity". Oh..and by the way, when does the term "patient" apply? From the fertilized ovum all the way to the moment of birth? ..Maurice.
JR said:
I see both sides of abortion. I understand and disagree at the same time. I totally disagree with the outright murder of the baby once it is outside of the womb. The woman"s body has ceased to be a rights issue. As for assisted suicide, I think people have the right to choose they no longer have the will to live. After seeing my father die with hospice through a Catholic hospital, it would have been more humane and dignified if assisted suicide had been an option. JR
F68.10,
I cannot argue with you. Who am I to think that I know God's thoughts? What I do know is that If one were able to look at God, all we would see is love. All I can do is what I believe that he wants us to do: love Him above all else and love our neighbor.
I am human, I am not perfect, I fail at times. Recently, I have less love for providers than I SHOULD have for them as my fellow man. When I hear of a physician committing suicide, I think that this person was following the training as a doctor and and ignoring patients' human dignity to the point that they can no longer live with themselves. I think that this person is never going to own up to, let alone atone for the atrocities they have committed against patients' human dignity, so society is better off without them because no one else will be hurt.
This is not me. Due to hearing stories recently like PEs on anesthetized women and people I know (like JR).
-- Banterings
A physician committing suicide? I don't think that abusive people commit suicide!
More likely that physician wasn't able a patient(s) that he or she thinks they should have been able to save.
Maybe there's bill problems. I think it's to common for doctors and medical staff to work long hours. Maybe they did to many hours for too many years and now their kids and grandkids don't know them or love them and they realized their mistakes.
It makes me feel really sad when I've heard about them committing suicide.
I don't think Twana Sparks kind of physicians would do it!
"A physician committing suicide? I don't think that abusive people commit suicide!"
Of course they do! Here's an example with a nurse (I know a similar example that's unfortunately not anonymised on the net):
https://www.sciencedirect.com/science/article/pii/S0379073805004184
The self blaming of abusers is a very real thing and can go quite far. Some abusers are without remorse, however, that's also granted. Couldn't find studies concerning suicide rates of abusers though. Seems like no one cares studying that specifically.
Physician suicide is a serious issue. They have a hard time forgiving themselves. Some of them may be hardcore sociopaths, but I do not think all abusing physicians are sociopaths. That would be way too convenient for an explanation.
Banterings et al: here is a definition of patient dignity as used in the medical profession which I learned today which turns around my orientation of the locus of the the dignity: Dignity is not inherent in any particular patient but it is the application of that description by OTHERS--in the medical system--by the physicians and nurses et al. Dignity of that patient is present when the professional sees behavior of a patient that fits their definition of "dignity". This definition would also affect my concern as to whether a fetus or unborn child should or should not be considered having dignity until the child is born and faces the environments of life. If dignity of the unborn is set by others then birth itself is not necessarily the turning point when dignity first can be applied.
Banterings, how do you consider patient dignity to be defined, as intrinsic parts of every patient or only if so applied by the evaluation by others? ..Maurice.
F68.10
After I wrote my comment it didn't come out like what I meant it to.
It looked like I was making physicians synonymous with abusive but I don't think that.
I think it's COMMON for doctors and medical staff to violate a patients modesty. I don't buy that it's all unintentional either.
I think I meant that really guilty people don't feel guilt about anything.
Any physician who commits suicide, probably is not a bad person. He or she went to college with good intentions. Possibly they feel surrounded by enemies. Other doctors who take shameful advantage of patients. Plus whatever else goes on in their world that maybe we don't know about.
I believe the following paper describes the concept of dignity as closely as I can imagine it and analyse it. There indeed is an intersubjective component to the concept of dignity. (I do have some issues with some aspects of the concept of dignity, though.)
https://link.springer.com/article/10.1007/s11673-010-9254-2
But there's indeed a link with some of my meta-ethics views. (They're too complex to nail down in a paragraph or two in such a post comment.)
When it comes to fetuses or unborn children, however, I do not believe that dignity is the most fundamental point. An ethical point that trumps, in my opinion, the concept of dignity is the concept of potentiality: do we have an ethical right to bypass the fact that an unborn child will be denied arbitrarily the right to have a life? I believe the answer is yes, but dignity has only indirect relevance to the argument I would put forth.
To me, dignity seems a concept more tailored to evaluate ethically what has been done in the past than it has to do with the future. That's what the concept of narrative refers to, as per the title of the paper I linked: "Dignity and narrative medicine".
(People, tell me if I comment too much! I absolutely do not want to annoy you!)
"Dignity is not inherent in any particular patient but it is the application of that description by OTHERS--in the medical system--by the physicians and nurses et al. Dignity of that patient is present when the professional sees behavior of a patient that fits their definition of "dignity".
This is the very problem that has been discussed here for years. What the patient thinks or feels is deemed irrelevant. Though the definition speaks to whether the patient is deemed to have dignity, at a practical level the ramifications extend to whether the healthcare provider treats the patient with dignity. Each healthcare staff member gets to decide for themselves what constitutes necessary and appropriate exposure in addition to how they are generally treated. This definition gives healthcare staff a pass for their behavior so long as they are polite while they do it.
JR said:
So does that mean when a man arrives having a heart attack the medical staff can judge & decide bc of this, that man deserves not to be treated w/ dignity? If that is the case, does it apply to other aspects in life such as an grossly obese person buying Twinkies, a person on an oxygen tank is buying cigarettes, a person on food stamps is buying booze/cigarettes w/ cash, or a 3rd generation WIC recipient is complaining about bc they cannot buy everything grandma did? I thought that affording everyone dignity and respect was what kept the world civil but if the medical class is able to judge who does and who does not get treated w/ dignity then it should apply to all. That is a scary definition of how dignity can be used but it does define how some religious hospitals exist bc they are the judge and the jury so no 2 patients can expect to be w/ the same dignity & respect principles. Is that also why many unconscious or drugged males are left exposed bc they judge bc they are unconscious/drugged that patient is owed no respect? How dare that patient be unconscious or drugged!
I believe that like in the link provided by F68.10, abusers may commit suicide when it apparent they are going to get caught. It is not remorse but they don't want to face the consequences of their actions. It is also fitting that a benzo was used as it is the group of drugs used for evil purposes of altering or erasing memory. Doctors have been that decision that us mere mortals are not strong enough mentality to have memories of our medical procedures. The nurse who did the hardcore abuse of my husband has quite the social media profile. She thinks bc she lives in a certain area, she is better than (although I grew up in that area couldn't wait to leave & purposely came to where we are at) where we currently live. She thinks she has movie star looks and all thinks she is beautiful and should adore her. She also lives to drink and party. She complains about work and how difficult it is. This is all out there for public knowledge. At school, we were told to be careful w/ social media bc parents & students look. Her political views are very radical & she makes no bones about her dislike of those who may disagree w/ her. Apparently, this nurse has no such restraint. It is not difficult to see why she acted like she did w/ her social media profile. I agree w/ Banterings, I would not be sad at all if I read she had committed suicide bc she is a monster for what she has done to mostly my husband & then me. I wonder how many more are silent victims of hers? What the cath lab was bad enough. Maybe the cath lab heifer-hags clued her in to what they had done so she could continue? Maybe when the have a patient on the gurney they don't bother to regown properly that is a silent clue they have judged that patient unworthy of respect & dignity especially when they let the gown fall off & no one bothers to cover the helpless victim? JR
"After I wrote my comment it didn't come out like what I meant it to."
That's perfectly fine. On such sensitive topics, we should allow ourselves to correct our wordings, backtrack on our positions, and even flatly admit that we were wrong or that we now simply don't have a clue anymore. Otherwise it can easily end up as ego posturing. So you're perfectly welcome to correct the perception of what you claimed.
"Plus whatever else goes on in their world that maybe we don't know about."
Oh yeah. As the son of a physician, I've delved far too deep in their psychism. It's tough, I tell you. They're prone to so much intellectual confusion...
As weird as it may sound given the hatred I have for physicians, I can safely state that as a collective profession, they really need the help of patients to sort out their mess, even if they won't admit to it.
What we should never do, however, is let their bullshit fly past us without clear opposition. And it's much tougher to do than to simply state or claim...
I wanted to encourage everyone to check out the below two videos by Medical Patient Modesty. The first video includes sections, Surgery and Your Modesty & Problems With Medicine Being Gender Neutral.
1.) Patient Modesty & How Patients Can Protect Themselves in Medical Settings
2.) History of Gynecology & How To Prevent Sexual Abuse in Medical Settings
Misty
The subject of religion has been mentioned on this blog in discussions relating to churchs etc. As you all may know there are
over 600 Catholic hospitals in the United States not to mention over 1900 other health related medical facilities. There are
mammography suites at over half of these hospitals and of course you all know there are no male mammo techs working
anywhere in the country.
Therefore why is it that there are no accommodations made for men in any capacity at any of these facilities. So the big question
then is, “ What would Jesus do”. After all these facilities deliver healthcare in the name of religion. Am I correct on this subject.
Their mission statement if you will says “ $&#@*%. raises the ministries collective voice calling for access to healthcare for all,
focusing special attention on vulnerable populations who are unable to speak for themselves.”
Please take time to visit CHA on their E-Web Advocacy tools for citizens who have concerns to address in that they may make
regulations and submit to policy makers in Congress.
Thank you
PT
I'm still looking for an answer to the question of whether patient dignity is inherent potentials within the patient,within all humans or is patient dignity something others (such as the attending physicians, nurses, etc) decide after observing the patient's behavior ("this patient demonstrates dignity" or "this patient does not demonstrate dignity"). ..Maurice.
Maurice
Why should ( physicians, nurses) ponder such thoughts? What behavior would a patient need to exhibit to elicit that they
are deserving of dignity. Is it not a fundamental concept that advocating for patients includes respect, privacy and involving
them in the decision making process. Are these concepts not involved in the bill of rights and I would think that the deceased
and the unborn are included but apparently not considering all the crap we read about involving the mistreatment not only from
what we read but from actual experiences of those posting here? Healthcare is in a shitty state of affairs. How much more over
the $4 Trillion dollars spent annually do we need as a nation to spend to get some dignity? I don’t think we can afford it.
PT
Related to m;y April 29 California court case description of a transgender man who was denied a hysterectomy at a Catholic hospital, here is a pertinent article in Mother Jones political news regarding "The Trump Administration Just Said Religious Doctors can Refuse Medical Treatment for Patients"
Health care providers can refuse to provide medical care, including contraception, abortion, and procedures for transgender patients, that violates their religious or moral beliefs, according to regulations published by the Department of Health and Human Services on Thursday. ..
The rules specifically mention abortion, sterilization, and assisted suicide as services that health care providers can opt out of performing for religious reasons. The rules only make a passing mention of gender, saying that the department had received a number of comments asking whether the part of the rule that allows doctors to refuse to perform sterilizations on moral grounds included sterilization because of gender dysphoria, such as a hysterectomy (removal of the uterus).... According to Politico, the administration is also expected to issue more specific rules that would roll back discrimination protections for trans patients.
A question about the profession of medicine. What are the limits regarding "moral grounds" to refuse to treat patients? Should those limiting "moral grounds" should be made known by all students applying to medical school education to become physicians? How should medical school admitting committees set limits to what "moral grounds" are acceptable for admission to become a physician? ..Maurice.
PT
In Leviticus in the Bible it's made bell clear that being seen naked by the opposite sex is to be avoided.
Possibly part of that problem is God talks to males in the first person kind of way ( or maybe the persons doing the translations did that )
In my church one of our co-founders Ellen White (we've been accused of making her into the god of our church ) speaks out about the intimate opposite sex exposure. She includes. female staff attending to naked/ nude men, INCLUDING female physicians. She talked about there being a need for female physicians all those years ago.
Babies don't feel ashamed of being naked/nude like someone older often do but that doesn't mean an older version of themselves wouldn't be upset by a naked baby picture.
I personally think it's a huge violation of who and what they are anytime a baby/fetis old enough to feel pain is aborted.
JR said:
As I said in an earlier post, no one has the right to decide if someone is worthy of dignity and respect. That would break down social order. That would allow anyone & everyone the right to decide if a fellow human deserves to be treated w/ dignity & respect. Or are doctors so special & deity-like they deserve that right to decide. Certainly, they already take enough rights away from patients.
PT,
Thanks for the info. on CHA. We are starting to send my husband's story out to various organizations. As much as he doesn't like sharing the fact he was a victim of sexual abuse bc being male, he feels people will laugh & think he was a weak male to let it happen, he also feels this needs to brought out into the open so others won't be victimized. We are sending it to the very top of the hospital corporation including the board. His medical records privacy have already been violated by them and really he does not have any type of privacy left as they also violated his bodily privacy. So in addition to all the agencies we have looking into them and violating their privacy that as a medical institution they enjoy and relish having, we want public spotlight on them. I feel they call for healthcare for all as they know they can control & manipulate the poor & uneducated. The medical community only likes patients who comply w/o thought. If you ask why, then you are labelled as being difficult. If we only knew the extent of how many procedures & drugs are done & given needlessly we would probably never visit another provider again.
Up to until when this happened, my husband was not opposed to care given by females as he never realized that he had a choice and it was always that way. The drop your pants & bend over routine seemed to be the norm in urology care. When he had his prostate ultrasound sound done & biopsy done, he thought nothing about it bc he thought it was okay since that area was needed but they did cover him after the drop your pants. It wasn't until this time when he was drugged and they didn't need access to the area that he realized as he was trapped in his mind with thoughts & humiliation he wasn't able to express bc of the drugs, what they were doing was wrong. To strip and leave him exposed was totally unacceptable. To be in the midst of 4 women while so incapable of defending yourself and not being able to stop them from doing whatever they pleased was totally scary. Then to be alone w/ the abusive nurse and her cohort while again totally exposed w/o reason was the absolute breaking point. What about my husband made them decide he was not worthy of respect or dignity? Was it bc it was a 67 yr old white male? Was it bc they thought he was a married gay 67 yr old yr while male? Was it bc where he lived as they look down on the town where we live? Was it bc they were called in on a Sat. night? Was it bc he said he had prostate cancer and didn't have it done there? What is the criteria used to decide who gets dignity/respect or not? To go down allowing one group to have special rights to decide how humanely groups are treated is a slippery slope. Just check how Nazi Germany. JR
About the modesty/dignity issue.
I don't think it's easy or even possible for a patient to just decide that they are not gonna be embarrassed about being seen naked.
It's true that some are not or that some are only a little bit embarrassed. But that's individual personalities.
If we could just decide to not feel the mental anguish , rape victims would certainly do exactly that.
I deliberately didn't say sexual abuse victims because in my mind modesty violations ARE SEXUAL ABUSE! It just isn't acknowledged as that within the medical world and what passes off as protecting and providing comfort to the patient is actually ABUSING the patient.
Dr. Bernstein: Medical professionals have the right to refuse doing procedures on patients due to religious and moral convictions. It was fine for that Catholic hospital to deny that transgendered man a hysterectomy. Patients can always find another hospital or another medical professional who have no moral or religious convictions to perform procedures on them.
Medical professionals have the rights to not do procedures on patients due to moral and religious convictions. Some examples include: abortion, euthanasia, intimate procedures such as pap smears, pelvic exams, etc. on patients, etc.
See how medical professionals can stand up for their convictions by going to this link.
Look at this important paragraph:
"Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities" according to Medical Student Section of the American Medical Association (AMA). See more information. It doesn't mention intimate procedures on the opposite sex, but conviction against doing intimate procedures on the opposite sex is certainly in the category of conscience-based objections.
JF:
It is interesting you mentioned Leviticus. It is true that it mentions that uncovering nakedness of the opposite sex who is not your spouse is wrong.
I think you would be very interested in watching this video by BiblicalModesty.com, Modesty in Medical Settings From a Biblical Perspective. It’s over an hour and 30 minutes long, but it has a lot of information from a biblical perspective.
Misty
I thought you all would be interested in reading this article, Med Student Avoids Pelvic Exam for Record 1,429th Straight Day. It is very encouraging that this male medical student stood up and refused to do pelvic exams. The truth is most pelvic exams are not necessary. Ultrasound is the best procedure for most cases of abdominal pain including ovarian cysts. We need more male medical students like him.
Misty
But Misty, how does one screen to detect by observation and smears cervical or vaginal cancer or cervical, vaginal or uterine infections as examples? Why have I been teaching with a gynecologist second year medical students the procedures to properly carry out screening or diagnosis on plastic female pelvis in preparation for practicing on female teacher standardized subjects? If a patient wants a female physician to do the examination, those physicians are available.
..Maurice.
Dr B
On THIS blog there have been articles talking about how x amount of women have to be screened for 30 years to detect ONE case of cervical cancer.
Also it has been brought up about self swabbing.
JR said:
Misty,
From what you said, then medical staff can be totally justified in not covering up patients if they morally or ethically don't believe in doing so. Some patients won't find that out until it has happened especially if the care is termed emergency. It is also is true the catholic hospital who abused my husband said if we didn't like how they treated him, next time go elsewhere. We would have went elsewhere this time if we had known and had been given information on choices. It seems they have no moral or ethical issue in supporting abusive treatment. So in order for patients to know what to expect, all providers including the hospital itself should be required by law to post what procedures they will perform and how they will be performed. That way they are bound by a more legal understanding. If a woman has planned to have tube tying done at delivery than if she would be taken emergently to a catholic hospital, bc of their beliefs, they will force her to have to have 2 procedures done. Given that, should the woman have the paramedics bypass the closest hospital if catholic to go to one that will fulfill her needs? Would the paramedics listen as they seem to operate w/ free rein. Paramedics do not have to honor a do not revive order and apparently they can give whatever drugs they fancy to give as well as taking you to whatever hospital they choose. How about the lack of dignity given by a paramedic when doing an EKG on a female? Many paramedics will totally strip their patients as protocol may dictate.
Cath labs want most shaves done in the ER so can you imagine how little patient dignity will be respected. The ER here locally did not close the curtain or door for my husband's cell. The other cells had their curtains drawn. Anyone walking by could see and hear everything that went on. I would pull it and they would open it. This went on for 1 1/2 hours as we waited for the not so speedy but more expensive helicopter ride. Of course, the local EMT could have gotten him there in 30 minutes if the hospital had truly cared about getting him there the fastest way possible. JR
It is like the prostate exam. The digital exam did not find my husband's cancer. It was an elevated PSA which we had repeated to verify. He no longer allows for a digital exam if he is not drugged and can defend himself against their actions.
Misty, I educated myself today with the most current answer to whether routine pelvic exams in a asymptomatic woman is proven valuable or necessary. It comes from
"American College of Obstetricians and Gynecologists Opinion" published September 24 2018 which reviews study information obtained, their conclusions and the studies and conclusions of other medical groups.
The ACOG conclusion is: Regardless of whether a pelvic examination is performed, a woman should see her obstetrician–gynecologist at least once a year for well-woman care (12). A preventive service visit also provides an opportunity for the patient and her obstetrician–gynecologist to discuss whether a pelvic examination is appropriate for her. Screening for gynecologic cancer and STIs are common reasons physicians report performing a pelvic examination in asymptomatic, nonpregnant patients. However, studies show that pelvic examinations do not decrease ovarian cancer morbidity and mortality rates (4, 10), and a pelvic examination is not necessary before initiating or prescribing contraception, other than an intrauterine device, or to screen for STIs. However, a thorough history should be taken from each patient to ensure that there are no indications for performing a pelvic examination. If a patient is found to be asymptomatic, a discussion between the obstetrician–gynecologist and patient regarding the potential risks and benefits of performing a pelvic examination should ensue. Whether to perform a pelvic examination should be based on shared decision making
It appears to be in keeping with the conclusions presented of the other organizations. Routine pelvic exam and testing in a asymptomatic woman is elective and based on full discussion with the patient.
OK..now I know why I am spending 4 hours each year with 4 groups of 6 second year students teaching them with a gynecologist how to perform a woman's pelvic exam. So they have the capacity to examine, diagnose and treat a symptomatic woman.
I would say for that 4th year male medical student to avoid learning to perform a pelvic exam with the intent not to be involved in the attention and care of a female patient is an anomaly in medical education. ..Maurice.
JR: I do not believe in abusive behavior based on religion. The way the Catholic hospital treated your husband is wrong. I was referring to medical professionals refusing to participate in opposite sex intimate medical care, abortion, euthanasia, etc.
Sadly, some religious hospitals abuse patients (like in your husband’s case).
Dr. Bernstein: While it is true that pelvic exams are necessary for some women, they should never be pushed on women. They should always have the option of having an ultrasound if it is suspected they have a ruptured ovarian cyst.
I disagree with you that all medical students should learn how to do pelvic exams. It should be optional and dependent on the specialty they are planning on going into. In fact, there is no reason for medical students who are planning on specializing in cardiology, orthopedics, neurology, etc. to know how to perform pelvic exams. There is no reason for a female medical student who is planning on becoming an ob/gyn to learn how to do prostate exams on men since she will never do prostate exams on men as an ob/gyn.
For male medical students who are planning on becoming ER or Family Practice doctors, there should be an option to opt out of doing pelvic exams if they plan on not participating in intimate procedures on female patients. Some male family doctors refer their female patients to female doctors in their practices for female health issues. Look at a discussion I had on Dr. Sherman blog at this link about this matter.
Misty
I previously stated that I'm OK with a Catholic hospital not providing certain reproductive or gender-assignment related procedures. This was because most hospitals have some limitations as to what they do, the difference here being the subject matter is politically charged.
Having thought about it more, the problem that arises in denying certain services is that where does it stop and who gets to decide. Just using one example, I'll now say if a hospital does mastectomies (which also occur pre-emptively before women get breast cancer), then they should be obligated to do mastectomies associated with gender reassignment. If we allow hospitals to discriminate based on who the patient is, how far will that be allowed to go. If the Catholic Church doesn't like this (and I was raised a Catholic), maybe its time to get out of the hospital business.
On the "where does it stop and who gets to decide" aspect of this, we already see how that plays out with fundamental patient dignity matters. Empowering each healthcare staff member to decide for themselves the extent of patient intimate exposure that is appropriate hasn't worked out real well for men, and sometimes women too.
In a nutshell, those who choose healthcare as a profession need to set aside their personal religious convictions as part of holding their license. Instead, choose your specialty carefully with that in mind.
Misty, you do great work but I will disagree with you on medical student training. To the extent that future physicians need to have at least foundational knowledge of the entire human body they need to accept the full scope of that training, especially when it is being done on paid patient actors who voluntarily serve as training subjects.
Misty, I wrote the following to a medical education listserv to which I subscribe without identifying you further than gender.
The multiple responses I got back from medical school educators was consistent with what I had written here.
What I wrote:
I need your help to respond to a female commentator on my long running blog thread "Patient Dignity (Formerly Patient Modesty) now Volume 98 https://bioethicsdiscussion.blogspot.com/2019/04/patient-dignity-formerly-patient.html who wrote the following there:
I disagree with you that all medical students should learn how to do pelvic exams. It should be optional and dependent on the specialty they are planning on going into. In fact, there is no reason for medical students who are planning on specializing in cardiology, orthopedics, neurology, etc. to know how to perform pelvic exams. There is no reason for a female medical student who is planning on becoming an ob/gyn to learn how to do prostate exams on men since she will never do prostate exams on men as an ob/gyn.
It is true, as reviewed currently by ACOG,
for female patients without acute symptoms or history of pelvic disease, there is no evidence supporting routine pelvic exams (https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Utility-of-and-Indications-for-Routine-Pelvic-Examination?IsMobileSet=false
So what should my response be to my commentator's argument?
At our medical school we teach performing pelvic exams in women and genitalia exams in men for all second year students. I know many of the students at this stage of their professional education do not yet have their eventual specialty of patient care defined. ..Maurice.
First response:
Maurice, you are right about the early stages of the degree and planning. I also wonder at this statement:
> It should be optional and dependent on the specialty they are planning on going into. ....There is no reason for a female medical student who is planning on becoming an ob/gyn to learn how
How far into their "planning" are these students? "Planning" to specialise in something is very different from already specialising in something. Plans change. If their curriculum is to be based on that they planned to do, then, all through the students' medical degree, every time they change their plans, they would have to change their curriculum. The only way this could work would be if medical students chose their specialty on Day 1 of their enrollment, and were not permitted to change their plans. If they changed their plans, then they would have to return to Day 1 and start all over again.
Next posting for other listserv responses
which supports my understanding that students in the first 2 years are not decided on their role in medical or surgical care upon entering residency. ..Maurice.
All medical students participate in an obgyn clerkship. Is this individual saying that's not necessary too?
As you both note, I've witnessed many students, planning on going into other fields, like pediatrics, and instead decide on obgyn once they've experienced that clerkship.
Likewise many/most specialty fields have general training first (like cardiologists do a general internal medicine residency first; many surgical specialists begin their training with general surgery). These exams remain an important tool for diagnosis in primary care as well.
Lastly, do we want our specialists so specialized that they have no experience or context of the other specialties? I don't think so. I think a general training helps when physicians of different specialties collaborate and consult together on complex conditions and situations.
And another, this from a profesor of obstetrics and gynecology:
On the first day of orientation, I tell my medical students, those of you who are NOT going into OBGYN need to pay the most attention during this rotation because I do not want you to graduate and be “afraid” of the pregnant patient and I do not want you to call me to do a pelvic exam on a patient on your service because she is having a yeast infection.
And I tell them about 3 real scenarios we had happen:
1) Gyn gets consulted on a hospitalized patient for vaginal bleeding- the patient was on her period!
2) A 17 year comes to ED for abdominal pain, Pregnancy test ordered, patient sent for abdominal X-ray, final diagnosis: Labor at 38 weeks gestation, clearly no one even recognized a third trimester pregnant abdomen or put their hand on the patient (or maybe they did and they do not recognize a pregnant uterus)
3) A surgery resident places the foley catheter in the patient’s vagina because was confused about the anatomy
Students not doing pelvic exams will only create a larger black box and will make them afraid of the pelvis as well. This will only compound the above problems and women end up getting worse care.
I also would like to connect to this the Basic Sciences discussion. Health care is already so fragmented and doctors are so sub specialized, complex patients lose out because some doctors cannot put it altogether because they do not understand pathophysiology of disease. We essentially suppress our students’ intellectual curiosity if we do not discuss the foundational sciences. And if we add to that, cutting portions of the physical exam, we will only produce worse doctors.
The words of one of my mentors never leave me:
Medical school without foundational/basic sciences= TRADE school.
I hope we do not lose our professional identity by taking short cuts.
Finally, it is really important to clarify that just because pelvic exams are not helpful in preventive care does not equal they are useless. Those are very different issues.
Misty, I think the teaching of physical examination and the diseases which may occur in patients should be the same for all students and when the individual, male or female finally after rotation on the wards in the 3rd and 4th years or later in residency decides on a ongoing specialty or general practice, they all will be prepared. ..Maurice.
And now..how about Patient Violence Against Physicians: What You Can Do"?. Does that diminish "Patient Dignity"? Does any of my Commenters find news stories naming names and documenting this issue? Though I personally have not witnessed the events written about in the linked article, this behavior is apparently going on. Is all this violence against physicians, in your opinion, initiated by physician misbehavior or worse? ..Maurice.
I've only known of a patient hitting a doctor one time. In 2000 a coworker said her elderly father in law punched his doctor for performing a rectal exam.
I can understand the old man's anger. I've had only one such exam and I wasn't happy.
I forgot to include part of my little ER horror story. The reason I am posting it now is because I want to make everyone aware of another class of drugs that can be very damaging - flouroquinolones. I am very grateful that JR and others have exposed what the makemsick criminals do with Versed and like drugs - to erase our memories of sexual abuse, plain ole' abuse, and of course, the many medical errors they make.
The ER DO diagnosed me, and I had an uncomplicated case of diverticulitis, an infection of the colonic diverticula. As has been noted on the blog - MONEY, POWER, CONTROL – these are what rule the makemsick industry, and they had their go with me! The ER DO, it seems, didn’t take the 45 seconds needed to look at my EHR, which noted previous eye surgeries, one for a retinal tear and the other for a retinal detachment, a most serious issue which can result in permanent blindness if not treated quickly. These occurred some 15 years ago. The antibiotics prescribed to me were Cipro and Flagyl, both in the flouroquinolone family of antibiotics. NEVER TAKE A PILL WITHOUT RESEARCHING IT BEFORE! I warn everyone of this class of drugs, for they have done much serious and lasting damage to many people, so much so that there are several I’ve been floxed type sites online. (Nerve damage and ruptured tendons are common side effects.) Cipro has been used as an anticancer drug as well as for anthrax, if I’m not mistaken! There are now black box warnings but apparently the ER DO didn’t bother to really care for me individually, he just prescribed the recommended poison. They got rid of me quickly after that. I was so ill (too out of it to think to call a friend) and I don’t know how I made it home driving a full size pickup on dark, rural roads. I recall hallucinating at one point, thinking I was back at home in the county in which I grew up in. I promptly vomited the Cipro and Flagyl up, and passed out. I took the Cipro for 3 days (a 7 day course) but was unable to even hold down water, so I discontinued it. The 10 day regimen of Flagyl I endured for 5 days, then discontinued due to continued severe nausea. I finally treated myself with amoxicillin and got rid of the infection!!! I was bed bound for a month, not because of the disease,but because of the drugs. I lost 30 pounds, a lot for a slender person. But, the real damage didn’t rear its ugly head until several months later, when driving home at night, I discovered I had had rapid cataract genesis, which is associated with some of the flouroquinolones. I knew it would be a long, painful journey to try and sue, so I am left with fairly severe cataracts, and I’m not a candidate for cataract surgery (which is not all that problem free, but, a real money maker!) due to previous eye issues. Flouroquinlones are associated with vitreous and retinal detachments, as well as cataract genesis, but, no one bothered to check my EHR and prescribe a less dangerous drug. I warn everyone, this family of antibiotics should only be used as last resort, but makemsick providers hand them out like candy, even for simple things such as acne! Now, I can’t drive at night, nor against a low sun. And, of course, the vision loss associated with cataracts is most distressing, and the glare can drive one crazy! Yes, the morons basically destroyed my clear vision for what - ??? I wish had treated myself, and my vision would be okay. I have worn glasses for myopia since 6th grade, and due to these poisons I have had to get prescriptions that are TRIPLE the correction I used all my life. And basically, one eye is along for the ride. I don’t know if I will pass my next DMV vision test. This severe damage to my eyesight was not necessary to cure the infection, but as I was just a senior pork belly, WTH!
EO cont.
So, JR, I understand how dangerous drugs can be, and the ones they abused your husband with are de rigueur, are they not, for the makemsick critters are eager to wipe out customers’ memories of medical errors and sexual abuse.
I would have much preferred an AI, both for diagnosis and nursing care. Maybe then I would have been treated as an individual human being, and maybe I wouldn't now have quite diminished vision and all the misery that accompanies it.
So, Reader, if at all possible, don't take ANYTHING from an ER until you can get home and research...
EO
Maurice
I just have to respond to the article regarding violence against physicians. In my opinion as well as others OSHA is just full
of crap, they are another useless organization like the Joint Commission. From what I’ve seen in my healthcare experience
violence against physicians is rare, very rare. Yet, I’ve seen physicians punish patients in a number of ways, ordering foley
Caths when the patient didn’t need one. Pinching patient’s skin with a hemostat to make them shut up and then the verbal
abuse which is instigated by nursing staff.
During an Orthopaedic surgical case the circulating nurse tells the surgeon, “ the patient is an attorney “ at which the surgeon
then states “ ok, we won’t give him any pain meds when he wakes up”. You see, it’s shit like this that makes me hate Fuc&ing
nursing. They do instigate comments like this to physicians when they hate their patients and they hate all their patients. There
does not exist enough cyberbytes in cyberspace to tell all our readers all the medevil Shit I’ve seen nurses and physicians do
to their patients over the last 4 decades. It makes me want to vomit.
Where are the countless articles published by OSHA describing the violence in nursing, why are they not on Medscape. Look
them up on the web. OSHA has published many articles on the violence among nurses and how they take their hate out on
physicians and their patients. Oh but precious Medscape and KevinMD and the New England journal of medicine, God forbid
if the true evil personalities of nursing ever reared it’s head as articles in those publications and journals, god forbid.
PT
I have seen accounts given on this blog that in my mind warranted being slugged. PJF's doctor and the female observer was one example.
What exactly could the woman have even learned from that encounter anyway?
Why didn't the doctor just show her a video. Nothing useful was learned and he helped her to mistreat and belittle her patients.
My dream is for some of these abusive doctors/ medical staff to be out and about and they be depants in a public place.
JR said:
EO,
I hear you about the antibiotics and feel your pain about what they did to you. Last Dec., a dr. w/ a religious name in her practice's title, prescribed my 87-yr old mother a fluoroquinolone family member. My mother had requested another one she had taken before w/o issue but this dr. knew better and which had her godly opinion of what my mother should take. Upon reading the side effects, she asked me what I thought. I told her not to take it. She called the dr. office & got a very hateful and superior response of if the dr. says so then it must be done. The next morning it was all over the media the FDA had put out a warning that the elderly should not take this class of antibiotic. Years ago, my mother let another dr. prescribe her statins for over 15 yrs. She now has severe heart muscle damage from the statins.
It seems that drs. seem to have the idea that in "fixing" one issue w/ rx drugs, it is okay to give you other conditions caused from the drug. They don't really seem to care but rather it seems to be the main point of rx medicine. If you don't have collateral damage then they seem to think they haven't done their job. That is why we took a good hard look at the DAPT route they said my husband had to take w/o missing or he would die and have quietly made our change w/o their knowledge. They gave him this little compliance speech as he laid naked & exposed on the cath lab table. It is just like the stents they put into him carries major risks of becoming blocked bc the arteries will forever think the metal is causing damage and will send plaque to repair the area thus causing a buildup at the stent site. The DAPT went from less that a year to a year to 18 months is less than a week. In fact, it change within hours. Now it is said to be forever but what do they really know and why should they be aware of what he is really doing? They lie and don't tell everything.
I don't condone violence but I understand why it might happen. The attitudes of the medical staff is beyond horrible. They devalue & dehumanize individuals until they reach their breaking points. This is done while people are under the additional stress of being ill. What they did to us could have very easily resulted in violence if we hadn't been the people we are. Do we wish them harm? Yes but we will not harm them bc they are the lowest forms of things & aren't worth us suffering more. Fate will take care of what they have done. We wish them nothing but the worse in how they choose to live their lives--only heartache & heartbreak along w/ literal medical conditions of any & every kind for everything in their lives. If I read about anything bad that may happen, it will make me smile. It is a thought so deep I know fate will intercede bc it always does as my aunt used to say: What comes around goes around. Here's to their around. JR
Misty, another response from a physician educator about gynecologic education of students:
Given the competitiveness of the Match these days, a surprising number of future Cardiologist, Orthropods, Neurologist, etc end up doing Family Practice and Internal Medicine residencies. (Oh, and all Cardiologists likely rotate through a general medical clinical during their Internal Medicine training).
I went through Neurology and then did a fellowship in Medical Informatics. During my fellowship I was encouraged to moonlight in the general medical clinical. My first shift I had a patient requesting a pap smear. Thank goodness I was trained as a generalist.
Schools have no control over what graduates will eventually do and their charter is to graduate students who can be licensed and that license in turn allows them to go on to practice any possible specialty. There is no real mechanism to graduate a doctor train in everything "except" specific disciplines.
So far no response on the medical education listserv which argues that students should select their early years training based on some anticipation of their own personal selection of some specialty in the future.
Should a second year student looking at ophthalmology as a specialty reject learning how to perform a pelvic or genital exam?
Since sexual transmitted diseases can lead to eye symptoms even an ophthalmologist should at least understand by experience the approaches to diagnosis by genital exam in order to educate the patient regarding further workup. ..Maurice.
Dr. Bernstein,
I agree that there are some medical students who do not know what their specialty is. But at the same time, there are many medical students who already know what specialty they want to go into. If a medical student changes her mind and choose a specialty such as OB/GYN that would require pelvic exams, then medical school can require her to learn how to do them before she goes into residency.
I disagree completely about an ophthalmologist needing to know how to perform pelvic exams. This is ridiculous. An ophthalmologist can always refer a woman to a gynecologist or another doctor/nurse practitioner if she has a STD for genital exams. There are many ophthalmologists who knew for many years that they wanted to help with eye disorders. It is unfair for them to be forced to do genital exams.
I strongly support any medical student or doctor who choose to not do intimate procedures on the opposite sex. I have so much respect for that male medical student I referred to the other day.
I feel that the requirement to do pelvic exams in medical schools have driven some great people who desire to be doctors away. For example, remember this stressed student on Dr. Sherman’s blog who had to quit medical school. The reality is medical school should have given her an exemption since she was not going to specialize in a specialty that required pelvic exams.
I believe one of the biggest reasons why there are so many patient modesty violations today is due to brainwashing that goes on in medical schools. Medical and nursing schools often indoctrinate medical students that genitals are just like any other body parts. This is why many medical professionals today make arguments like: We’ve seen many private parts so it’s not a big deal. I believe one of the reasons Dr. Sparks did unnecessary genital exams on those male patients was due to the desensitization she went through in medical school. The truth is ENT doctors should never do any genital exams since their specialty focuses on ear, throat, and nose.
I strongly believe that every doctor, medical student, and nursing student have the right to refuse to do procedures based on their religion and moral convictions. For example, think about a good Christian man who has the dream of performing orthopedic surgeries on patients to help them to walk better. Let’s say that this man is very devoted to God’s word and honoring his wife by not seeing and handling private parts of another woman based on the Bible. The Bible prohibits you from seeing and touching private parts of a sexually mature person of the opposite sex who is not your spouse. This man has the right to refuse to do pelvic exams, abortion, and euthanasia due to his religious convictions. It is likely that this man would become one of the best orthopedic surgeons. Medical schools should make exemptions for medical students who have religious convictions and can say for sure they will be choosing a specialty that does not include OB/GYN or urology. The truth is a few medical students have strong moral and religious convictions so it would cause no harm. You still have a big group of medical students who do not have religious convictions. It is unethical for medical school to force a medical student with religious convictions to compromise his convictions. I know there are some male family doctors who refuse to do intimate procedures on women and they simply refer their female patients to female nurse practitioners or doctors in their practice. They are not denying their female patients health care. It’s pretty common for doctors to refer patients to other doctors for certain specialties so this is not a big deal.
Misty
Continuing …
Dr. Bernstein,
I wanted to remind you again of this paragraph:
"Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities" according to Medical Student Section of the American Medical Association (AMA).
I realize that you and I will probably never agree on this issue which is fine with me. I appreciate you keeping this blog and letting different opinions for many years. I have gained many wonderful insights from contributions on this blog.
Misty
Misty
Medical and nursing schools do not indoctrinate their students that the genitals are like any other body part. If that were the case Misty
then why were there foldouts of nude males from PLAYGIRL magazine posted like wallpaper in the staff nursing bathrooms. Would I
have expected to see pictures of elbows and thumbs.
Furthermore, why didn’t Dr Sparks just examine her male patient’s knees and toes when performing ent surgeries. It was always her
male patient’s genitals and if her nursing staff were SO desensitized about genitals then why did they always erupt in laughter? If I
had it my way and if the New Mexico State medical board and the city prosecutors didn’t have their head so far up their ass Dr Sparks
should be sharing a prison cell with Dr Nassar.
PT
To the extent possible I want male doctors, nurses, techs etc for any intimate care, but I also want female doctors, nurses, techs etc to be fully qualified to examine or treat me should I find myself their patient. I don't want any of those females shying away from doing what needs to be done because their religious convictions say they should not be viewing or touching males intimately exposed. That would be denying me healthcare or giving me inferior care if they had been allowed to skip certain aspects of their training. There isn't always someone else who can step in for you.
Sparks wasn't doing genital exams. She was sexually abusing and should be doing time. The coward nurses who laughed are evidence of how useful medical chaperones could be.
PT,
I think you misunderstood me. I believe many medical and nursing schools try to indoctrinate medical and nursing students to accept that genitals are no different than other body parts and this is why you hear those arguments when patients express concerns about their modesty: we’ve seen all so it does not matter. Because of medical school’s heavy emphasis on genital and pelvic exams, this gives some medical and nursing school students the opportunity “enjoy” doing intimate procedures.
This does not change the fact that many medical students may get thrill out of them simply because genitals are private parts. I am sure that Dr. Sparks was one of those doctors who got thrill out of doing genital exams on male patients in medical schools. Sadly, I know there are some nursing school students who enjoy making derogatory comments about male patients in nursing school and that’s where their misbehavior started.
I agree with you that Dr. Sparks should be in prison. I am very disappointed that they let her continue to practice.
Misty
JR said:
There is a big difference between a dr/nurse performing a needed treatment or exam on the genital area and just exposing bc they can and they love to abuse their patients. However, it does not seem that the hospitals, government or the law cares about patient abuse. It has been hidden for years that female nurses abuse male patients. It is a dirty secret that is okay bc what happens to men doesn't matter. In fact, the nurses who saw Sparks sexually abusing the male patients just stood by and laughed. For those, the punishment should be group rape/torture so they could perhaps get an understanding of what it feels like to be abused and their family can experience what it is like to have a family member who was raped/tortured. They also should be given drugs against their will and always wonder what else took place. A slap is too good and too short to do any good. It is too bad it is not an eye for an eye anymore. If there were real consequences for the harm they cause, I imagine many would suddenly remember what their professional standards should be. However, in the meantime, it is acceptable for medicine to actually destroy lives instead of mending them. In their vicious, perverted world when a patient is under their control they are allowed to treat that patient however they want. They will continue not to care that patient is actually a person bc they have lost touch w/ humanity bc of the power and control they have over their patient-victims. They will continue to demoralize, devalue, destroy, dehumanize, and degrade selected patients bc it is fun & entertaining. That is the real story of American medicine. I think of medicine as Nazi regime or like North Korea. It wants everyone to think it is doing everything for the patient when really it just wants to personally destroy selected patient-victims. So just remember although you may have some control during an office visit, if you have a procedure done or are admitted as an emergency case, you are totally at their mercy and they have none. They will drug you and abuse you. Patient dignity and respect is only something they put in their brochures to look good. They expect patients to be truthful w/ them but they don't feel they in turn have to be truthful to the patient. I imagine if a patient asks for patient dignity for a procedure they will go out of their way to abuse that patient bc they know w/ the drugs they choose to use to erase your right to your memory of events, you won't remember and will be totally defenseless. It seems that feel that patients have no right to expect to be treated as if you a person who matters. You may be "awake' but not really. They are cowards that hide behind the guise of kindness & caring so they can catch their victims off-guard. I don't imagine the abuse that happened to my husband would have been done if he was not drugged. For one thing, he would have some degree of control. That is why that drug when other countries don't use the drugs like this country does. Our medical system is full of cowards who are unsure of their abilities so that is why that use so many drugs. They want no witnesses to their crimes and incompetency. JR
Misty
Just to clarify myself, there is no indoctrination process!!!
PT
Misty, I appreciate your views and also the views presented by all the commentators here since that is what the title of this blog is all about "Discussion".
However, I must tell you and the others here that a number of postings to my initial and subsequent comments on the medical education listserv have fully agreed (none disagreed) with my view that the initial issue of second year students rejecting actually practicing on standardized teacher-patients was unnecessary because of specialty decisions at this point in the their career is in error. It is because it is clear 1) vast majority of students admit no decisions regarding specialty was yet made 2) students with some decision do change their minds to another specialty in the later years of medical school or in residency.
The matter of morality or religion to learn and practice these techniques is something which should have been made known to the Admissions Committee before entry into the medical school. I cannot find that the American Medical Association has accepted in this regard the offerings of the Medical Student Section of the AMA. Certainly, if the licensing boards either state or national permitted a medical student to reject this teaching because of their possibly premature decisions of future medical activity, medical schools and their specialty deans and us instructors would know about it.
Misty when you write " Because of medical school’s heavy emphasis on genital and pelvic exams, this gives some medical and nursing school students the opportunity “enjoy” doing intimate procedures." is wrong. Based on my direct observations in the past on students performing male genital exams (I have not witnessed female exams) but also repeated conversations with students of both genders, none appeared or disclosed any "enjoyment" with the exercise but admitted their discomfort such as SS, the female student who wrote about her anticipations for such exams to both Dr. Sherman's and my blog.
The behavior of Dr.Sparks and all the other publicized sexually misbehaved or criminally acting physicians have nothing to do with teaching how to properly examine the genitalia, to make a diagnosis and treat, to a second year medical student.
If I get any opposite views from the teaching officials writing to the medical education listserv, I will promptly describe them here.
In the meantime, everybody, this is a DISUCSSION blog and that is what we are doing virtually every day! ..Maurice.
Oops! Sorry for the misspelling of DISCUSSION. We all are open to errors and that is what this blog and thread is all about: finding errors in practice and providing approaches to corrections. ..Maurice.
Maurice ,
You said ( I have not witnessed female exams ) . Why are you only doing genital exams on males ? You also mentioned both genders appeared to get no enjoyment with the exercise . How do you know what someone else is thinking ? Who would be dumb enough to tell their instructor that they really enjoyed doing that genital exam . AL
AL, I was not clear in what I wrote. I have been participating in teaching students the methods of physical examining various systems including for second year students the genitalia of male and female. These latter two exams are practiced as I have previously noted on plastic models. Shortly, thereafter, the second year students have a sessions which our instructor group need not attend but which is to examine and be instructed by teachers who are the students' "standardized patients". I have attended only a few sessions (carried out in the evenings) as an observer but my visits happened to be only with male "standardized patient" teachers. I haven't been present at another time to observe students with female teachers.
Of course, the student later feedback to me was not "enjoyed" the session. However, in the sessions with male "teachers" which I actually observed one could easily see student, both male and female, anxiety by the students' behavior.
This exam session happens only once in the second year and I have not been part of
the third and fourth year education regarding genitalia examination. I hope this explains what I have experienced. ..Maurice.
Dr. Bernstein,
There are a variety of responses by medical students. I do not believe that all medical students enjoy doing intimate procedures or dread them. There are some medical and nursing students similar to Dr. Sparks who enter medical and nursing schools to take advantage of patients. Of course, there are medical students similar to the stressed student. In fact, I know a number of nursing and medical students who were very upset about doing intimate procedures on the opposite sex. I think many of them did not realize that they were required to do them until they entered nursing or medical schools.
One Christian lady who entered nursing school shared at first she was uncomfortable doing intimate procedures on men because they were not her husband. But then later she got desensitized and labeled patients who care about their modesty as prudes.
I think it is a good idea for a medical student to let the medical school dean know his/her convictions ahead of time to see if they can work with him/her. Someone told me that he found out that one Christian medical school does not have genital teaching assistants (GTAs).
I agree with Al. Medical students who enjoy doing intimate procedures most likely would never tell you since you are their professor. I remember many years ago when I was in college that when the professor left the room that some students started cheating on their tests because he was not there. But then when he came back, they stopped cheating.
Misty
Dr B
All that sounds reasonable but all it takes to refute it is one genital exam with that silly involuntary grin and that rational goes down the drain.
You've not heard students talk in a sexual way because you ( their instructor doesn't ) If you were to talk in an unprofessional or derogatory kind of way, some of your students would also.
As far as your students feeling stress. of course they would. They're on trial.
F68.10
I did eventually read the article that you posted about. For some reason I just never got around to writing about it. To a large extent I forgot about it. At any rate suffice it go say I was not impressed with it. I stand by my previous comment. PA
Yes there are some who purposely add a sexual component to their interactions with patients. However they are not the norm but rather the exception. The issue is instead a mindset that males either have no modesty or shouldn't have any modesty. This mindset is not unique to healthcare settings. Currently it plays out in sports locker rooms, prisons, youth detention facilities, and military settings where males are expected to not mind being exposed to fully clothed females. For those of us who grew up in the 60's or earlier it also played out in school & sports physicals and mandatory swim classes in the buff. Sisters could watch their younger brothers be bathed but never the opposite. Boys could be spanked pants down in front of sisters & female relatives but never the opposite.
It is this mindset that accounts for most of the unnecessary exposure males experience in healthcare settings, not some purposeful ill intent to humiliate the patients or give the staff sexual jollies. Yes there are some with ill intent, but not the vast majority. The vast majority just doesn't see it as an issue at all. Society says it is OK for women in the course of their employment (healthcare, law enforcement, guards, reporters) or in family settings to see exposed males.
For that minority that has ill intent be it sexual jollies or some feminist power trip, the victims are likely carefully selected. The good looking and/or fit guy or the genital outlier in terms of size might get the attention of the one seeking sexual jollies. The guy they view as a problem patient or perhaps as sexist might get the attention of the one on a power trip.
While it might come to be that laws or court rulings will change the casualness with which male patient exposure is handled, even that will likely require some degree of societal mindset change concerning the very concept of male modesty.
Maurice,
What is your source for your definition of patient dignity?
My definition of patient dignity is a subset of human dignity. So is human dignitary NOT inherent?
Does someone decide to what degree one has human dignity (which, by the way, is the basis of human rights).
Misty,
"Med Student Avoids Pelvic Exam for Record 1,429th Straight Day" is a parody. None of those articles are real.
The Gomer Blog actually makes fun of patients as well as providers.
GOMER is a slur against patients: Get Out of My ER...
It is an "undesirable" patient.
Biker,
According to the WHO publication, Guidelines for medico-legal care for victims of sexual violence:
Power, anger, dominance and control are the main motivating factors for rape.
As per UNICEF:
Sexual violence as a weapon of war.
Read more about rape being about power, not sex. This issues of intimate exposure, exams, procedures, pics, are about controlling the patient and maintaining power. The gown reenforces this notion. Its roots are in paternalism.
-- Banterings
From a Standardize Program Coordinator from a medical school who wrote to the medical education listserv:
Male urinary teaching associates (MUTA for short) and gynecological teaching associates (GTA’s) are professional educators who are extensively trained to teach male and female pelvic exams, as well as female breast exams using their own bodies. These men and women have made a conscious choice to be this type of educator and they are paid for their teaching. Having worked with GTA’s & MUTA’s for years, I can say that many of these teaching associates do this type of work because they are inspired by their ability to function as advocates for the patients to whom the medical students will eventually provide care. I do not see an ethical issue here. I would see an ethical issue if we were recruiting people in vulnerable economic position and offering them money to be to be teaching models, but this is not the case with MUTA’s & GTA’s.
I agree. And I am proud of what they do. By the way, would any of my visitors here want to become a MUTA or GTA after effective training? If serious about it, I can research some sources of information (oh! I forgot, Google, you can do so yourself!) ..Maurice.
Bantering, despite what some in the media and feminist circles would have the general public believe, not all men are rapists. In fact very few men ever rape anybody. Yes some healthcare professionals rape or otherwise sexually assault patients, but they too are the exception. They are the few amongst the many who work in healthcare.
I cannot see any parallel between rape and the general societal and healthcare casualness when it comes to male exposure. Rape is an act of violence by very bad people. Healthcare staff being casual with male patient exposure is just standard protocol in accordance with societal norms. Rapists know what they are doing is wrong. Most healthcare staff don't think they are violating male patient privacy/dignity when they casually expose them more than was necessary. They just don't think men care or that it matters. Their focus is instead on being polite. Though I may feel I have been needlessly exposed on occasion and that I have had female nurses take a sexual interest in me, I would never liken my experience to women or children being raped. To do so would be an injustice to those true victims of sexual violence.
Until societal norms change the only tool I have is to speak up for myself in healthcare settings. Each time any of us do so, we ever so slightly nudge society in the direction of change one staff member or practice at a time. My complaints about the dermatology practice moved them in a year's time from hostility towards a man daring to express a modesty concern to acceptance and accommodation of such concerns. Someone who came before me surely prompted my urology practice to hire a male nurse and train the staff that its OK for people like me to request him. Most of the women in my dermatology and urology practices might still believe that most men are not modest or that we shouldn't be modest, but they now at least accept that some of us are and are respectful when we speak up.
I just don't see the millions of female nurses and other staff out there waking up every day thinking they will spend the day purposely abusing male patients. For most, male modesty isn't even on their radar.
Girls could watch a brother being bathed but never the opposite. Boys could be spanked pants down in front of sisters and female relatives but never the opposite. Biker. Maybe that has been your experience but it's not universal.
I have witnessed girls spanked pants down in SHOPPING CENTERS!
Also I'm aware of instances of teenage girls spanked pants down in front of younger boys.
In my mind that is sexual abuse.
It could be that it's more common for boys to be treated that way.
As far as the bathing, when me and my brothers and sisters were small , we all took our baths together. ( we were stair step kids )
JR said:
Banterings,
You're right. That is how we feel--like my husband was raped. Rape is a crime of control, power, anger, dominance, etc. It is not about the sex but rather the sexual act is the item that allows them to belittle and humiliate their victim. Medical people are quite aware that unnecessary & prolonged exposure should not be happening. It is taught in medical classes & textbooks. It is not that they don't know but rather they make a conscious choice to expose. There is nothing polite about being forced to carry on a conversation while you are naked especially if you really shouldn't be naked w/ the nurse or whoever. It to me is a game they play to see if they can control you and how you react when then inappropriately expose you.
No one is belittling a female who has been raped. There are different degrees of rape. There is the stranger rape, the date rape w/ maybe the use of versed, and spousal rape. However, when anyone strips off someone else's clothes w/o their permission and leaves them exposed for a reason not of medical necessity, allows strangers to have access to their exposed genitals, have the patient drugged and defenseless w/ another nurse and what they are doing causes extreme laughter and they deny the patient the right to have his family and the family the right to be w/ the patient, touch his penis and testicles, to make him urinate and clean him in front of non-medical spectators, then to me that is also rape. Maybe they did even more than that. During his prostate surgery, he knew he would have his genitals exposed. He didn't like it but that was the way it was. However, for a PCI (that he didn't agree to have or even know he was having), genital exposure is not necessary. In fact, literature says they will be covered so to provide for patient modesty. So for the cath lab to leave him exposed before and after the procedure for extended up to 45 minutes afterward, that was a calculated choice on their part. There was also no consideration for his safety as the cath lab room is kept very cold & his blood circulation at that point was not good so his temperature dropped due to their need to be sexually abusive. A rape fact is that women are raped like 85 yr old women so saying that sexual abuse by female medical workers only happens to good looking men or well endowed men is not factual. Again, rape, is an act of control, power, anger, and dominance. Anytime someone invades the genital space of someone else w/o permission or a valid medical reason, a sexual crime has been committed. As I said, you can defend when you are not drugged but once you are undergoing a procedure, you are totally vulnerable and although you may think you are going to be "granted" personal modesty, you better think again. It won't happen. Most of us can defend ourselves when we are conscious but drugged is another story so that is why they choose to drug us. It is no different than being date raped. My husband's soul was raped by those people. That is what rape does. It makes you feel helpless and forever dirty. It makes you feel like you have totally lost control of your life. As a spouse, it makes me angry. They also raped my soul. It makes me feel like a failure bc I didn't protect him. I was a fool & thought medical people wouldn't harm him in this way. I knew they weren't heroes just treating patients out of the goodness of their hearts as they are well compensated. I just never realize they may actually hate those they treat and inflict harm as they are "curing." So, yes, what they did was rape. A woman touching & manipulating a man's penis w/o his permission while he is drugged w/ a date rape drug is rape. A woman putting a drugged man's genitals on display for all to view is a rapist. Women do not have penises to penetrate but they do have other means to sexually molest. JR
Biker said “ I just don’t see millions of female nurses and other staff out there waking up every day thinking they will spend the day purposely abusing male patients. “
Why don’t you see this? Is it because you have never worked in healthcare? Are you in denial? Many are in denial and it’s because our
society teaches us to be in denial. You have read the Denver 5, Dr Sparks, the hospital in Penn. the nurse in New York. These are some
that have made its way to the news media. Remember hospitals work very hard to contain all the bad. They have risk management that
keeps it all under the rug.
Biker let me ask you this. Do the Target stores have a risk management department. Does the Macy’s department stores have a risk
management department? Why would they? Again I’ll ask you and our readers. Why do hospitals have risk management departments?
Why?
How do you define abuse? How do you define sexual abuse? State nursing boards define sexual misconduct, sexual impropriety. One
defining issue is why nursing staff leave patients unnecessarily exposed, inappropriate draping. So how many times a day do they do
this to their male patients? It seems fairly evident to me that they don’t have to get up in the morning to think about this or if they work
the night shift to get up in the evening to think about this. It’s an automatic. Thus when the moment presents itself, then it’s taken further
as in the Denver 5, etc.
Don’t forget all the cases on www.Propublica.org.
PT
Which article are you refering to?
I did end up becoming violent. I won't detail how exactly, as, while I do not regret it, I take no pride in it either. In my case, I was just fed up to a very severe extent with the medical system, and demanded to regain freedom from medical care. As I could not regain freedom, I said basically that I now wanted euthanadia or that I'll start being violent against them. It was their choice, up to them, at that point. As neither medical freedom nor euthanasia were on the table, I then carried through my threats and became violent. I'll say no more on a public forum.
To me, it's up to the medical profession to decide how to organise pelvic exams.
"I think a general training helps when physicians of different specialties collaborate and consult together on complex conditions and situations."
But, in a nutshell, that is to me the killer argument. I completely agree with this statement.
"Despite what some in the media and feminist circles would have the general public believe, not all men are rapists."
Very true.
"I would see an ethical issue if we were recruiting people in vulnerable economic position and offering them money to be to be teaching models."
I do not see as much en ethical issue here. In fact, I'd even argue that it would unethical not to allow people in vulnerable economic position to get these positions. But I likely do not have the same moral epistemology.
I apologize if I insulted the feelings or views of my contributors here by my questioning whether anyone would want to become a "male urinary teaching associate" or a "gynecological teaching associate". It may be that my visitors here really wonder about the true motivation of those "standardized patient" instructors. Does anyone feel that they are doing what they are doing for the betterment of the medical education and the profession of medicine or are they really doing it for their own sexual interest and pleasure?
I understand this is a "touchy" subject and question but what has been written on this blog thread over the years about sexually related behaviors and frank misbehaviors or worse of various components of the medical profession has led me to entering this question.
I personally would look at these teachers as trying to promote at the outset of these students' genital exam experience the very best understanding of a patient's usual reaction to such exams and how the professional should perform and respond to the patient. I think they are needed and my opinion is that they are not doing this job for the own personal sexual interest. Some here may disagree. Anyone here want to be a MUTA or GTA? Personally, I can state I am satisfied to be, as I have been, the introductor and followup resource to this medical student teaching experience. ..Maurice.
F68.10, please excuse my last posting which was done before I read your prior writings since it may have been wiser to provide a comment following up on your own troubling story.
My comment is that it is good that you have ventilated a bit on our blog thread. That is the benefit of anonymity which always has been the allowance on this blog. ..Maurice.
PJF here.
JF – How right you are! There was nothing special to be gained in terms of medical “technical learning” for the female student by shadowing the urologist and observing my exam. But there was indeed something to be learned about patient interaction and ethics that did not happen.
The urologist SHOULD have asked my consent for her to observe, and I would have said no (or to step out for the pants down bit), and she would have learned how to properly approach males for an intimate exam. Recall that consent should have been asked for two issues – her being a female and also a student. Instead, his MO was to act as if her presence was no big deal and hope I would not say anything. I felt that he wanted to show her how to control a patient. He taught her absolutely the wrong thing. I have nightmares of them leaving the exam with him saying “see – there is no issue with you being a female for a male intimate exam”. WRONG!
Further, in our subsequent phone conversation, he mentioned that she spent the week in urology. Well I happened to be the first patient Monday morning that week so it was a great opportunity for her to be educated at the very start about male dignity. But he blew it and taught her the wrong thing – and equally – I blew it and did not speak up. Had I said something, especially in front of her, he likely would have changed his MO and asked for consent at the following appointments. I am sure I was not the only man ambushed and embarrassed that week. I feel bad that I let my male brethren down and did not speak up which would have protected both them and me. Interestingly, several months have now past and I am mostly over the exposure/embarrassment issue and now what troubles me is remorse that I did not protect myself as well as the other men after me.
In an ideal teaching world, he would have shown her my letter, discussed how males have modesty and deserve dignity and how he should have handled the situation differently and asked for consent. But this would make him feel embarrassed for such unprofessional behavior and most likely did not happen. It’s OK to embarrass the patient but not the doctor.
JF – also thanks for your response of April 23 that my phone conversation with the doctor was doomed from the start to not end well. Your comment has made me feel much better. That phone call really bothered me and I felt maybe I was too emotional or harsh with him. But in my mind this was a serious error he made that has damaged me mentally. He literally stated that he hoped I would accept his forgiveness – well that was not going to happen. And his viewpoint was females needed to be trained too and that I could/should have refused. So the conversation really had nowhere to go but down.
And Dr. B. – thanks for the 3 cheers! And thanks for training all your students to ask for consent in these types of situations.
PJF
Dr. Bernstein, asking if any of us would consider being a MUTA was a rather interesting question and to me at least it wasn't offensive at all. It is only a theoretical question for me being it is a 1.75 and 2 hour drive respectively to the nearest 2 medical schools, but interesting nonetheless. There is a 4 year RN program at a college less than a half hour from me but I doubt they use MUTA's for anything.
Modest though I am it is something I think I'd be willing to try if the role playing allowed for the patient to express modesty concerns and to give feedback on their handling of it. That might be too much for students who are nervous if not terrified themselves and I suspect it would not be allowed. The other aspect that I'd want to be able to give feedback on is perhaps even more important to their training. This is whether they betrayed via body language or otherwise their judgement of my having lost a testicle. Such a discovery would come as a surprise as they do their exam and it wouldn't have been anything their instructors prepared them for. Real world patients are going to sometimes surprise them and towards that end it could be a valuable lesson. They likely wouldn't forget receiving feedback that rather than maintaining a purely clinical gameface they embarrassed their patient instead. Years ago I was embarrassed by a nurse not maintaining her gameface and her body language betraying her negative judgement. It is not anything I have ever forgotten.
I am not pretending serving as a MUTA would be easy for me to do. What would mitigate the personal impact for me would be knowing that by being able to express myself as noted above these future doctors might be more sensitive to the tens of thousands of patients they will see over the course of their careers. At least that's my theoretical musings. As an aside, I could care less about the being paid part of being a MUTA. Being able to give feedback such as I describe would be all I'm looking for.
Lastly, know that it makes my stomach churn to let my guard down writing this post but I do so in hopes it helps further the discussion. I tell myself that perhaps those who work in healthcare that read w/o posting themselves might think about how even their unspoken reactions can impact patients.
JR said:
Dr. B.,
I don't see anything wrong w/ individuals freely choosing to become those to be practiced upon by med. students. The key is freely choosing and not having it done as surprise you are the patient in our hospital and here we are or having it done w/o consent when anesthetized. I viewed your offer as a tongue-in-cheek offer as most of us here have had issues w/ sexual abuse or having our modesty/personal dignity violated so I found your offer more of a slap in the face after everything my husband & I have been through or maybe thinking that you really don't understand that sexual abuse suffered in the hands of a medical staff member is real & lasting. It certainly has changed our lives & not for the better.
PT,
I agree w/ you in part that for some it may be an automatic action. However, like what the ccu nurse did to my husband was more a calculated action & the degree of sexual abuse was so much more worse. Whether the cath lab did what they did bc of thinking he was a gay, older man or bc they just treat all men like they have no rights as a human being or both, we really don't know & probably never will. However, I believe all of the sexual abuse is driven by the need to control, to dominate, to have power, and no patient interference w/ what they are doing.
If you examine when a criminal man kidnaps a female victim, he usually strips her naked to make her more submissive. He will rape her repeatedly to totally break her down. He will keep her in isolation. To me, this is the same line of thinking that a hospital follows. Men are thought of as being more stronger than women and less medically compliant. So if they are able to make a male patient more submissive and compliant by their forms of torture, then their job will be easier. My husband was not using his Medicare to their full benefit--he didn't have 20 doctors, 100s of prescription meds., no follow up after the prostate cancer like is standard, & believed in natural supplements. He also was relatedly healthy. We are not sure what caused the heart attack.
Yes, we as a society are in denial. Most don't want to admit that when they are at their sickest they are also in their most vulnerable state. So therefore, they don't want to think about the possibility of medical staff abusing them. For years we have accepted that nursing is a mostly female occupation. Men have to have females taking care of their most intimate needs. However, females are usually not that accepting of male nurses taking care of their most intimate needs. We as a society think only males have sexual needs & will act on them. We turn a blind eye that females also have that same need not to mention females also like to enjoy power & control just like the male medical staff--drs. So since female nurses usually do not control the drs. but rather take much abuse either mentally or sexually harassing it makes sense that nurses take out their anger on male patients. Some females nurse may also act purely on sexual instincts too. Some are just bad at their job of protecting their patients like in their oath. Others simply do not care about their fellow human beings but rather more about being a "nurse" and what money it gives them. And then, there are some who are good nurses but where and how do you find them? JR
JR, the medical school where I teach specifically notifies first and second year students that they should not perform genital or rectal exams on their assigned hospital ward patients or practicing on each other.
The only time they perform these examinations is on the assigned "standardized patient teachers"during one session on each gender in the student's second year. I am not aware of the program details for students in the 3rd and 4th years but I understand it is with the informed permission of patients. ..Maurice.
Maurice,
In response to MUTA/GTA: I had the pleasure of meeting up with "my friend up north" and a female friend of his in Manhattan. As we walked through the streets near Times Square, with each step her mini dress rose up to expose her bare vulva. The light stretchy material kept twisting and allowing a nipple to poke out. She enjoyed the attention.
She also relayed that when she visits her gyno, she just gets totally naked and has no problem with that. She is also of interest to the staff because of cosmetic work she had down there. She has no problem sharing with those interested. She is an open person, a nudist, one who is completely comfortable with her body, I would not call her an exhibitionist. She enjoys the attention. She has no problem with seeking healthcare, even intimate care.
She has a thrill seeking personality. She does get a thrill out of being seen. She would easily be a GTA and get a thrill out of it. I do not know if what she gets is sexual, an adrenaline rush, or both. She is very open sexually.
My friend brought up a joke that she played on her gyno. (She has a very good report with her gyno, her gyno is her PCP handling things such as antibiotics for sore throats.) She had to get stitches removed from her head from some cosmetic work done over seas, and her gyno was going to do it.
When she was brought into the room, she got completely naked and sat on the table for when the gyno came in. Her gyno very much enjoyed this joke.
So yes, some people get some enjoyment from it. Whether that is sexual, adrenaline rush, or something else, I do not know.
Biker,
The forgetfulness of providers may not rise to the definition of rape, sexual assault, sexual battery, or sexual violence, but the patient (like JR's husband) do feel like they were sexually violated.
NOT ALL MEN ARE RAPISTS. Both myself and Ray have presented information in previous volumes (perhaps Maurice remembers off the top of his head where) that female sexual predators are just as prevalent as male sexual predators, but due to societal attitudes about machismoism, and their modus operandi, they are extremely difficult to recognize and study let alone to apprehend for a crime.
It is all about maintaining power. Again, as I have presented information in previous volumes, in the Stamford Prison Experiment, WITHOUT DIRECTION, the people playing the prison guards used nudity as a means to gain and maintain power over the priosones.
-- Banterings
Dr B and Biker,
I think you are both decent and good. I think you both have had a positive influence regarding our issue. But you give so much benefit of the doubt to medical workers.
Believing them / believing what has been described on this blog conflicts.
Saying First impressions are the most important and lasting is synonymous with saying the outside is what people see the first.
I think subconsciously you might be doing a little stereotyping. It might be easier for you to believe a person who is borderline retarded to misbehave in this way. Or somebody unattractive. Somebody low income.
PJF
I thought maybe if you remember the woman's name or could find out , you could maybe get her address from Google and write to her for yourself. Tell her what you told us. She also maybe needs to be told that MANY patients, male especially avoid medical care for years and years because of the blanton disregard that doctors and nurses often show their patients.
Maurice,
Why should the students not practice on each other?
-- Banterings
Banterings, Ah! At our school they do practice on each other in formal workshop sessions for each system but also in the weekly group meetings covering separately each of the following elements of a physical examination : Vital signs, general appearance, mental status, complete neurologic exam, opthalmological exam, full musculo-skeletal exam, full pulmonary exam, full cardio-vascular exam, full abdominal exam. The breast exam is carried out on male students with the approaches in technique to fit also with a female breast exam. However, the female breast exam is formally taught in addition on standardized teacher patients. Ear, nose and throat is not specifically taught in the first or second years in sessions which are part of the teaching I am involved with. Again, as noted above, the students are sitting or lying on exam tables for the exam by another student (male or female) and the students then rotate so everyone has a role of patient and examiner. Female students undress their blouses to their bras and their skirts are lowered to their hips for the abdominal exam. Males are bare chested. I walk around demonstrating and monitoring.
I think I wrote about this before on this thread: only once in my many years of participation did two female students want to go into an empty class room away from the others for lung exam (but I, of course, was allowed to monitor) and only once did a male student refuse to expose his abdomen because of a active colostomy was present. I didn't object. In fact, these were the only two exceptions I can recall over many years, otherwise the students of both genders permitted examination by either gender. NO GENITAL OR RECTAL EXAMS practices are permitted on each other or, in fact, even on hospital ward patients in the first and second years.
In conclusion, Banterings, medical students do practice on each other and I have watched them do this for almost 30 years--and at times showing parts of my body too. ..Maurice.
JR said:
But what you supervise and even you showing your body is different. You were in control. Patients are not in control especially again if drugs are used. Like with the cath lab, many are not prepared for the total and unnecessary exposure bc after all, their penises and vaginas are not the parts needing help. They are also drugged so they will not be able to protest the exposure and who is seeing them exposed nor can their protect themselves. Your student are not exposing from what I read their lower genital region. They are really not experiencing what it is like to be laying there totally naked, helpless, and loss of control. They also not experiencing the mean remarks made or experiencing the shock of being stripped naked by strangers. They are not experiencing being just left exposed while drugged, cold, and confused as to what is happening. It is different to be the one this happens to. Knowing in advance while will happen, who will be present, why it will be happening, and in an environment that is safe from photos & staff abuse is different from what an actual patient experiences. They use versed bc they don't want patients to remember all the dirty remarks, the exposure, the observers, etc.
What happened may not be the same rape as a man does to a woman bc of anatomy differences. However, all the other elements are the same: the control, anger, dominance, power, the humiliation, the belittling, dehumanizing, the forever feeling of a loss of control over your intermost being. You cannot discount what happen just bc it does not fit the stereotypical rape description. To the victims & their families, my husband and I, it has been devastating. When he had the prostate lap, he knew he was going to be strung up in a severe lithotomy position. He knew he would be exposed. He knew he would have tubes inserted into his rectum & penis. He knew he would be shaved from nipple to mid thigh & prepped. He knew there would be women involved. He gave his permission. He didn't like it but accepted it bc he actually got informed consent. They treated him differently than the hospital from hell. He was not molested nor did they leave him exposed unnecessarily. I was allowed to be there to be his advocate. The hospital from hell performed a procedure on him w/o his consent or knowledge. To complete their criminal assault of him, the female nurses decided that sexually assaulting would also be fun & entertaining. So it just wasn't enough for the hospital to decided he was going to be treated against his will & forever have him avoid medical care of this type bc of their tyrannical power but they completed his journey into the bowels of hell at a catholic hospital by raping & torturing not only him but his family. We never expected to be victimized trying to save a life so if anyone can say why they picked him/us to literally unleash such horror on pls. let me know. We know we have protect ourselves during office visits & during most tests but what is the use if you know you cannot seek hospital care such as procedures bc of what has been done? We were talking about this today & the stress of ever going back like if he has a heart attack again, instantly causes him SOB,severe coughing, & tears from the stress of the thought of being raped & tortured again like last time. For me, it makes me angry & depressed like what is the point of living just knowing that I could be taken against my will to a hospital or that someday he may be accidently taken to a hospital. Victims of medical abuse have no recourse & they know it so that is why it continue albeit silently. They know men usually don't speak out about such things and if they do, no one will believe them or help them. JR
"What is the point of living just knowing that I could be taken against my will to a hospital?"
That permanent thought brought me to the brink of suicide.
"They know men usually don't speak out about such things and if they do, no one will believe them or help them."
Very true. Men hide this type of abuse. Took me years to come out of the wood.
Another comment from a physician writing to the medical education listserv, the topic of which I started with the title "Teaching Pelvic Exams: Do All Students Need That Education?".
Prospective students must attest to the technical requirements for admission and then annually thereafter attest to technical requirements for continuation in medical school. Technical requirements are "defined" by the individual SOM-- with the caveat that LCME requires that a compliant SOM curriculum must prepare students for entry into "any" residency program. LCME language. Prepare students for the "general practice of medicine"... however the faculty of a specific medical school define that. That is our responsibility.
A previous version of our own technical requirements was for proficiency in the use of microscopes. I have been a physician for 30+ years so (a) learned (b) used-- microscopes. Is is necessary and desirable for today's medical students to know how to "use" a microscope? My esteemed pathology colleagues would say, "Yes!" With utmost respect, I would argue... no. I trained before the "invention" of internet and of the modern pathology laboratory.
That being said, I feel strongly: the examination of the human body in all respects and in all its intimacies--- is an essential requirement of a physician. It's not religious or political or sexual. It is essential. To "examine" means--- to inquire. I inquire into a patient's history, into their physical findings. It is an essential part of being a physician.
There is no "opt out" about routine physical examination skills. Our students need to LEARN.
For your information: SOM is School of Medicine. LCME is "Liaison Committee on Medical Education" which sets the standards for medical education by the medical school in USA and Canada. "LCME accreditation is a voluntary, peer-reviewed process of quality assurance that determines whether the medical education program meets established standards. This process also fosters institutional and programmatic improvement. To achieve and maintain accreditation, a medical education program leading to the MD degree in the United States and Canada must meet the LCME accreditation standards contained in the LCME document."
So far, a number of responses to my posting and all are in agreement that rectal-genital examination should be taught in medical school without excuses by students. ..Maurice.
F68.10
What I was referring to is the counterpunch article you were referencing on your post of April 27. PA
Yes my nature is to view people in a positive light until such point as they demonstrate they shouldn't be, but if all the women who work in healthcare do so because they enjoy abusing their male patients, then urology would be absolutely the most sought after jobs, enough so that they could pay less given the demand to work there. Women's health centers and the like would pay the most in hopes they could attract some women to take those jobs that preclude access to males. In areas such as where I live that have nursing shortages, the women's health center and OB/GYN practices would be shuttering their doors for lack of anyone willing to work there, the potential staff all gravitating to where the male patients are.
The above is a gross exaggeration of course but it wouldn't be too far off if it were true that all the women in healthcare wake up every day looking forward to abusing their male patients. I stand with my statement that very few fall into that grouping. The problem is instead a casualness concerning male exposure that society as a whole condones. I stand by my premise that most of them are not being purposely abusive but are blinded to the protocols they use by their social conditioning, same as men are conditioned to not speak up. Using my cystoscopies example of the male nurses covering me up after prep while we wait for the doctor whereas the female nurses never did, odds are those females if they even thought about it at all figured they just did the hands on prep and so there's nothing to hide that they haven't seen and touched already,and that it simply doesn't matter for male patients.
JF, do you really think that all your female co-workers that you've worked with for years come to work every day looking to purposely abuse the male patients?
JR said:
Thanks, F68.10 for saying "Took me years to come out of the woods." That means it can be done. Right now, both of feel so horrible for different experiences and have intense reactions to what happened to each one of us personally while experiencing deep emotions to what happened to the other. It has been a double hit. Then our son also was there and he was labeled "the spouse". Our daughter is upset bc what has happened to all of us. None of us want to ever go to a hospital again. Even my mother who used to love medical interference has changed her mind as she could see how ugly it can be when they choose to strike.
I don't disagree that med. students should learn about the human body. However, the human body (patients) certainly have the right to refuse. Intimate exams on unconscious patients should not be performed unless medically necessary and never by a group. (Didn't say your university does this.) It has been my experience that whatever the medical community thinks they can get away with (and that is about everything) they will regardless of the patient's consent, knowledge, or will. The medical community treats patients as if we are wild animals and we don't have the skills to understand or make decisions. I would have said a child but children today actually have 100% or more rights than patients. Patients have no rights unless the medical community "allows" them the favor of having a right or two.
Nurse appreciation week is coming up. Here is what I appreciate about nurses. Nothing as long as they are a nurse. Nurses to me are the most vile creatures. (Although the males nurses did not seem to possess the same attitude w/ my husband as did the female nurses but I don't know about them & a female patient. Maybe their attitudes are different.) Nurses to me ever more so than drs. are controlling, power hungry, angry, dismissive, patronizing, and anything else bad. Jr
The students can practice on their spouses. But the rectal part might end up in divorce.
WE ARE WINNING THE WAR!
Intimate exams still occur on ALL patients (except women in 5 states where state law makes it illegal), patient dignity is NOT respected, providers are not owning up to their past offenses of patient dignity (how did they learn intimate exams in school?) or making amends.
medicine refuses to cede power to patients, so we are taking it away.
First time, employed physicians now outnumber independent doctors.
I am fine with this indentured servitude. It keeps the balance of power in check.
-- Banterings
Medical ethics at it's best:
Docs push unnecessary & expensive hysterectomies in rural India (Reuters).
About 3% of Indian women had hysterectomies found a landmark government survey in 2018.
Nearly 80 percent of all procedures carried out were hysterectomies. We counted 1,000 hysterectomies in a year in the five (private) hospitals.
A Thomson Reuters Foundation investigation found many women - often young - targeted by doctors whom medical experts say seek to profit by prescribing the surgery for minor ailments, with the operation and later costs driving families into debt.
-- Banterings
More and more comments on the medical education listserv support the current concept of medical school teaching of physical examination. There has been no comments limiting teaching to the desires of an individual student. Here are some of the current responses:
I could not agree more. I am emeritus professor of Internal Medicine , retired but somewhat active in our med school.
My observations over the last decade or more are that residents and students are getting less likely to examine patients and rely on some form of lab or imaging to establish a diagnosis.
There is ample evidence we are wrong in these initial assessments many times, in part due to lack of appreciation of as complete information as possible.
Test selection seems more random than Evidence Based Medicine utilization would impart by recognizing the predictive value of a given exam if results are positive or negative.
The EHR is also rife with potential misuse due to over utilizing cut and paste techniques or "smart phrases" resulting in erroneous communication.
In short being a physician requires we have and utilize the basics of patient interaction , examination and clarity of communication, other wise I do not believe we are truly professional.
Another:
In my opinion, the focus should continue to be on the best ways to help students learn. To help each student be prepared for whatever specialty they choose. It is not a productive conversation to try and decide based on personal reasons, or ideas, the specific pieces that should be taken out of a curriculum, or what should be inserted. The education community should always attempt to see the bigger picture, to use the GPEP as a guide. As the amount of information continues to explode our focus should remain on establishing the best ways to help students learn, and how to help shape the professional foundation of every student. They will learn to be physicians in their chosen specialty during residency and beyond. The honor of being able to help in this formation should be cherished.
The GPEP Report was a formal study in the late 1980's about how medicine should be taught in the upcoming 21st century.
After reading all of the comments on this topic, I feel ever more firmly that if you don't want to examine a particular part of the body, you don't get to be a doctor. Period.
There have been even more responses by medical educators but not one agrees with the concept that the medical student should demand modifying their practical teaching of the physical examination based on the student's own ideas or emotions regarding the teaching value in terms of what will be their future use or rejection of use of the teaching.
What do you think about this virtually unanimous expression of a view by medical educators regarding accepting a medical student's rejection of learning and practicing the genital-rectal examination?
In learning and preparing for other established professions, should students have the right to reject participation in certain teaching procedures due to their personal, moral/ethical/religious or sexual beliefs and where this rejection may have potentially negative or harmful value towards other? Think of a student planning to become a fireman but is willing to fight the fire of a building from the outside but refuses to learn how to properly enter and fight the fire from the inside because of his or her rejection of entering burning buildings. Could this be an analogy to the medical teaching issue? ..Maurice.
No surprise for me that doctors unanimously agree on a no-restrictions curriculum. I may not voluntarily choose a female doctor for anything intimate but I darn well want any female doctor that I find myself within the ER or OR sufficiently trained and experienced to handle whatever intimate matter that needs dealing with. Same with nurses, techs and others. They need to be trained in the full scope of their licenses and certifications.
Again, the training under discussion uses paid patient actors who voluntarily allow these examinations. We are not talking unsuspecting real patients.
"Thanks, F68.10 for saying "Took me years to come out of the woods." That means it can be done."
I wouldn't be overly optimistic. If I were to be accurate, I'd say that whether or not it can be done is highly dependent both on the type of medical abuse and the cognitive setup of the mind of the abused person. I'd say furthermore that I do not necessarily believe that it's always a good thing to come out of the woods and I'd even go as far as claiming that it sometimes is in the person's best interest not to discover the abuse in the first place. (Once something is learned, it cannot be unlearned.)
Being medically abused is one thing. Discovering to which extent you've been abused or bamboozled is a double-whammy.
https://www.youtube.com/watch?v=vX5vJRU6x7s
(Sorry for the hyperbolic analogy, but it's the best I could come up with...)
It can be a triple-whammy if the abuse continues while you're aware of it because you have no power to hold it back. It's a quadruple-whammy just to try to stop it. It's a quintuple-whammy when you start talking it out publically. It's a sextuple-whammy when you realise all the talking points you have to micromanage to get your message out. Only then can you start seriously coming out of the woods. And then you have to figure out how to engineer a change for the benefit of others, a whole other topic.
So I do not believe just anyone is cognitively equipped to manage that journey on their own. Outside help is often needed and it's difficult to know who to "trust". And I do believe some people going through all that crap commit suicide. I was too darn close, and still regret not having done it. Not exactly a state of mind I'd recommend for anyone...
"I would have said a child but children today actually have 100% or more rights than patients. Patients have no rights unless the medical community "allows" them the favor of having a right or two."
When you go through Munchausen by proxy and the caregiver is a physician, you have the incommensurable benefit of having no rights on both the counts of being a child and a patient, with the added delight that all of that is done because of bullshit... Lovely.
Ah. OK. The purpose was not for you to find it impressive. And I'm no leftist (always been center right in my country by all measurable standards).
Honestly, I couldn't care less about that specific topic. It's because you seemed to care about "socialised medicine" that I purposefully gave you that link.
You're free to make up your own mind. I'm just pointing out the obvious: There's many ways to make up one's mind. You can rely on facts, data, logic, intuition, theology, ideology among many others. All these add up in your mind to what you end up "deciding" to "believe". It's up to you to hierarchise all that data and all these thoughts. I'm just saying that there are better ways than others to do it... One way to convince yourself (not me, I do not remotely care about the topic) that you're doing it right is to confront yourself to opinions different than yours, which was the point of the counterpunch article. Logically, if a better opposite case than the counterpunch article has been made, it should be published somewhere on the net. It's up to you to find it and reflect on it. The onus is not on me to validate what your thougts are on a topic I don't even care about: I only care in helping you think more precisely with the most conflicting and data heavy material out there. It's not a rhetorical attempt at convincing you.
You may feel bullshited by data, evidence, unspoken ideological beliefs masquerading as sound rhetoric. That's fine by me. I don't judge you in any way. But you still may be interested by the following discussion, specifically part 3 at 7:22.
https://www.youtube.com/watch?v=AGvGQSazaTM
I'm not claiming you're a flat earther! Not at all! It's just a video that may help you think as straight as you possibly may want to. Not lecturing you in any way: I'm myself likely much more concerned by the topics discussed in this video than you likely are.
80% of our patients are women and the vast majority are elderly. Nursing homes and Assisted Living Homes don't attract the thrill seekers.
Biker , I think you're a good person but a little on the naive side. I don't recommend wearing your anger on your sleeve like PT sometimes does. That being said I think PT is more accurate about the way things are.
Nothing else is equivalent to an intimate exam. The fire fighting analogy is different. An intimate examination is sexual regardless. Maybe not to everybody but even if ONE party, doctor OR PATIENT is affected...
I have been searching for a urology practice in my area that has male assistants for male intimate care. Not much luck. Then I happened across an article in a local magazine that showed a photo of the staff of a nearby urologic practice touting the Resume procedure for BPH treatment. Behold, a male nurse practitioner was in the photo. I quickly got a referral to go to them.
Upon being examined by the doctor, I learned that they do indeed have a male nurse practitioner on staff but that what he does is independent of what the medical assistants and nurses do. In other words, he doesn't do their tasks. I related my abuse experience and the doctor took the discussion to the nurse practitioner who agreed to do the necessary tasks. I was greatly relieved. I have a fast rising PSA and hope to be screened for cancer but can't do the intimate stuff with a female present with my abuse history.
The doctor recommended a Urodynamics test, followed by a prostate ultrasound, which may then result in a biopsy followed by a cystoscope. Today, May 9th, I did the Urodynamics procedure.
The nurse practitioner actually performed it, but he was so inexperienced at it that he needed the LPN, who normally does this procedure, to run the computer. I have to say she is very compassionate, and understands my situation completely. She went out of her way to respect my privacy. She kept her back to me the whole time.
For those who don't know, the Urodynamics test is EXTREMELY exposing and lasts for a long time, in my case, close to an hour. I went into the room, and with the NP present, stripped from the waist down, including socks, and put on a paper gown open to the front. I peed into the large funnel which collected my urine. Then, to determine how much I had retained, I was straight cathed to remove the remaining urine. My first catheter ever. OUCH ! Then I was placed in stirrups and a smaller catheter was placed and another catheter was placed in the rectum. Two leads, like an EKG, were placed opposite my rectum, and another on my hip. The leads and the rectal catheter were hooked to a bluetooth device around my neck and the urinary cath was hooked to a saline bottle. The bluetooth communicated with the computer. The saline was pumped in slowly until I was in distress at which point I was allowed to pee around the catheter, which was quite messy. Now I know why the socks came off. Once I peed as much as I could with the catheter in place, the procedure ended. The LPN left the room and the NP began the tedious process of removing the two catheters, which were held in place with tape, and the leads.
After it was all over, I told the NP I would have been mortified if a female had performed his role. I thanked him and the LPN for accommodating my situation. If not for them, I would just have had to live with my rising PSA and the potential for cancer.
Next week, we will do the prostate ultrasound and if there is a suspicious appearance in the gland then they will do a biopsy. I hope all is clear. I have been assured that the doctor will perform the ultrasound and the assistants will keep to the side without any direct genital exposure.
JR said:
F68.10,
The memories have come flooding back as the versed & fentanyl didn't do their complete job this time. Yes, he remembers--he remembers lying there while it was happening & being trapped in his mind unable to physical resist or even verbalize. This is why we compare what was done to the torture of a war prisoner. Neither of us will ever be able to talk to someone professionally in the medical field as the damage in our trust of them is complete and irrevocable. Knowing they have the power to force upon an supposedly free individual living in a supposedly free country a procedure they did not want or consent to and did so with the help of using mind altering drugs is alone enough to shatter trust. However, couples with the sexual abuse, the lies, and dehumanization and devaluing push it over the edge into an abyss. We constantly see their sign as it near our home so they invade our home space w/ their "heartfelt moments." That is why I am going to take out a billboard or two to advertise what heartfelt moments really mean.
Banterings,
I think the physicians that are basically employees of a hospital are even worse. The hospital from hell only has physician employees. The drs. malpractice insurance is through the hospital which is self-insured. They all belong to big doctor groups. Independent doctors have no hospital rights. My son's doctor does not practice at any hospital bc he does not believe in hospitals owning the doctor.
I was at a salad bar the other day. A group of nurse from the hospital from hell from the location near us (not the one we had gone to) were there for lunch. They acted as if they owned the place & everyone should move out of their way bc they were nurses. Of course, I didn't & I actually moved at a pace slower than a snail & blocked their progress as much as I could. Petty maybe but it felt good to control them.
As for Dr. B.'s contributor saying: "The EHR is also rife with potential misuse due to over utilizing cut and paste techniques or "smart phrases" resulting in erroneous communication." I totally agree w/ this statement as I can verify the EHR are full of flat out lies to CYA. The surgical reports no longer tell what is exactly done & by whom. I still insist there are two sets of MRs--one for patient release & the other one kept in secret for the hospital. The EHR gives the medical community the even greater ability to defend themselves from malpractice suites as they literally have nothing put in them that has not be phrased & reviewed by teams of lawyers. JR
8flyer,
It is very encouraging to hear that you had a good experience at the urologist’s office. It’s wonderful that female LPN kept her back to you the whole time. We need more female nurses like her who are willing to respect male patients’ privacy by not looking at their genitals as they are undergoing procedures.
You did a wonderful job standing up for your rights to modesty. You are a great role model to other male patients who value their modesty.
Would you be willing to submit your successful story to Medical Patient Modesty’s web site by filling out this form? This would help to encourage other male patients to know they can stand up for their rights like you did.
Misty
Good for you 58flyer for speaking up and for the doctor and staff doing their best to accommodate you. I don't think I could go through a urodynamics test myself if it was female staff doing it. It is extremely insensitive for any hospital or practice to not have some male staff available for that testing. My guess is most men show up for the testing not knowing it will be women doing the test. It took me by surprise when I went for my first cystoscopy and found out it would be a woman doing the prep.
For anyone in Vermont or New Hampshire, I can point you to a hospital where urology has 1, maybe 2, male RN's. In the past 3 years I have had 2 different males there do my cystoscopy preps, and my asking to be assigned to a male RN is taken as a perfectly normal kind of request. I'm not sure if we're supposed to name names so I'll just hint its a large teaching hospital near Dartmouth College.
JF, I agree that no analogies are equivalent to intimate exposure in healthcare. The stupidest one I have read numerous times is likening a patient's intimate exam to a mechanic working on a car. Do they really not see the difference between a patient and an inanimate object?
What I have been reacting to is the thinking that all women in healthcare purposely abuse all their male patients. If what was being said instead was that most women in healthcare view their male patients through a sexual lens I would be in agreement. There is a big difference between the two. Seeing someone through a sexual lens is an automatic involuntary human reaction. We all do it all the time whether we want to or not.
Abuse is purposeful such as JR's account of what happened to her husband or Dr. Sparks abusing her male patients. Being viewed through a sexual lens on the other hand is simply part of being human. Some patients are seen as better looking and/or having more sex appeal than others. The question is more correctly whether they act on those judgments. The judgment itself is not abusive, acting on it is. Purposely leaving the proverbial late teens skateboarder in the ER more exposed than they do the fat middle aged guy is acting on it. At a minimum it is abusing the teen's trust even if they convince themselves "he's a guy so he doesn't care". What makes it abusive is the purposefulness with leaving him exposed when they know he didn't need to be exposed.
The gray area is when needless patient exposure is based on protocols that carry no overt ill intent. "This is how we do it." "It's how I was trained". That those protocols differ for men vs women speaks to societal norms that apply different standards based on stereotyped modesty differences male vs female.
The question then is how much needless exposure is due to poor protocols vs being intentional. I have experienced both. Using the teenage skateboarder & fat middle aged guy example, if both are equally exposed in extent and duration for similar treatments, then it is likely protocols at work, even if it means more exposure than was truly necessary. If the skateboarder gets exposed more in that example, then we're talking intentional and have crossed the line into abuse.
Perhaps I am naive but I'm just not seeing all women in healthcare abusing all male patients they have intimate access to. I think poor protocols are a big part of the problem vs it all being purposely abusive.
When I started having panic attacks whenever I saw a pharmacy or an advertisement for medication, I too did start wondering whether or not I had been "tortured".
https://www.google.com/amp/s/amp.theguardian.com/law/2014/dec/14/torture-survivor-fear-doesnt-go-away
Torture explicitely refers to abuse perpetrated by state or paralegal institutions for their own goals. As healthcare is altruistic in essence, this kind of abuse doesn't technically qualify as torture. I would say that this point is rather moot. What matters is indeed the psychological consequences, and most notably the learned helplessness (technical term you can look up on the net). As far as I see, your husband is not there yet, so "rejoice" that you're likely not in this category. Your husband seems traumatised, and terrorised to some extent, and may feel vulnerable. That's quite bad but not as bad as torture.
"Neither of us will ever be able to talk to someone professionally in the medical field as the damage in our trust of them is complete and irrevocable."
You should honestly think twice about that. You cannot endlessly avoid healthcare. It will catch up back with you. Get your husband to see a psychologist to reconcile himself with the concept of healthcare. If you do not solve that issue ASAP, it will catch up back inevitably at the next hospitalisation.
I'm sorry to say that, but he doesn't have a real choice. He needs to find a way to outgrow that dread.
"Knowing they have the power to force upon an supposedly free individual living in a supposedly free country a procedure they did not want or consent to"
Yes. Society has given that power and responsibility to doctors. For good reasons too: there are so many families that do appalling things with their kid's healthcare, for example, that society has given doctors the power to coerce others into care. I know that first hand.
Overall it's a good thing doctors have this power. The problem is the way they have gone fully down that rabbit hole, and that they are now rather unchecked in the way they use coercion.
It's a political issue with many many shades of grey, and it's tough to think about, let alone know what to change, and even less how change chould be brought to the front of the political agenda.
Your husband will need your help.
Hello,
Rather that worry about how prospective doctors will be taught to do medical exams, maybe doctors should receive an exit exam in ethics. See below: Doctor And Physical Therapist Found Guilty Of Participating In $30 Million Scheme To Defraud Medicare And Medicaid (May 9, 2019; U.S. Attorney; Southern District of New York) https://go.usa.gov/xmEje
Virginia Doctor Convicted on 861 Federal Counts of Drug Distribution, Including Distribution Resulting in Death: Faces Mandatory Minimum of 20 Years in Federal Prison (May 9, 2019; U.S. Attorney; Western District of Virginia) https://go.usa.gov/xmEju
Reginald
Reginald, how correct you are! I wish we had a way to identify these "misfits" or worse name before they were allowed to graduate and go into the active profession. A question I will look up or ask on the medical education listserv to which I subscribe is whether there is some organization or medical board or the medical school itself looks back at the individuals medical school records for clues which could explain the physician's later behaviors. It is unfortunate that virtually all physicians in practice are not scrutinized by the medical school itself and reviewing school records and looking at these records to come to some conclusion as to whether the "good doctor" or the "bad doctor" behavior years later could be anticipated in school. ..Maurice.
58Flyer
I’m fully aware of your history as I’ve read your posts for years on other sites. Let me first say that urodynamics testing is worthless
and a complete waste of time,it’s a money grab for tests that don’t give any real credence to the already suspected diagnosis. I’m
prepared to get flamed by any urologist who reads this and wants to question my knowledge on the subject because I’ll throw it right
back in their face with the scam billing as well as the statistics of useless medical information gained from these stupid tests.
Second, the possibility of a renal infection from being cathed and even getting MRSA as a possibility. Is it really worth it in the end. To
know how many seconds it took for 92 milliliters of urine to leave your urinary bladder, STUPID. Follow the money as its already surpassed the 4 Trillion dollar mark annually. There is already enough unnecessary testing in healthcare as it is especially when multiple tests are ordered that are complementary to each other.
You are one of the male patients in our society that the entire healthcare industry should be apologizing to. That the medical industry
should have learned something from this but apparently not. That some sick, demented psychotic Fuc&ing female nurse felt the need
to strike your testicle with a metal object all because as a young boy you had an erection and because of this you lost a testicle due
to infection. Did it ever dawn on you that maybe this could be what after all this time the possible cause of a rising psa and prostate ca.
Your story should be the preface of all nursing manuals and how the wrong people choose a healthcare career. Apparently a lot of
nursing students did poorly on their human physiology classes I would guess or rather they were not paying attention when the phrase
first do no harm was presented. Right up there with the definition of dignity there should be respect. All patients should be given dignity
and respect and especially given the fact considering what we are paying. Our healthcare industry is Pathetic!
PT
Biker
Sorry for calling you naive. Giving people the benefit of the doubt , maybe that's not such a bad thing.
Being deliberately abusive is the worst. Being negligent in providing privacy is possibly an unconscious act but patients are harmed by that also.
Overworked staff comes to mind. Maybe they're working to many hours or not getting their lunch break in a timely manner. Maybe they have more work to do and not enough time to do it.
That kind of thing has a negative influence also.
I think the number of lecherous staff is smaller than the number who violates out of overwork and absent mindedness.
No need to apologize JF. I admit I might be naive at times given my propensity to give people the benefit of the doubt until they demonstrate otherwise.
That said, in healthcare settings I have experienced purposeful violations of the sort we discuss here. Even then, and here perhaps is my naivety, I think most of it wasn't intended to harm me but rather female nurses either thinking I wouldn't notice or thinking it was OK because they've been socialized to think guys don't care. They did harm me though and it was wrong no matter what their intent was or how polite they were.
What JR's husband experienced on the other hand seems to have had the intent to harm him. Nurses like that need to be fired and their licenses revoked.
I think most of my experiences more fall into the unthinking ignorance that comes with poor protocols rooted in societal norms that men either have no modesty or shouldn't have any modesty. The bad apples that purposely sexualize patient encounters, whether intending to harm or not, need to be weeded out, but this societal norm is the larger problem I think. Sadly the trend line may be making it worse. I saw in the news yesterday that the head of the NBA wants 50% of coaches and refs hired going forward to be females. Just a guess on my part, but I suspect those female coaches will be in the locker rooms with the guys after the games when the guys are trying to shower and dress.
JR said:
F68.10,
No, neither of us will ever see a psychologist as they are part of the medical community that we do not trust. Not only was his bodily privacy violated but his private medical information has been violated multiple times. There is no way to measure if any medical provider is ethical & follows the law before they have the chance to violate you. Also, I disagree. Torture is done by ordinary individuals to other ordinary individuals. Torture is just not reserved for use by state or paralegal entities. And yes, we can avoid hospitalization. We may die younger but we are willing to accept that so what happened this time will not happen again. He and I don't need to outgrown that dread bc the dread is not imagined but is a real experience that happened. If we are not fully aware of what happened then it could easily happen again. Women are told not to walk alone in the dark at night in secluded areas. Hospitals for him is where the crime was committed. As far as I see, healthcare is only going to worsen. They have no need or incentive to change. There are so few who bring their stories to the front. Here in the US, the healthcare lobby is so strong that it is impossible to get reform. Also, as in the opiate crisis, from what I have seen, they are only punishing the suppliers of opiate prescription drugs and not the pushers--the doctors. They had to punish someone so they threw a couple of pharm co. under the bus.
And no, doctors should not have the power they have over adults. Because society has doctor/nurse-worship syndrome is a big reason why they have an overinflated opinion of their power and control. Sadly enough, the families who want to do horrible things in their children's healthcare are usually families who have a very strange religious conviction. At least that is how is happens here in Indiana. So you have the Battle of the Gods. Usually the religion wins out.
I disagree. It is a conscious effort to not provide males privacy when they mostly provide privacy for females. Of course, you have some that provide privacy for all but these are few. They probability do no think it is abuse but it is. Again, during procedures that is why they give versed & such bc they know they expose patients & want the ability to talk freely so they give a drug that erased the patient's memory & makes the patient submissive and disinhibited. Versed should be a patient choice not mandatory. The hospital fought us hard over the misbilling. We finally won but it took months. They didn't send a letter but sent a billing statement showing a credit. They simply cannot admit they were wrong.
Reginald, When we brought this to Medicare's attention, they didn't care as they said it was outside of the time period. Our bill was not sent until it was out of the period & it was not an itemized bill. We had to ask for it several times over a two month period. Of course, that made it outside of Medicare's allowed period. They know what they are doing. JR
JR
I would have brought the manager over to observe these nurses at the salad bar all the while making my point known
about them spreading germs from their scrubs onto the food, that’s it’s just not sanitary. Making sure everyone heard
my concerns.
Misty
I would hardly call 58Flyers experience a success story. She may have been a medical assistant for all we know and
for all I care she not only should have had her back to him if she couldn’t leave the room, but a black hood over her head
and braile on the buttons of the equipment.
PT
Part 1/2
Wowowowowo! Slow down! I believe you're getting me completely wrong!
I completely understand your position! Believe me! I've been there.
My personal position is that I SHOULD be CANNOT get psychological care. I believe the position you and your husband is "happily" somewhat milder. I'm just trying to advise you on how not do things that will go against your self interest!
Let me try to explain my position. Take a bird's eye view of the problem.
Take a wild ride on the frightening Internet where the most nonsensical stuff and the most sensical stuff are in a state of constant warfare for the hearts and minds of the lay public. And ask yourself if the following paragraph makes sense or not. Do not ask yourself whether or not it pleases you, but only if it makes sense:
If you pay close attention, you will see that so-called rationalists and skeptics will often mock and deride their opponents with sentences like "you're in a rabbit hole, and you keep digging deeper and doubling down on your beliefs!". You can see on the Internet that these same people will often defend healthcare tooth and nail to the bitter end. There's a reason for that... But it doesn't change the fact that, according to their own vocabulary, some people are indeed in a "rabbit hole" of so-called "delusions".
Part 2/2
What they fail to perceive is that people do not dig "rabbit holes" for the pure pleasure of doing it. Some people are thrown, willingly or unwillingly, deep down in a rabbit hole against their will... and other factors have blocked the way back to the entrance and forbade the natural way out of the rabbit hole, which would be to backtrack. These people are stuck in their rabbit hole, and have NO OTHER CHOICE than to keep digging!
I've been there, and I've cartographied all the ins and outs of the mental confusion I was forced into. It was exhausting and it took a very serious toll on me.
What I claim is that healthcare pushes people deep down into the "rabbit hole:. Unwittingly.
So let me show you, and document, what the next step in the "rabbit hole" is. And where it leads to... as you put it yourself:
"No, neither of us will ever see a psychologist as they are part of the medical community that we do not trust."
I'm going to put a link below where people commenting indeed "rage" on and on with the same kind of position as yours: "as long as psychology is medical, I have no trust". I happen to have the same position. And the people in the link below have been forced into psychological care as part of a medical measure. Measure their rage and discontent in the comment section. And their relentless call at demedicalising psychological care.
https://www.madinamerica.com/2017/06/antipsychiatry-say-what/
That's the place you may be going if you keep digging in the "rabbit hole". Let me tell you: it goes way way way way deeper than what you see on that blog. I honestly wish that you'll never go down that path.
But I have one question for you: do you deny that this specific "rabbit hole" exists? Or not?
I'm not telling you that seeing a psychologist will help your husband. It can either help your husband out of this "rabbit hole", or it can push him way deeper into the "rabbit hole". I have no way to tell.
"And no, doctors should not have the power they have over adults."
It's complicated. When you see adults trying to cure autism in their kids with bleach... what do you do? Do you say, yeah... that's right... go on, it's fine? Well the societal consensus on that is that's it's not OK. No way around that fact. When it comes to other cases of medical coercion, I agree with you that doctors should generally not have the power society gives them. But it's not something we'll fix by ranting on a blog. It's a political question and it goes much further than mere politics. I know: I've been down that rabbit hole to the bitter end. I can tell you more about it.
When it comes to torture, I said: "Torture explicitely refers to abuse perpetrated by state or paralegal institutions for their own goals. As healthcare is altruistic in essence, this kind of abuse doesn't technically qualify as torture. I would say that this point is rather moot."
What I did in this statement is state the "official" "definition" of torture. Explaining that it "technically" requires the perpetrator not to be "altruistic". And that I found this specific point "rather moot".
I do not see where we disagree...
Reginald et al: Today I wrote the following to the medical education listserv to which I subscribe which explains why I am motivated to have doctor's student records reviewed and analyzed. ..Maurice.
Unfortunately, the topic of this [medical education listserv] posting really strikes "home" to me as a long time member of the University of Southern
California Keck Medical School. In recent years, we have had two deans of the medical school, one a replacement for the
removal of the first before that dean also was removed because of serious misbehavior and finally removed was the long time gynecologist of
the USC campus student health for years of sexual mistreatment of the students he was examining. I haven't looked into which medical schools
each of these three physicians attended but I wonder if the schools or any certifying organization is looking into these physicians' student records
for clues that might prognosticate these 3 individuals' later "misbehaviors". Firing,fining. loss of licence to practice or jailing is one series of actions
which may be taken by society but how about "prevention", "prophylaxis" of other physicians by analyzing physician's medical school records and
looking for 'tip off" or "clues" that may, in the long run, be more significant than some certifying questions or technique skills as the student
graduates out of medical school.
By the way, it is tough to learn about physician misbehavior (especially twice at the dean level) and especially if associated with the medical school in which one is participating. Perhaps that is why I look forward toward some approach to prevention and prophylaxis even at the medical student level
if anything like that can realistically exist. ..Maurice.
And here is a Comment on the medical education listserv written in response to my presented issue that is worth reading. I am sure virtually all of our Patient Dignity writers and readers will fully agree. I do.
..Maurice.
Dear Maurice and All,
I wonder if any of you have read this article by Papadakis and colleagues that starts to address this issue-- there is a clear link between professionalism/ethical behavior in med school and later in practice:
https://www.nejm.org/doi/full/10.1056/nejmsa052596
I think that part of the issue is that entrance to medical school has become principally about MCATs and GPAs, for anyone can pretend to be "normal" during a series of interviews-- unprofessional behavior or unethical behavior would be almost impossible to detect unless there is a longitudinal observation of the applicant. And of course, that cannot be. But medical schools "bragging" about their high GPA/MCAT scores, then USMLE 1 and 2 etc. has put otherwise mission-driven or humanistic medical students at a disadvantage. And I am not saying you cannot do both-- surely you can. BUT, students have no incentive to really expose themselves to empathy-building activities if they know its just a "check box."
Furthermore, ethics courses are present, but challenging to assess (i.e. everyone thinks its a good idea, but how do we know they actually work?) Very little data on this, in my humble opinion. These courses (as well as professionalism education) need to be present, but do experiential opportunities-- like working in a nursing home, homes for the disabled, underserved areas-- even in a service (rather than medical capacity).
Third, I think the idea of "vocation" has eroded for many students. Medicine for many is about the 3 Ps-- prestige, power, puzzles (i.e., the human person is just a complex "puzzle" to be solved/fixed), and this makes a difference in terms of motivation, moral action at the crossroads, burnout (which leads to unprofessional behavior)...
Finally, while I agree that EVERY discipline has good and bad actors, I would like to think that because of the unique role of medicine in society-- as a healer's profession, as one in which a vulnerable person comes to us in the context of illness/sickness and must TRUST us [see Pellegrino's work on this]-- physicians should be held to a higher moral and ethical standard. The difference you can make in a person's life through kindness, generosity, and ethical behavior while wearing a white coat is amplified because of what it means to be a doctor and a patient; conversely, unethical behavior in and outside of clinical practice on the human person (and society) is amplified because a DOCTOR did it.
I think tracking med students throughout their 4 years is being done in some places, as far as professionalism lapses go, but once they transition to residency, there are likely issues like privacy, logistics, and poor professionalism tracking/education at the GME level that would make tracking the SAME student very difficult. From there, how does a medical school keep track of them as they go to fellowship or a job and beyond??
In Ohio recently, we had an ICU physician who allegedly killed 32 patients because he allegedly felt that since they were DNR they were going to die anyway. He has since been fired, license suspended, being sued-- co-workers in the paper described him as charming, arrogant, cocky etc. He did residency and fellowship at 2 nationally prominent OH residencies whose initial review showed no major red flags. How can this be? Again, would going back to the med school help here? I am asking some of these questions because I really don't know-- food for thought...
www.pennlive.com
Ashley Ann Smith Lpn, a Nurse at Kane McKeesport nursing home has been arrested after she had taken
cell phone pics of 17 of her nursing home patients while they were nude. She then sent the photos on to
other co-workers. Now, some here on this blog are going to say “ oh this is just an isolated incident “ or
make other excuses.
Fact is, she got caught but many don’t or the facility keeps it under wraps. All the while Maurice continues
to catch HELL for the mis-givings of some med students and/or why don’t some simply refuse to learn how
to perform a pelvic exam. That he has to gather opinions from every medical organization in the world to
see what their thoughts are.
PT
It’s been suggested by some of our readers that “ no, female nurses don’t get up in the morning with the intent to abuse or humiliate
their patients.”
Yet for Ashley ann Smith lpn who was recently arrested for taking nude cell phone pics of her patients this is what the police said
about her arrest.
Police said the photos are explicit and private, and some have the sole purpose to humiliate the patients.
www.wtae.com
This nurse had been doing this for some time.
PT
Therefore
With reference to Ashley Ann Smith lpn, arrested for taking cell phone pics of her nude patients so as to humiliate them
Versus
Being critical so as to set educational limits on the learning of a pelvic exam by med students
Shouldn’t we
Be contacting vis listserv, the American nurses association, the ethics of nursing organizations etc
as to why
These organizations are not looking into these nursing students files.etc as to why these crimes are happening.
PT
JR's husband was harmed deliberately and to the extent that the offending staff should be footing the bill in addition to some of them being fired, but it doesn't seem likely to happen that way.
Medical staff are untouchable on their own turf. If this issue is ever going to be overcome, it won't likely be anyone law abiding doing it.
It'll be guys/women singling offending staff away from their throne. Taking cellphone pictures with their ( the staff members own cellphones ) and sending the pictures to their contacts. Naked pictures of course.
It wouldn't be difficult to get some of those love starved women , while away from.their turf. I don't know about the doctors.
PT, I agree. Unfortunately and I mean unfortunately I have no knowledge of the details of the teaching, screening for clinical knowledge or ethics that is part of nursing education. I have no knowledge of the teaching of behavior also in activities such as technology operators (techs) or even scribes. But nurses, who time-and-activity-wise may have more direct patient contact than physicians should have their training and behaviors in training to be dissected. ..Maurice.
The 1:19 pm post had no pseudonym noted. Please be sure, for proper continuity, each posting is identified with your pseudonym. ..Maurice.
I would strongly advise my visitors here to read the NEJM article recommended by the medical education listserv poster:
https://www.nejm.org/doi/full/10.1056/nejmsa052596
It really gives insight to the matter of early identification of students who may turn into "bad" doctors. But this was published in 2005 and more recent studies are hard to find. If anyone does find..please note the reference here. ..Maurice.
JR said:
Read this article in MedPage:
https://www.medpagetoday.com/publichealthpolicy/ethics/79749?xid=nl_mpt_DHE_2019-05-11&eun=g1266452d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-05-11&utm_term=NL_Daily_DHE_Active
Seems like the world of abuse & mistreatment is catching up to some. Some dr. in KY at a religious affiliated hospital doing unnecessary stenting too. Stenting is a really big moneymaker to the tune of $300,000 more or less if any overnight stay is involved which usually there is w/ stenting.
F68.10,
I was just trying to explain why for both us getting any more medically intervention was not going to happen. Maybe years ago, healthcare was altruistic but now they are in it purely for glory, money, and power. They are just another block of power besides government, religion, and the media. They may even be more powerful as they service all of those people. Whether it fits the official definition of torture or not, for us it certainly felt like we were & had been tortured. Yes, I do believe you can go down a rabbit hole but it is up to us not to let that happen. Our main problem is each of us was abused/tortured in a different way but we both share the abuse/torture of the each other. It has been a double dose of bad medicine. Avoiding hospitalization is not impossible. My husband did have an EKG in another hospital done but he explained what happened to him & they were very good. With Banterings help, I now recognize what we are experiencing. Before joining this group, I thought we were alone w/ what happened. It was hard to believe what happened did in fact happen. We are just very average people. My husband looksI have done my research & know the triggers are as we have discussed it. Music for me a great escape--David, Rod, or Neil are really good for me or anything from the 70's when I was just a young child. I have always lost myself in music or reading about Napoleon as my childhood really sucked. A psychologist I worked w/ yrs ago told our disability reviewers that when you feel rage growing, take a hammer and beat a tree stump, a piece of metal or throw a glass object as the breaking of the glass is like the breaking of your rage. He no longer practices but his advice does work.
I agree that my husband was harmed deliberately but it evades us as to what was the cause or was it a combination of ill-fated happenings. I do believe that some do intentionally set about to harm others. I also believe that some may not realize what harm they are doing in not allowing a patient their dignity and to be respectful of them. However, I do believe there are administration rules that cause this to happen. One rule is the use of drugs that allow the loss of dignity/respect to happen. These drugs make patients defenseless & vulnerable not to mention submissive & compliant. They gave these drugs to my husband when he had refused them & did not need them. It was a conscious effort on their part to not record his directive as they knew it was their standard procedure to give these drugs so they could do their job w/o patient or family interference.
PT,
You have just put some of those organizations on my radar.
To all I just wanted to say thanks bc you have helped us in so many ways. At least for us, what you are doing on this blog has made a difference for we know we are not alone. JR
JR, ventilation by one and understanding with support by others is definitely a method of therapy. I am glad this blog thread and its contributors are being therapeutic. ..Maurice.
Misty,
Thank You for the kind comments. Thanks also for your continued attention to male modesty concerns. I completed the form at the link you sent. I only ask that you keep my email address confidential.
Biker,
Thanks for the response. I was fortunate in my first and so far only cystoscope ( I will have another one in 2 weeks) in that I asked the doctor to perform the procedure without any assistants. I cannot imagine a female doing that prep on me. My primary care doctor has a nurse who is an LPN, shared with me her husband's experience with a cysto. Since I have had one, her description was right on. She said he was brought in by the medical assistant and told to strip waist down and put the 3' by 3' paper over himself. When she came back into the room, the medical assistant never said a word and put on the elastic gloves, ripped a hole in the paper over his penis, then grabbed his penis and inserted the lidocaine gel into his urethra, applied the metal clamp, and then just left him exposed for the next 10 or 15 minutes while she milled about with small talk until the
doctor came in and did the procedure. Talk about an ambush! She said her husband said he was so mortified that he will never seen another urologist. I suppose that is the usual experience of many men in their first encounter with a urologist. With that experience with her own husband in mind, my doctor's LPN personally called every urologist in my area seeking any who had a male assistive team. She wasn't able to find any and relayed that information to me. I appreciated her taking the time to do that as it was a big job. My doctor is part of a large group (Ocala Family Medical) and when I am there I can see she is extremely busy and for her to take the time to do that was exceptional.
PT,
Good to hear from you. You may have gotten some facts confused so I will clear them up. I was struck with a closed fist or maybe it was a karate chop, I don't know as I was looking the other way, it was not a metal object. I did not lose the testicle but damage was done to the epididymis and once healed calcified and did not allow the movement of sperm cells to the prostate and they were absorbed by the body. The problem with that is the body reacts to the sperm absorption with the creation of antibodies. Over time the sperm produced by the undamaged testicle is attacked by the antibodies which is the reason that a long term vasectomy reversal is unsuccessful. So she basically gave me a partial vasectomy, without asking for my permission of course. By the time I was married some years later and wanted to produce children, I could not.
Also, the staff at my urology practice are all required to wear name tags that give the first name and the title, such as nurse, or medical assistant. My nurse is identified as an LPN. In my state it is illegal to identify oneself as a nurse if that is not actually the case, so I do believe that she really is an LPN.
As too Urodynamics, I did find it useful to know that when I voided normally, and then when cathed I produced another 150cc of urine. Now it may be possible that this information could have been obtained with a bladder scan, but I am not sure of the accuracy of that assessment. I am with you on the rest of the test where when I voided around the in place catheter, the stream went in 2 different directions, part into the funnel, and the other off to the right against the gown and then onto the floor. How could they obtain an accurate measure of that I can't imagine.
I wish Trump would step up to the plate about medical costs. Criminalizing overcharging. He could require it be made known exactly who gets every penny and why.
Also the laws voted in that the vast majority of patients never get to vote on, he could put an end of the small number choosing for everybody else what is acceptable and what isn't.
He said he would replace Obama care with something beautiful.
Also if there could be publicized cases of punished ( a show ) and the penalty made harsher every year...
58flyer, first, I can tell you that they get easier. My 1st one wasn't painful per se but the insertion sure got my attention. Perhaps the number of times I've had it done has stretched me somehow but now I barely feel the insertion. It would be different certainly for any guy with an enlarged prostate or any kind of urethral stricture.
Your description of that guy's cysto prep process varies a bit from mine and speaks to something I've said a number of times. This is the lack of actual standards for most procedures. Each staff member or practice gets to decide what they think is appropriate.
I have had about 20 cystos at this point, most at a large teaching hospital in Boston and the last few at a large teaching hospital in NH. Like the LPN's husband I had no idea going in for my 1st one how it was done or that a female nurse would be doing the prep. I had not yet found my voice at that time and did the "man up, doesn't bother me in the least" routine that most men perfect along the way. Of course it was all the worse that she was young and pretty. It would have been less embarrassing with a matronly grandmother type RN but that doesn't seem to occur to urology practices.
At that hospital all the nurses did it in precisely the same manner, so clearly they had an approved protocol for that practice. Pants and underwear off in a private changing room, empty the bladder, put on a cloth gown, come out into the procedure room, get on what I term a birthing type chair that has me spread eagle, the nurse lifts the gown up to my abdomen fully exposing me, covers my legs with a sheet, puts a square cloth with a hole in the center over the genital area that leaves just the penis exposed, washes my penis with that brown disinfectant stuff, inserts the lidocaine, puts a clamp on it for 5 minutes or so, removes the clamp, and then stands right at my hip until the doctor arrives, assists him with his gown and gloving, stands again at my hip until he is done, then hands me a cloth to wipe myself. I return to the changing room, get dressed, and she's waiting for me with 2 cipro pills to take, one right then and there and 1 to take home for that night.
I will note that they all told me what they were going to do each step in the process before they did it. Every one I had there was with a female nurse doing the prep.
My current hospital does it a bit differently. Rather than the spread eagle birthing type chair I lie on a table which feels a bit less exposing, though for all practical purposes it is not. Rather than use the cloth with a hole in the center, the draping used to cover my legs extends up past my abdomen, the two sides coming together in a way that attempts to just leave my penis exposed. They then add small towels to give a bit more coverage to achieve just the penis exposed. I'd prefer the square cloth with a hole in the center if I had a choice. The two key differences are that a cloth is added to cover my penis until the doctor arrives and the nurses don't position themselves at my hip but rather busy themselves elsewhere once done. That, and I've had male nurses each time at this hospital. Also, only 1 cipro now.
The female nurses at the 1st hospital never did anything overtly wrong but I am so much more at ease where I am now with male nurses. I will add that for my very last cysto at that 1st hospital, the nurse struggled to maintain her "this is purely clinical" gameface. She even varied from the standing at my hip standard to standing by my shoulders doing her best to look me in the eyes vs looking elsewhere. It was perhaps mean spirited of me but I admit finding comfort in her discomfort in that for the 1st time ever I felt like I held some power in the dynamic.
JR said:
JF,
I'm w/ you. I wish Trump would do something. He is a businessman & should be able to recognize how healthcare is ran is not good for business. More should write to him. You don't have to like him to ask him to take care of this. It is my opinion that O'Bamacare has helped create the atmosphere of today. We sent our story to Trump a few weeks ago. I hope he responds like it is said he does. I also sent it to Velma at CMS & Hank Azar at HHS.
I think there may be more bad nurses than drs. as there are more nurses/techs. It seems from reading through the discipline reports at the state level that even when a nurse has serious issues, she is never sanctioned or loses her license. I realize there is a shortage but they should realize the danger they are putting patients in allowing these monsters to continue to practice. Here is a suggestion: all schools should have patients like us come in & tell our stories of abuse or patient dignity violations. High schools do it w/ drunk driving victims & even some of the offenders give a lecture about the harm they have done.
PT,
We fear that my husband's abusive ccu nurse & her cohort may have taken cell phone pics. He was still drugged & was in a state of aware & nonaware. She had already put him on display for a roomful of people who weren't involved in his care & certainly didn't need to see his penis, him urinate, or having perineal care. She & the other nurse was alone w/ him for over an hour--laughing & doing what? They knew they were in the wrong bc they documented on the Epic system they permitted his family to see him at 3a when in reality we didn't see him until 4a when my son physically nabbed the cohort.
What does everyone think of me notifying the 2 hospitals that they should read this blog & my website? JR
JR, just a point of clarification. Did they cover your husband before you and your son were allowed in the room or did the two of you go into the room with him still exposed?
JR said:
Biker,
My son did not actually go all the way into the room as he had forgot his diabetic supply case and left to retrieve it before he entered the room. He sprung up that quickly to ran after the laughing nurse. I entered the room alone. The abusive nurse was facing a computer screen w/ her back mostly towards me. My husband was lying in bed w/ his gown bunched up slightly above his navel and the sheet was folded down around his knees. As she turned towards me, she was smiling but as soon as she recognized I wasn't who she was expecting, her smile stopped and she said for me to get out as he was exposed cause she was examining him. As she said she pulled up the sheet. That's when I said I was his wife. She then turned back to the computer and was looking for info still challenging me on who I was. Eventually she must have realized I was his wife and not his husband. That is when she started laughing again and said she did not know how to examine his groin sheathes w/o exposing him. Still laughing, she said she had figured it out by saying she could pull the sheet between his legs still leaving the gown bunched above his navel. My son entered the room during this exchange. She then started pulling on wires on his exposed right abdomen saying she wished the cath lab wouldn't leave all the wires attached bc she didn't know what they were for. She also said as did the other nurse when she was nabbed by my son that the room had been full of techs & others bc she couldn't get the equipment to work. My husband remembers that but he didn't know the times as he was drugged & time meant nothing to him & there was no clock he could see. He said once we left she again exposed him as she as done previous to our arrival. Also, around 6a, he vomited as she did not give him the prescribed anti-nausea med and again left him totally exposed while cleaning him up & changing the bed linens. How she left him exposed is contrary to all the nursing medical books & class teaching descriptions we have read. Supposedly a nurse of over 10 yrs of cardiac ccu had no knowledge of not knowing how to examine groin wounds w/o exposing the penis/testicle area of males (or the vaginal area of females is totally unbelievable). When I was "permitted" to visit the prisoner for the 10 minutes, he wasn't responsive on his own. Getting him to say sentences was impossible. He would respond yes or no. He would have his eyes open but would close them but would open them & look around. When I asked him if he was tired or sleepy, he said no. He remembers the exchange I had w/ the nurse. He remembers whenever he would look around he would be exposed even while she was working on the computer or while she was elsewhere. He was still slightly unresponsive the next day. The nurse said I could only visit during regular visiting hours even though that too was a lie. I could have spent the night in the room I later found out. He doesn't remember every second but he remembers enough to know he was abused but not enough to know the total extent of the abuse. He also remembers having prolonged, total exposure in the cath lab before & after (45min). This too is in direct conflict w/ the advertising done for cath lab procedures saying they provide for max. patient dignity. However, with the drugs, they make sure the patient cannot protest or protect themselves. He wasn't even aware he was having a procedure & didn't realize it until the next day when I told him. JR
I wrote the following today to the medical education listserv to which I have been communicating my view of looking into a physician's medical school behavior as a clue to future misbehavior. However I also have considered what has been written on our blog thread regarding the current medical system itself and so I wrote:
You know.. I was thinking of what I have written. Maybe the clue to why "bad doctors" appear in our
medical system is NOT looking back at the time of medical student education for a clue or answer
but to consider what is happening now and in the future of the behavior of medical system itself as the
driver, the pathology itself of what causes "bad doctors" to generate into the system: making medicine
a "business", demands by healthcare institutions and companies to "increase patient load", demanding
documentation of doctor-patient visits more for business purposes.and more pressures by the system
on physicians and their staff leading to physician "burnout" or "bad doctor" behaviors. Rather than looking
"back", maybe we should "look around" and "forward". ..Maurice.
JR, if your husband was left there exposed when the techs and others were there supposedly helping her figure out the equipment, the fact that none of them covered him up speaks to the general culture there. It wasn't just those two nurses. Anyone with common decency would cover up the patient even if the patient was thought to be unaware, yet none of the others did that. Clearly those nurses were enjoying the view or for reasons not yet known they wanted to humiliate him. That none of the others bothered to cover him up may mean they were enjoying the view. Or maybe none of them have an ounce of humanity.
JR said:
There were non medical techs in there such as IT techs. At least one of them was a male. There as a phlebotomist in there. The chaplain who also served as our warden was also in there although my husband had already told them he wanted no chaplain when they had asked him previously. The only ones that were not permitted to be w/ him was his family. I would say they have no humanity. As far as the view, he is just an average 67 year old man. The only thing he said is that cold affects his penis & it withdraws. He was very cold from exposure & the fact he had a heart attack to his blood was not circulating especially to non essential parts. The 2nd night he was home he mentioned this, out of the blue, that he thought his penis may be different now although this is not occurring now. He couldn't explain at the time why he said it or why he thought that but now we know he was probably subconsciously remembering their conservations. The hypnotist said we should not delve deeper as he had very emotional and traumatic reactions to what he has remembered during the sessions. The hypnotist was very good and did not give hints to what he should remember but rather let him tell the story. I was present with him. That is the only reason we can think that he would be kept exposed continuously was for their entertainment. It is beyond criminal if this was what they were doing for them to entertain themselves at the expense of a very ill, drugged, & defenseless man. My husband clearly remembers being exposed with the room full of people. He remember having to urinate in the male urinal in front of all of them. The equipment monitors were at his shoulders so they were right there for a front row seat. The nurse's computer was at his right shoulder. The curtain was not pulled. The door to his room (now we know) was directly in front of a set of double doors that went directly into a waiting room. His cell was the last door on the left and the farthest away from the nurse's station. His next nurse at the 7a change was a male & this nurse kept him covered up as best as possible. Of course, the dr. didn't care if he was exposed when he removed the sheath. The dr. was probably still angry that he had to come in on a Sat. night & stayed through to Sun. morning. Of course, bc he was drugged was why he was unable to defend himself against their abuse & they know how these drugs works especially on older people and they knew he was extremely sensitive to them. This is why is so important to us to get something done & why we both have been so traumatized. JR
58Flyer
Good to hear from you and to know that you are still out there. I use your story because I like to be sarcastic and being sarcastic
to the medical industry is what I like to do because of the inhuman way they treat human beings. It dosen’t pay to be civil and
nice because it gets you nowhere. Your story is not a sobby sobby story. From an evolutionary standpoint your purpose in life
is for the advancement of the species. You were robbed of that because of some nursing C#&T who felt the need to assault you.
Your story is the epitome of what a female nursing bitch really is, the absolute definition. Some people on here like to relate their
happy happy experiences because it’s a fetish to them, that’s why they are so nice about it. Makes me want to puke listening to
them and we all know who they are. There is a website describing female nurses who would be instructed to use a spoon on any
offending male patient. Those people doing crap like that need to have their teeth kicked out or kicked in, or both!
PT
As per the ongoing discussion about the NEJM article, "Disciplinary Action by Medical Boards and Prior Behavior in Medical School
": As I have stated (and proven) medical school creates sociopaths.
Here is an article that looks at Medical Sociopaths. Although the author is a practitioner of complimentary (formerly called alternative) therapies, it supports my assertions.
According to Medical Daily, "Sociopaths are liars, manipulative and lack the ability to judge the morality of a situation, but not because they lack a moral compass; rather, their existing moral compass is greatly (yet not always dangerously) skewed. Psychopaths are fearless; sociopaths aren't. Psychopaths don’t have a sense of right and wrong; sociopaths do. But both are equally capable of ruining lives and destroying relationships — not that they care."
Sounds like a perfect description of too many mainstream doctors today, who act like Gods in all their self-righteousness. Common denominators between doctors and sociopaths are traits such as superficial charm, an exaggerated sense of self-worth, glibness, lying, lack of remorse and manipulation of others. Most doctors think they know better about how other peoples' lives should be lived or ended.
-- Banterings
I just put the following comment up on the medical education listserv where I participate. Let me know whether you think the most productive time to detect the development of a "bad doctor" would be in the early hospital residency period of stress and uncertainties. ..Maurice.
I was thinking when in time we should look carefully and dissect behavior for evidence suggesting progression into a "bad doctor" behavior. Perhaps, in medical school is too early and later as an independent physician may be too late. i would like now to offer the period within the early residency work where the physician has just moved into the "deep water" of his or her occupation. Unfortunately, those involved in supervision are themselves so preoccupied by their own "pressures" that such dissection of the behavior of the new residents to find the developing "bad" medical team participants may be difficult.
However, I want to offer this point in time where misbehavioral actions might be better determined than during the period as a medical student. The consequences of the "bad doctor" in action can be a terrible injury to the medical profession and its duties to society and for prevention of this pathology we must find the point of early detection and hopefully therapy.
Biker, thanks for the very informative accounts of your experiences. Strange that there is not a standardized procedure to be used nationwide. When my cystoscope is done I will post the account of it here for comparison. On Wednesday I will have the prostate ultrasound done with the probable biopsy. I have acquired one of the Covr colonoscopy shorts and I will bring them along and see what they think of my using them. Again, I will post my experience with that.
PT, yes I am still here. I no longer post on Allnurses. I stopped for awhile and when I tried to sign on I discovered that my account was closed. Imagine that! Since I have a new computer and new IP address, I created a new account under a different name. I haven't posted anything as of yet. Really don't plan too. I noticed a lot of changes to Allnurses. In your last post you mentioned a website that instructed nurses to use a spoon. What is that website? I want to take a look and maybe confront them.
I may have missed, throughout all the Volumes, this maltreatment of a physician's patient by that physician: "patient abandonment". Definition from an article written by Dr. Joseph S. Eastern MD:
“patient abandonment,” which is generally defined as the unilateral severance by the physician of the physician-patient relationship without giving the patient sufficient advance notice to obtain the services of another practitioner, and at a time when the patient still requires medical attention.
JR, did I miss reading amongst all the other non-professional behavior you have described in detail, the experience of "patient abandonment"? ..Maurice.
JR said:
When he left the hospital from hell, they had set him up w/ a dr. of their choosing. He had to see this one as they had left a stitch in that should have been removed before he left. We immediately started looking for another dr. not connected w/ that hellish hospital but waiting periods were 3 to four months out so he was forced to see that doctor. The dr. who did the procedure was not chosen by them. Rather the dr. they chose him to see was just an internal med. dr. When he started cardiac rehab. unfortunately this dr. got the reports. This dr. was the one who didn't list his side effects to the med but lied by saying he was doing well w/o any side effects and told him to suck it up. He also told him that medicine is only a bandage and he could take all the supplements he wanted as they made no difference & he didn't need to tell him which ones he takes. No dr. directly told him not to come back but the hospital Service Unexcellence Director said if he didn't like how he was treated at the hospital to choose another hospital the next time as if he really had a choice. My husband made the choice to discontinue seeing the assigned dr. as he wanted nothing to do w/ the practice associated w/ the hospital who abused him & me. He was willing to wait on the appt. to see another dr. He now has the head of cardiology at another hospital. The dr. he really wanted who had nothing but good comments about how compassionate he was not available as he became ill and discontinued practicing. We choose this cardiologist bc he listened to his story w/o telling him to accept what happened & get other it or trying to downplay what happened. We wanted to make sure even though this dr. will only see him in a non-hospital setting (as he refuses hospitalization) that he understands what trauma has happened. JR
We are WINNING!!!
States seek explicit patient consent for pelvic exams
Note what the scumbags atYale Medical School did:
Yale Medical School asked Connecticut lawmakers to rely on medical societies to set clear standards designating when it’s medically appropriate or necessary to conduct a pelvic exam on an anesthetized patient. The school cautioned lawmakers against legislating clinical decision-making and helped persuade them to shelve the bill.
-- Banterings
A. Banterings
If you read the comment section on yahoo regarding explicit consent for pelvic exams you would see what true skumbags
some people are. You’d think they were required to give up their first born child! I wonder if this bill includes men too? I doubt
it and if it did there will be no real enforcement, Dr Sparks is living proof of that.
Folks, how do you think this bill will be enforced and do you think hospitals will self report. This will continue as it always has
just by sweeping it under the rug.
58Flyer
Allnurses does not like men on their site bringing up unprofessional behavior, assault , sexual assault that occurs to male
patients. In fact, they just want you to go away! Their tools consist of issuing a gag order, by blocking you. Free speech is
controlled by the wretched hags that have permeated that site for years. The site I mentioned I believe was www.tigershark.com
but I’m not a hundred percent sure. I’m certain you can find it with the way back machine.
PT
I am sure that no medical institution is advising avoiding a manual pelvic exam prior to gynecologic surgery on a unconscious, patient under anesthesia. But I fully agree that the patient should previously be made aware of this part of the procedure. Moreover, I think that those medical students who are scheduled to perform pelvic exams on the anesthetized patient must also be present in the room and identified when the patient is informed and gives permission for also the students to perform the pelvic exam. The anesthetized patient cannot reject, the awake and alert patient can. And when it appears that over many years the medical societies have failed in setting student-learning standards in this matter, then it is time that state law makers should become involved.
Oh..another matter: we are approaching 170 Comments on this thread Volume 98. BE ON WATCH FOR THE BIG SWITCH TO VOLUME 99 TODAY. WHEN THE SWITCH OCCURS BE ATTENTIVE TO THE SWITCH NOTIFICATION I WRITE AND NO LONGER WRITE TO VOLUME 98 SINCE WHAT YOU WRITE WILL NOT BE PUBLISHED ON THIS VOLUME.
P.S.- I have obtained a GIF file to be the introductory graphic for Volume 99. It should hopefully set off some discussion of the role of the patient in educating and protecting the physician. A bit different approach than what has been the major point of discussion here.
..Maurice.
Shame on Yale. Legislating informed consent requirements for medical students to perform vaginal exams as part of the student's education does not involve clinical decision-making. It has nothing to do with the patient's medical care but rather the student's education. These women are real people, not classroom props.
I agree that the students should be physically present for that consent being given by the patient.
Hello Dr. Bernstein,
You’re right in looking to doctor education for signs of unethical behavior. I understand that many posters have a negative view of doctors; however, a look at doctors’ training may be beneficial.
Apparently, some residency programs are beginning to shorten doctor on-duty hours. I’m not sure why there’s an assumption that many hours of intense doctoring will produce “battle-hardened” physicians. The military and the police are quick to realize that, after traumatic situations, R & R is necessary to avoid PTSD. Why shouldn’t this be the case with extremely-fatigued residents? Is there the macho belief in medical residency programs that they’re preparing their fledglings to be MASH doctors? Where is the evidence-based data supporting long hours with little rest or nutrition? Is NIH looking for it? (See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655905/ and https://www.ncbi.nlm.nih.gov/pubmed/29098048 ) One can measure the time spent on an activity but, where’s the evidence that correlates greater medical proficiency with extremely overworked residents?
If med school does not treat doctors with compassion, is there any reason to believe that doctors will demonstrate empathy for their patients? We learn by doing and by example. Great learning comes from proper practice and great example. It’s time for medical schools to introspectively ask what they’re doing to form the next generation of humane physicians.
After “proper” education, what can be done to stop otherwise proficient doctors from becoming criminals? One suggestion might be a biennial conference, seminar, etc. which hosts patients who have been “wronged” by medical personnel. Here patients could present themselves as harmed people and not as cases. This could be part of doctor/ nurse/ tech CME (with computers and cell phones checked at the door). Would health care individuals be helped after hearing JR and her husband’s story?
No doubt, many health-related crimes are crimes of opportunity. Drugs are present, bodies are available, passions and power are peaked. This is the perfect storm for otherwise “good” people to become “unethical”. With a periodic (3-6 mo) retreat from medicine and biennial patient “horror stories” maybe medical personnel can be kept from going “off the tracks”. More suicides may also be prevented. What saith your listserv?
Reginald
NOTICE: NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 98. YOU CAN CONTINUE THE DISCUSSION ON THIS BLOG THREAD BY READING AND WRITING TO
VOLUME 99 .
..Maurice.
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