Patient Dignity (Formerly:Patient Modesty): Volume 97
"Not OK" and who decides it's "OK" or "not OK" in a medical professional-patient relationship? Should the final decision be made by the patient (autonomy) or by the medical professional (paternalism). My view and practice as a physician is that patient informed but autonomous decisions (or informed decisions made by the patient's surrogate, if necessary) should be the determinant state in all patient-medical profession relationships from onset to final actions. So this view applies to clinical interaction in all stages of medical practice. In non-clinical relationships (as briefly discussed in Volume 96) the final decisions are more complicated if a clinical relationship had previously been present.
From the onset of this thread topic, the views presented have clearly held, with examples of patient hurtful contrary professional behavior, that it is the patient who should "be in charge". What is my opinion is that simply mumbling and grumbling on this blog thread as to what is "not OK", I fully agree with the attempts by some of our visitors to "move on" to publicize their view for a need for a changes within the medical system to attend to the needs of patients to maintain their dignity beyond maintaining their health and that there are many examples of professional behaviors which are simply "not OK"with them. ..Maurice.
GRAPHIC: Created by me utilizing the Microsoft Paint Program
NOTICE: BEGINNING APRIL 29 2019 NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME. COMMENTS CAN BE WRITTEN TO VOLUME 98.
posted by Maurice Bernstein, M.D. @ 11:04:00 AM
177 comments
177 Comments:
The way healthcare is paid for by insurance is a deterrent to getting good care. Medical care SHOULD NOT be free. But health insurance is just extra people to be paid and maybe they'll help pay and maybe they won't. Having all different networks forces more of the cost on patients. One of my former coworkers husband had 2 different insurances. One was Medicare , the other something else. But because he chose the wrong insurance to pay his bill they BOTH refused to pay.
Wouldn't it be better to just pay a monthly bill to Medical Care period? Just end overcharging! If somebody doesn't pay their monthly bill and seek care THEN go after them and what they own. Insurance makes all the rules, and in the long run patients are milked to death. I also have a problem with doctors making MORE money when they don't do their job right the first time. Their patients must then return until Doc desides he/she has milked them enough.
Continuing on with the occasional physician-patient relationship which needs ethical resolution.. or does it?? When the doctor–patient relationship turns sexual. My question: is this a professional or public issue where standards of behavior of both doctor and patient should be defined? Should this behavior should be considered "OK" or "NOT OK"? Or is this one issue which can arise in the doctor-patient interaction which no public or professional guidance is required and should be considered "off limits" in public or professional discussion considering the dignity of the parties involved? ..Maurice.
I think it should be ok in most circumstances. A lot of people met through work. An inequality would be any relationship where one person earns more than the other.
JR said:
Thanks, JF. He doesn't want to talk about it as it is way too painful. That is why I vent here so I have others to help me. He, at this time, does not want family or friends to know that he was sexually abused by the prolonged exposure and the questionable alone time the cardiac nurse and the laughing nurse spent alone w/ him when he was drugged and purposely isolated from us. There is more to what he remembers when they were alone w/ him than I have shared here and it is really horrifying. It is hard being the spouse of someone who was sexually abused. I haven't suffered what he has but I still am suffering. He doesn't want to add to mine and I don't want to add to his by making him hear what I have to say. I really cannot imagine what it feels like to be betrayed and violated like he was.
Banterings,
We had always thought of ourselves as being in control of our healthcare needs. However, even if you are in control, all it takes is to have what is termed as an emergency and be drugged w/o consent, and all of that is down the drain. While my I saw doctors, I only chose ones who would respect that I was in charge. My husband also learned over the years to be assertive and be in charge. However, we were living in a dream world because reality of ugly the medical system is reared its monster head and we are left w/ the abuse.
Dr. B.,
It should be defined as an absolute no. If a doctor/nurse has access to someone's information and has examined them intimately or given intimate care, never should they cross the line of being more than a doctor/patient relationship. So that means if a doctor/nurse has treated a patient in a medical encounter, there should never be any type of relationship beyond doctor/patient. The only way that should change is to let the patient see all the doctor/nurse information and naked body so the patient would be on equal footing to make their decision. What is fair for one should be fair for all involved. In fact, since exposing body parts don't matter, than doctors/nurses should have naked pictures so pictures could view what is under the coats and scrubs to make everyone on an equal level. Remember we are told as a patient, being naked w/ these people doesn't matter so let's see if that is true. JR
Sometimes timing is everything. The very recent discussion we had about dignity after death became real vs theoretical for me today, and I drew upon that discussion in helping guide my family. My sister in her 50’s died unexpectedly and unattended without any obvious cause. The coroner’s office determined there was no foul play and chalked it up to undetermined natural causes. Had it been suspicious they’d of ordered an autopsy. To do an autopsy would thus be up to the family if we so chose. As much as we all would like to know what happened, there won’t be an autopsy. My stance was why should she be cut up just to satisfy our curiosity; that we should just let her be and assume it was a heart attack or stroke. It wouldn’t have been the first time people in our family had a stroke or heart attack in their 50’s, she was just alone when it happened and wasn’t able to get help. I’d rather live not knowing than live knowing we prioritized satisfying our curiosity over maintaining her dignity in death.
Hello Biker,
I offer you my sincerest sympathy for the loss of your sister. I also think that your decision for no autopsy is well-thought and commendable.
Reginald
JR said
Biker
So sorry for your loss. JR
Sharp grossmont hospital in San Diego admitted that cameras in their surgical obgyn suites were secretly videotaping patients in various stages of undress, the lawsuit alleges. Why? So they could catch a physician suspected of stealing drugs. What is more important, the privacy of hundreds of patients or proof of a physician stealing medications?
This is in a hospital and yes, hospitals record their patients all the time in various stages of undress neglecting to let these patients know they are being recorded. There is pending limitation regarding this in a class action lawsuit since 2016, you know if male patients were ever recorded it would never be known and there is a most obvious reason why.
Administrators had access to the recording as did many other non-medical staff at that hospital. Who pays for the hospital staff to secretly mount these cameras and record patients, you do. Who pays for staff to sit and review the recorded images, you do. It’s all figured in to the cost of doing business. Next year, that cost will soar above $4 Trillion dollars to buy better cameras to spy on you when you are a patient.
PT
Biker, my thoughts now, of course, is for the living including you and your family in this unanticipated loss. I am glad that this blog thread recent topic did helpfully affect your evaluation of the options which potentially was confronting you and your family.
I have to tell you that over the recent decade, I have repeatedly taken groups of second year medical students to our city's coroner's office to watch a full autopsy but in a large room where many autopsies were going on simultaneously for all present to observe. Yes, all the bodies were of deceased men, women and children, of course all without clothing or covering and being all cut open and organs removed or tissue fluids obtained, it was "quite a sight" but there was no patient or family to observe only me, the students, the pathologists, their helpers and in some cases police officers. My presence there was to be present and monitor and help the very occasional student who felt faint having suffered a vaso-vagal reaction in the midst of this experience.
So that this coroner's environment is not something for some novice to find "pleasant" but also there will be many patients where autopsy is really unnecessary when one considers the deceased patient load and the coroner finding sufficient information in the history not to expect a diagnosis different than the clinical one and there is a family available for consultation. In fact, the office will perform the exam in that case only on the request and fee paid by the family.
In conclusion, based on what you wrote, I have a feeling Biker that your rationale was appropriate. ..Maurice.
Ray, erroneously wrote the following to the closed Volume 96. ..Maurice.
PT: Regarding your questions about Gallup, when it conducts U.S. polls, it takes samples of between 500 and 1,500 adults 18 or older and interviews them via randomly chosen land-lines and cell phones after using a technique called random-digit dialing. Contrary to popular opinion, these sample sizes are sufficient for generalizing to U.S. adults if chosen properly. The figures given by Gallup are called point estimates (the single best estimates) of some variable. For example, a Gallup poll in 2018 found that 29% of U.S. adults over 18 answered “yes” to the following question: “Within the past 12 months, have you or a member of your family put off any sort of medical treatment because of the cost you would have to pay?” The 29% is the point estimate. The respondents were not asked about other reasons for delaying health care such as iatrophobia.
The actual statistical analysis was a bit (but not much) more complicated than what I’ve described. Because the Gallup researchers chose a sample of 18+ year-old subjects rather than the entire population of 18 + year-olds, there was sampling error (error due to taking a sample from a population rather than the entire population) to consider. Sampling error is estimated via the square root of P x Q/n where n is the sample size (500); P is the point estimate (.29) while Q is the remainder of the proportion (.71). If a researcher wants to be 95% certain of his findings, s/he has to multiply this formula by (approximately) 2; if s/he wants to be 99.99% certain, s/he must multiply by (approximately) 3. In our case the sampling error is estimated to be 2 x the square root of .29 x .71/500 = 4%. We can say that we are 95% certain that the percent of the U.S. population who answered “yes” to the question was 29 +/- 4% or between 25% and 33%. You can see that as n increases, the sampling error diminishes and as P or Q approach zero (or 1.0), the sampling error diminishes.
The predictive accuracy of Gallup polls as an aggregate is pretty good but it ranks behind some other pollster organizations. However, when you compare Gallup to the organizations with superior accuracy, the percent difference between the former and latter on the same subject is not very great. The question asked by Gallup to determine level of public trust in people who occupy different occupations is: “Please tell me how you would rate the honesty and ethical standards of people in these different fields -- very high, high, average, low or very low?” Ever since nurses were included among the occupations, they have ranked first. Clergy used to rank first; now they rank 8th. They lost considerable ground after all the bad press regarding child sexual abuse. I understand that Gallup does a lot of paid consulting work for businesses, schools, government, etc. But, for PR purposes, it also does a number of polls on its own which results in some financial loss. -- Ray
JR said:
PT,
It is my understanding that most procedures are recorded. For instance, they review the recordings of certain procedures in round table discussions. This can be procedures done in the OR or the cath lab. This is the reason why on most consent forms there is a standard phrase about the hospital having the right to film or photo because most procedures are filmed. This is one phrase my husband and I always object to and this one reason we know he was not given true informed consent. He would have objected. He was also drugged and unable to communicate his thoughts. Sedation drugs are not to be used before informed consent is given and hospitals know it but do it anyhow. The law acts as their accomplice. Hospitals know how to "operate" on the fringe of ethical and/or lawful in their pursuit of money and being the "go to" hospital.
I think as far as most polls saying nurses are the most trusted, people have read or seen on tv about priests molesting and teachers having sex with students. There really is not much out there about nurses. More needs to be said about nurses. However, the Catholic church kept the priest abuse secret for many years until it burst out. This is what needs to happen to nurses. To me, doctors are less involved in the actual abuse of patients. They are guilty bc of the staff they are over. But it is difficult to control a bunch of women and doctors are really busy with other things. Flocks of women tend to be petty and vicious especially younger ones. They mellow with age.
As far as there being spectators during an autopsy, I think the family should be notified and given the option to say no. I think the respect of the person should also be observed even in death. If that person would not have wanted to be exposed to a crowd in life, then they should have the same respect in death. I also have issues with autopsy pictures especially of celebrities being released. It is very invasive. I also don't think crime pics should be released and if they are, then whoever did it should be arrested. Their death pics are none of my business. JR
Ray
The missing equation is the socioeconomic factor, in other words what neighborhoods were these random calls made. Statistically,the greater the sampling size the smaller the standard error. Nonetheless, I’ve no doubt the poll is a close reflection, troubling as it is , that
people put off seeking healthcare for what they say is a lack of affordability.
Polls seeking public trust are skewed, most people surveyed will have some family member who works in healthcare. The big question is
what benefits are there for these kinds of polls. Polls can be used to measure attitudes or shape public opinion. Is it fair and ethical to say
you can trust your nurse more than you can trust your family Doctor or your clergyman?
PT
I hope you all can take a few minutes to read this current article in “Public Discourse” with the following address: https://www.thepublicdiscourse.com/2019/04/51161/ arguing against the American Nurses Association draft position statement regarding “Nurses Role When a Patient Requests Aid in Dying” and, of course reading the ANA document itself. However, it seems that the link provided in the “Public Discourse” article does not go directly to the statement itself (and I would appreciate help from our link experts here to discover how to obtain that original ANA statement. ) However, the issue is to give the nurses more freedom in participating in “aid in dying” which the authors of the Public Discourse argues against the ANA and fits with my theme to this Volume: “NOT OK”.
Why I am presenting this resource here is that the authors may be in line with the consensus of my commenters here regarding the virtually “accepted” misbehavior of some nurses and may be folks to contact directly with your understandings and views and they may be helpful in furthering your views. ..Maurice.
Stephen J. Heaney
Stephen J. Heaney is Associate Professor of Philosophy at the University of Saint Thomas in Saint Paul, MN. He has published in The Thomist, The National Catholic Bioethics Quarterly, The Human Life Review, Nova et Vetera, Crisis, Homiletic and Pastoral Review, Touchstone Magazine, Twin Cities newspapers and, of course, Public Discourse on topics in ethics and political philosophy such as abortion, marriage, sexuality, and voting ethics.
Dianne Marie Johnson
Dianne Marie Johnson received her nursing license in 1972 and recently retired after 44 years of bedside nursing. She worked as an oncology certified nurse in radiation oncology and has extensive experience in coronary care, intensive care and as a “pioneer” nurse in radiology nursing. In 1998 she received her B.A. with double majors in Philosophy and Catholic Studies. In 2006 she received her M. A. in Catholic Studies with emphasis in biomedical ethics from the University of St. Thomas in St Paul, MN. In 2001 she founded Curatio, in part to answer her own longing for integrity between her faith and her work, and in part, to answer Saint John Paul II’s call for re-evangelization of the modern world and to recover the sacred, sacramental vision of the human person in health care. She is married to Reed Johnson and they have three wonderful grown children, 7 grandchildren, and 5 step grandchildren, all who keep her young at heart! She is passionate about helping others develop a closer relationship to Christ in healthcare and currently serves as the Mission Director for Curatio.
Sarah Spangenberg
Sarah is the Outreach Coordinator for the Minnesota Alliance for Ethical Healthcare, a diverse, statewide coalition formed to fight the legalization of assisted suicide in Minnesota. She is currently finishing a graduate degree in Theology from the Saint Paul Seminary School of Divinity in St. Paul, Minnesota.
Correction: In my piece about regarding the coroner's office, it is the local County and NOT City to where I attended.
By the way, it is my understanding that because most small hospitals do not have autopsy facilities and staff for elective autopsy, nor these days there is not much family interest in having an autopsy performed, mainly cases of potential criminal or unknown cause deaths are required or referred to the coroner for autopsy and diagnosis. ..Maurice.
Maurice
The original document can be found on Nursingworld.org,
PT
Maurice
Opps, sorry www.nursingworld.org/~4af287/globalassets/docs/...
PT
PT, I guess your revised address just took us to more "oops". But thanks for the attempt. I do think that presenting the views of patients on this blog to someone like Professor Stephen J. Heaney might be a valuable resource for dissemination of those views to a more widespread audience. ..Maurice.
Maurice
I apologize
If you type into Yahoo as a search engine, “ nursingworld.org physician assisted sucide”
The returns will be Euthanasia, assisted sucide and dying- nursingworld.org
Click on it and there it will be
PT
Ray, you are continuing to write to Volume 96 which is closed for further Comments. Are you typing a Comment on Volume 97 but it is somehow printed out at the end of Volume 96? If you have any info on this which need not be written to the blog, you can e-mail me at doktormo@aol.com. Here is what you wrote this evening and published on 96:
Maurice: Regarding your questions, I cannot answer any of them, although I have some hunches. I searched for research on the subjects but could find nothing. -- Ray
..Maurice.
Darn it, Maurice. I did it again -- several times. I'm sorry.
I'll repost here the three I just sent sent out to Volume 96 -- Dang!
Biker: Thanks for a great example of pluralistic ignorance. Actually the concept would apply if your buddies or a goodly number of them believed as you did but said nothing because they believed that you and everyone else thought what you experienced was no big deal. I’ve done the same thing. In a sense, when we do not express what we really believe, we become enablers -- we enable those who would strip us of our dignity. To the extent that pluralistic ignorance prevents us from expressing our outrage, we discourage other like-minded individuals from expressing their outrage.
Thanks, too, for the example of the inappropriate statement made by the nurse. I and nursing students in the early 1990’s found that male patients were more likely than female patients to be subjected to inappropriate comments (usually something about their bodies), although the inappropriate comments made to female patients were more likely to be sexual in nature than they were for male patients.
Misty: I watched your video. It was cutting, acerbic and well deserved. However, I'd like to add one thing to your post. Tell me what you thing. Male providers are more likely to abuse female patients than female providers are to abuse male patients but male patients are more likely to be abused by female providers than female patients are to be abused by male providers. -- Ray
PT: If I recall, Gallup uses cluster sampling. I don't think that the socioeconomic status of communities is one of the clusters, though Gallup does use weighted samples and it often breaks down responses according to income of respondents. For example, below is the breakdown of "yes" responses to the question having to do with delaying seeking healthcare because of cost by income. https://news.gallup.com/poll/245486/delaying-care-healthcare-strategy-three-americans.aspx -- Ray
Annual household income
Less than $30,000 31 38
$30,000 to $74,999 23 34
$75,000 or more 15 22
The medical education listserv to which I subscribe is now conversing about the presence of video/audio equipment in patients rooms to record or transmit images and sound for monitoring and teaching those physicians in a residency program. The purpose is very practical in terms of residency education since much of the resident-patient interaction is not observed by monitoring physicians actually being present in the patient's room since, if a physician monitor was present, in person, that might affect the resident-patient spontaneous interaction. And it is that spontaneous interaction which is what observation of the resident should be the basis of the educative monitoring. Should such audio-visual monitoring in each patient room be allowed and to be done by observation at the time in a "video control room" or tape later reviewed. Should all patients be made aware of the possible observation and should all patients sign a release to accept this video-audio observation? HIPAA regulations would likely permit this observation since the physician monitors would be part of the patient's health team. Video in the operating room would also apply as part of the monitored teaching of surgical residents. How all these monitoring tapes are subsequently handled or disposed of is also another matter. So is this all, related to my graphic for this Volume considered by you. the patient gripping your dignity an "OK" or "Not OK"? ..Maurice.
P.S.-By the way.. you should all be pleased that the folks teaching physicians are considering such matters and if and how they should be carried out and attempting to obtain ethical and legal consensus.
Good Evening:
As far as audio, still picture, or video taping go, the medical community MUST ALWAYS get all patients to sign a release to accept this type of observation.
The request must NOT be hidden within any forms the patient is asked to sign. It should be a separate document.
Only those that want to participate and further the education of a resident will sign on. Those that don't should not be pressured in any way to "go along" with it.
Do this wrong and it could be healthcare's Waterloo.
I suspect the majority will NEVER go along with it because people are at their most vulnerable time when in the hospital and don't want any type of recording device(s) around.
Regards,
NTT
Hello Dr. Bernstein,
Who will be responsible for turning off the camera after the "teaching moment"? Will these cameras find an "extended" use to "assist" the nursing staff? Why am I thinking that this is a great CYA for the hospital and another loss of privacy for the patient?
Here's a thought. Ask the patient for permission to have Dr. To Be (even as many as 3 Drs. To Be) sit behind the closed curtain. Attending Dr. could perform his functions and verbalize his actions (now I'll palpate... placing my ….) for Dr. To Be to hear and/or note. Dr. To Be's listening skills would definitely be improved and the patient would behave in an uninhibited fashion having forgotten that Dr. To Be was sitting quietly behind the curtain. Attending and Dr. To Be would then debrief after the encounter. All of this would be done in real time and unedited. Yes, this would not be as efficient as filming for a larger audience; nevertheless, face-time between Dr. and student might be enhanced. They might even find time to discuss the real person that was just encountered. The current mantra of the medical profession seems to be to endorse whatever "enhances the patient experience". Please ask your listserv colleagues, "How do cameras enhance the patient experience now?" Appealing to possible benefits to future physicians does not answer the question. I'll leave the camera cost analysis to others; although, we all know who ultimately pays the bill.
Reginald
Ray
Which sex abuses the other sex more? According to what we've seen on this blog?
In non medical settings I believe we ( females.) are much more likely to be abused.
In my family there is me and 4 other sisters. ALL of us have been sexually abused. Mostly in childhood. Of my brothers only one has admitted to it and it was a same age girl when they were teens. They were kissing and she suddenly shoved her hand down his pants. One male cousin was sexually abused by his step grandmother when he was 11 and 12.
Otherwise 2 of my brothers have admitted to rape ( although they never used that word ) One brother and 2 of his buddies took turns on a girl who cried and pleaded with them to stop. One of the guys tape recorded her. They were about 15 at the time.
The other brother was in his early 20's and our cousin held down his own girlfriend so my brother and another guy could have their way with her.
I think that in part that is why some female medical staff treats male patients so horribly.
The mindset that men abuse women/ girls, so lets let these male patients pay for it.
It makes no sense though. If there is going to be retaliation target WHO abused you. Not males in general. Not females in general.
JR said:
This was part of the consent they had my husband sign while still drugged and which he remembers them telling him he didn't need to read it as it was only for billing/insurance purposes.
Consent to Photograph: I consent to procedural or surgical photographs or videos pertaining to my condition or treatment while I am a patient at the hospital.
The form was titled Consent to Medical Treatment/Authorization of Care. They hid this little beauty as medical people do not act for the good of the patient or so we have experienced. This already looks to me like they have the ability to have cameras in patient rooms as this was after his assault & battery procedure. Knowing he was still under the influence, they flat-out lied about the purpose of this form. Of course, it wasn't the first and only lie in their quest to commit as many offenses as they could. As I have said, they already do have that in procedure consent forms so you can bet it is just not being talked about but it actually happens. What about the patient--shouldn't they too have the right to have cameras and video recorded of the procedure and what happens in their room for future legal use or just a record of the event? Fair is fair. Why is it every patient's duty not only to have to pay for medical care but to made sure future healthcare workers get education through them? I say this is an invasion of privacy. What would keep them from filming the patient whenever they pleased to see what is being said? Nothing would as many of them have no conscience, ethics, or morals. I think patients should have the right to refuse health monitors as part of their care. It is just another way sneaky way to educate by dehumanizing patients. JR
Patients should never be recorded without their knowledge and consent. I am sure most patients would say OK if it was explained to them. Part of the issue is what is being recorded. Even allowing that the hospital in California had good reason to identify who was diverting drugs, that good reason did not extend to it being OK to video patients intimately exposed, nor was it OK to not maintain close control of who had access to those videos.
When seeking to monitor Resident interactions with patients, the same applies. It may serve a useful purpose to monitor the interactions as part of Resident training, but that does not mean it is OK to video patient intimate exposure and possibly be casual in controlling access.
In some hospitals, it is the resident physicians who do all the "work", responsible for the care of many patients.. at all hours and for many hours and this experience in medical education where physician "burnout" begins or actually occurs. I am sure most patients would agree to professional educative supervision of these hard working members of the medical team. The issue is, of course, how should this supervision be carried out with the ultimate benefit for the patient but also for the professional education benefit of the resident.
Every appropriate clinical evaluation and management of every patient should be considered different between patients with the same general diagnosis. With the pressures of diagnosis and care demanded by the system on resident physicians the monitoring of such responsibilities should really apply to each and every patient under resident care. So if " monitoring by means outside a patients room" for one patient should apply to all. ..Maurice.
I want to give you a recent example of the value of observing the behavior of a hospital resident. As I noted in our last Volume, the volunteering physicians at the "free" clinic recently are having patients worked up by hospital residents in our presence. To give you an example of my role as observer and educator in this patient-resident relationship, here is one example. As I sat near by observing the resident taking the patient's medical history, I observed the resident physician, moving her head in a lateral "negative" "no" direction during the act of asking the patient a direct (yes or no) question (example: "have you ever had any discomfort in your chest?") This, of course, is a head motion by the questioner which may suggest to the patient a "no" answer. I watched this occur again and again and at the end of the session when I was alone with the resident, I told her about my observations and she told me she was unaware of her head movement while posing a "yes" or "no" direct question and no prior supervising physician had brought this to her attention but was thankful I did since she didn't intend or want to bias a response by the patient.
Anyway, this is a minor (but could have been major) example of the role of monitoring the behavior and actions of resident physicians in their direct interaction with their patients. ..Maurice.
In keeping with our current topic of discussion, you may be interested to go back to a September 2013 blog topic:
Patient Informed Consent for the Teaching Hospital "Trainee" Care: Informing Realistic Scenarios
which had written and was published by "Bioethics.net" and with visitor responses that followed. ..Maurice.
Gosh! There is SO MUCH to discuss with regard to the definition and maintenance of patient dignity.. here is another issue to discuss.
What medical errors in diagnosis and/or treatment should be disclosed and explained to the patient and/or family? Does the patient have an ethical right to be notified of any judgment or action error which has occurred and if so..when? As soon as the error has been recognized by the profession or at the conclusion of the professional-patient current management?
Let's get specific. For examples: suppose a hospital nurse accidentally gave the patient another patient's medicine pill, should the nurse await some clinical symptom in response to the error before notifying the patient, assuming the nurse had notified other staff regarding the error?
What do you see as the limits setting attention to patient dignity? Revealing only major medical/surgical errors? Attending to a potentially dying patient in an emergency room? A criminal as a patient? The deceased? Should there be limits set to the definition and response to patient dignity? ..Maurice.
I've seen nudd people on the TV and it seemed dignified. That's the difference between nude and naked. Last year I went on a family outing where swimming was. A teenage girl went strolling past and I barely noticed her at first. But when she was walking away from us her bottom was completely bare. Nobody, male nor female seemed to notice or care ( except for me )
I told my niece and my niece said " Yes , they do that now , but they're covered in their front."
I have sometimes been able to identify with Dr B when he couldn't understand why it's been such a problem for us , being displayed before unnecessary people.
When I had my gallbladder surgery, I wasn't concerned about modesty at all. I was asked in person if med students could observe and I said yes.
Otherwise, when awake and in good health , I don't undress in front of anybody.
I remember on an earlier post I suggested a video recording be used in place of a chaperone to protect patient privacy. Nobody thought it was a good idea. They talked about people having the ability to hack. Maybe it's true. I don't know.
But from more recent posts it's like they are video taping anyway.
In my theory nobody medical could access the recordings. Possibly not even be aware of them. It would be accessible by court order only. After an accusation has been made.
There also needs to be a hidden tape recorder in the break room. Not for just any little wrong thing said or done. But for our issue here to be caught. The offending staff would then be fired. Use a trump up reason ( like what's done already ) that way the staff doesn't realize they're being recorded.
Good Afternoon:
Any medical error that directly effects the wellbeing of a patient must without question, be disclosed to said patient by their attending physician as soon as the error is detected.
As far as limits setting attention to patient dignity? There should never be any. Each and every human being no matter who they are or what they may or may not have done, deserves to be treated with utmost respect and dignity.
At times, I'm sure that can be very hard to do but its our ability to show compassion and empathy that sets us apart from all other live things.
Once you start setting levels you take the human aspect out of the equation. Something that must never happen.
Regards,
NTT
JR said:
I think it is absurd that when people become and then become patients, it is thought of as being acceptable that in their time of illness and extreme expense they are there to become experiments for ones becoming doctors. While it is true they must learn somewhere, it should not be thought it is an automatic right that every patient is there for educational purposes. The majority of hospitals now state they are a teaching facility. This is not right. Ill people should not have the added burden of being an experiment in learning whether they are exposed or not. However, with being put on displayed naked, it adds stress to some & may impede their recovery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377527/ is a great article about patient dignity. As for the cameras, since they cannot act appropriately now, just imagine how they will act if cameras are standard in all patient rooms. As I have said, it would appear that some places use them now as their consent forms has that possibility listed. They would have the ability to listen in on private patient/family conversations and video the patient constantly. What a terrible invasion of privacy.
I also believe there is a difference between being naked and nude. Naked is what the hospital or prison does, nude is like an actress/actor does with consent for money. Many times in hospitals like prisons, it is done by being told to strip and having no choice in whom is present. It is especially upsetting to have this done when drugged or unconscious because you really don't know if they acted appropriately as we have found out. You can never be sure what type you had. This is why it is important that patients have advocates with them at all times and those advocates are not being paid by the medical community as that advocate would not really be your protector. Patients should have the right to photo/video medical encounters too. As we were explaining to my husband's medicare provider other day--because of the abuse he suffered both sexual and otherwise, he will no longer seek hospital treatment as they seem to take great pride in their abuse and/or torture. She offered to find another doctor/hospital (we did that immediately) but she really didn't understand when trust is broken like it was, there is no guarantee that it would not be broken again as we didn't expect it this last time. He is going to stop all the meds and take his chances. He never wanted this procedure and does not want the prescription drug consequences their decision causes. The actions of the medical community and their godlike decrees have major and life altering consequences to its victims but they do not care and will continue to give themselves more power and control over their patient victims. This is the greatest power of modern medicine. The manner in which treatment is delivered has only worsened during the course of years and will only continue as they become more confident in their path of having absolute power and control. Patients are people whose primary purpose is not for medical people to use them for study purposes. They are being paid for a service not the other way around.
Yes, any and all errors should be reported to the patient immediately. It also should be reflected in the medical records however, the EHR are set up so this type of info is not reported and protects only the medical person and not the patient. There is no longer any compassion or empathy shown to patients as least from what I've seen of late. They are just power hungry tyrants who don't realize that the manner in which treatment is delivered is as important or maybe more than the treatment itself. They can have what they term as a successful treatment but the abuse and violations they inflicted in giving the treatment may cause more overall harm to the patient thus making the treatment ineffective. JR
There is a way to help minimize the lack of respect and dignity shown by the medical staff. At the same time, a way to address the physical proximity issue and also relieve the overwork burden by MDs.
Think of AI as personalized medical care for Generation X, Millennials, and Generation Z [a total of over 215 million potentials in the US]. They are so comfortable with electronic interface, that AI is more comfortable for them than dealing with people [think of two individual in these generations texting each other while in the same room].
Here's a scenario. Patients walk directly into one of the open sound proof booths with available curtains that are under the patient's control. No appointment necessary - no power trip by the receptionist. Not only have the patients avoided the big waiting room, but also the small waiting room [AKA exam room]. The AI voice {natural language processing} greets them and states how can I help you? Eye recognition will validate identity and health insurance. When AI recognizes non-standard English, it will ask patients what language they would like to converse in and accommodates them. For those that prefer, a room monitor would be available to assist.
The patients can present all the symptoms and ask all the questions for as long as they want. Bean counters will eventually impose costs based on time spend. And who doesn't know those who would tell AI their life history [which might be psychologically healthy for them]. AI will refer patients to MDs for cases outside their scope which in time as AI advances won't be that many.
Patients themselves can handle the blood pressure, pulse, temperature, and stething. They can secure the pressure cuff [if unfamiliar both the AI voice and the screen can assist], put the electronic thermometer to their foreheads, stethoscope on chests, and how difficult would it be to design a device so that the stethoscope could be placed on their backs [an advocate or even the room monitor could assist]. That's all the touch labor I have received for years during routine office visits, then again I'm at the disposable age [and male]. Everything else in my recent routine health care involves lab panels that AI is superior at analyzing and prescribing.
The patient's medical history [EHR/EMR] is automatically retained and available to everyone not limited by HIPAA [joke].
Most prescriptions will be available when the patient leaves the booth from a system similar to technology used in warehouses for over 20 years, again with eye recognition. A pharmacist will be available although AI will have time to address all questions during the visit. A printout of prescription and AI directions will be provided. How many patients don't remember everything that the MD tells them? All of this technology is available today.
This AI technology eliminates the lack of respect and dignity served up by current medical community staff plus excellent and consistent medical treatment. The selling point to MDs is that they will no longer be burdened with routine cases. This AI visit replaces what is now known as a routine office visit. Don't you feel sorry for all those poor staffers that no longer will be able to control patients with impunity [and retaliate] during routine appointments?
The technology is available today. It's only a manner of the cultural lag before something like the above happens because it involves cost savings.
BJTNT
Maurice,
HIPAA says that if there are ANY pics or video taken by the facility, then they become part of the medical record.
I wonder how many facility include the video for monitoring residents, teaching purposes, security, etc. as part of the medical record.
Here is some resources:
HIPAA - Photographing, Video Recording, Audio Recording, and Other
Imaging of Patients, Visitors and Workforce Members
HIPAA Restricts Some Photography, but Not All
Some states have additional protections beyond HIPAA:
The Consequences for Violating Patient Privacy in California?
-- Banterings
Maurice: You wrote, “Should such audio-visual monitoring in each patient room be allowed and to be done by observation at the time in a 'video control room' or tape later reviewed. Should all patients be made aware of the possible observation and should all patients sign a release to accept this video-audio observation? HIPAA regulations would likely permit this observation since the physician monitors would be part of the patient's health team.”
Here’s a general rule of thumb: If healthcare providers wish to do something to patients that is not essential to their health or healthcare, then those providers must secure the informed consent of the patients. As for HIPAA, it is not the best source for determining what constitutes ethical behavior. After all, it allows commercial film crews to be defined as business associates (which the law never intended) and, hence, to film patients in ERs who are deemed by physicians to be unable to give consent and have no legal representatives available to do so. The AMA considers this decision to violate its Code of Medical Ethics; I find it to be ethically reprehensible and indefensible. -- Ray
BJTNT: Interesting futuristic piece you wrote. As I read it, I thought, “Although, technically, this could happen in my lifetime, it won’t. If implemented today, it would make a lot of jobs in healthcare obsolete and would cut into corporate profits.
Your use of “cultural lag” was quite apropos. Cultural lag is both a theoretical concept and a theory. The theory was first introduced by William Ogburn in the 1920’s. The concept itself refers to a phenomenon whereby the non-material culture of a people (e.g., beliefs, values, norms, practices) lags behind the material culture (e.g., technology). The theory is that societies and their constituent parts experience disruption due to cultural lag. The nature of society is to gradually accommodate to the lag until, in a sense, the non-material culture catches up to the material culture. Disruption can take the form of increasing deviant behavior as we may now be experiencing in its many forms in healthcare. -- Ray
JR
I have so many doubts that our victory over our issue will come from anybody law abiding.
I'm more inclined to think it would come from motorcycle gangsters. The office or hospital humiliates the wrong guy? Of course Mr Macho Man wouldn't be straight with his biker buddies about the reason for his upset. He'd probably make up a bogus excuse for the retaliation that he plans.
JR said:
I can tell you from experience that too many medical facilities including the one from hell, do not follow the law, regulations, and policies of HIPAA or really anything governing PHI. They are above the law and the law allows them to get away with it. I am sure there are two sets of medical records: one that they give when requested by outside entities such as patients and one that use for their own purpose. I believe systems like the Epic will allow this. As I have stated, we recently have encountered hospitals in normal, non-procedure consent forms having photos/filming mentioned in them. If it is mentioned and asked for patient signature for acknowledgement, you can bet there is a reason. I also know that many ORs use recordings to have round table discussions about procedures. This is covered by the procedure consent form. As I said, one dr.'s office said they didn't have filming in their exam rms but the consent wanted signature for it. They said w/o signature no dr. visit. I said w/ signature and nowhere to disagree, it would be a he said/she said matter where my husband would come out the loser so we walked even though no intimate contact would have been done. It is the principle they can do whatever and get away with it. They know the rules and how to operate and sedate the rules as well as people. It seems to be a game to them.
JF,
I am afraid that something that you described may happen. I hope not as the patients there for treatment don't deserve to be hurt anymore than they are by being there and being abused and violated by the medical staff.
What is being described here in this blog really resembles a prison-like setting for patients. Patients must strip on command. Patients can be put on display for and touched by any stranger the medical people desires. Patients can be videotaped and/or audio taped at any time or all the time. The medical people have total control over what happens to them when in their prison facility (except prisoners have more rights than patients on this). Patient's sleep periods, menus, and mealtimes are controlled by the hospital. Visitation may be allowed or not and may be recorded. There is no recourse for crimes committed against a patient (prisoners do have civil liberty guarantees while patients have no recourse). Some patients are confined to certain areas as are prisoners. Isn't modern medicine the greatest thing ever that it has actually progressed backwards to make people who have the misfortune of being ill treated worse than an actual criminal? Medicine should be very proud of themselves. Hopefully, each and every one will have the opportunity to become a victim of their own doing or one of their family members. That would be the greatest justice to me is that they are allowed to become victimized by the same system they use to victimize the common person. That is fate! JR
Thanks to all for your recent Comments. There is so much intricacy to parse out if one wants to come to some conclusion. Perhaps that is why the medical system is not meeting the standards being set here. Or is "intricacy" not the correct excuse?
By the way, has anyone noted, we are missing further input by "AB in NW"? Hopefully, all is well in NW. ..Maurice.
JR said:
It is really not all that complicated. I believe the medical community view us as pieces on a chess game or to be more precise, pawns. Pawns are thought of as being the weakest pieces but in reality, losing one without a well thought plan can mean losing the whole game. This is what the medical community is doing in reality--losing the whole game. Knowing how to treat your pawns is what separates an expert chess player from the novice. The medical community is too full of its self-importance to realize this piece of information. They are willing to lose because they think the king is the most important piece. They seem to have the misconception the only thing that matters is they make and follow through with the treatment of their choosing and not taking into consideration the treatment ultimately affects the patient for the rest of their life. Medical people are too defensive and get too offended when patients have opinions or want respect. However, most medical people want respect from others delivering services to them. I would imagine most medical people want a polite, attentive server who delivers their steak rare instead of medium even after the server warns them that eating rare steak is unsafe. I wonder how they would feel if a mechanic said they needed new brake pads on their BMW and couldn't reach the dr. and went ahead and did it anyhow because the mechanic felt the worn pads were too unsafe as well as having a leaky power steering pump so he replace the whole steering system? Outrage and a refusal to pay would probably be the result. However, they never consider that patients have the same right as the medical community is only a service provider too. We are the bosses and they are only the method in which a service is delivered. The service should be delivered with respect, explanation, and only with consent. The medical community should not be making this concept so difficult. It is what they expect in other aspects of their lives so why is it so difficult for them to see that patients have the same right. Fate, will someday make them patients too and I am sure they will want to have a say bc at that time, some wet behind the ears medical provider will remind them they are not a dr./nurse but merely a patient.
Dr. B.,
I see you mention the free clinic but how many rich patients are subjected to the student exam situation? Does having money exclude this learning on patients? It seems to me that only the poor and us middle class people are subjected to the medical teaching aspect? How many celebrities have a roomful of students and teachers practicing on them? How many celebrities get special consideration in protecting them from unnecessary exposure both bodily and medical records? Certainly the medical community is discriminative in its deliverance of medical care. I know there have been uproars when a celebrity's privacy has been invaded while hospitalized but for ordinary people there is basically no action taken. JR
Maurice,
The answer is simple, and I have espoused it ad nauseum:
Power corrupts; absolute power corrupts absolutely.
Just look at the abuses that occur when there is a group that has absolute power:
- prisons: Abu Greib, Gitmo
- cults
- dictatorships, totalitarian regimes
- Feudalism
- slavery
You have to look no farther than how slaves were treated in our country. The slaves were dehumanized and used at the whims of the masters.
I am sure that Ray can expand on this line of thought...
Thankfully society is slowly stripping medicine of their medieval guild powers and subjugating the profession. The pendulum is swinging the other way. The profession will suffer the way that patients have. Turnabout is fair play...
-- Banterings
JF: You write, “Which sex abuses the other sex more? According to what we've seen on this blog? In non medical settings I believe we (females.) are much more likely to be abused.”
I would not quibble with your observation, JF. All three sources of data – official statistics, self-reported studies, and victimization studies – suggest that men are more likely to abuse women than women are to abuse men. Men are also more likely than women to abuse men. The same patterns exist in the case of sexual abuse.
However, in healthcare settings, per se, one may find that male patients are more likely to be abused by female providers than female patients are to be abused by male providers, primarily because female providers are in the numerical majority. On the other hand, male providers may be more likely to abuse female patients than female providers are to abuse male patients. As an illustration, imagine that a hospital has 100 female providers and 20 male providers who treat 200 male patients and 200 female patients. All 20 male providers abuse as many female patients. Fifty female providers abuse as many male patients. The rate at which male providers abuse female patients, then, is 100% while the rate at which female providers abuse male patients is 50%. Yet, the risk of female patients being abused by male providers is 10% while the risk of male patients being abused by female providers is 25%.
I have not come across reports about research on the interaction effects of patients’ sex and providers’ sex on the likelihood of abuse in healthcare settings so can only hypothesize what the outcome of research would be based primarily on anecdotal evidence of the sort accessible in this blog. -- Ray
JR, there are major teaching hospitals which are part of medical schools, minor teaching hospitals with affiliation to medical schools but the hospital is not part of a medical school itself and hospitals without teaching students or residents. University of Southern California Keck School of Medicine in Los Angeles, where I have taught first and second year medical students past 30 years and where I completed my residency, has Los Angeles County-Keck School of Medicine as it's major teaching hospital. The hospital is across a street from the medical school campus. In addition, the school has its private hospital unrelated to the County a block away. The medical school and its students and residents participate in the learning process in both hospitals.
You may be interested in this article: Navigating Hospitals:Teaching Hospital vs non-teaching, Does it Matter?
Banterings, do you look at the medical system as political, a political entity? If not, then as a form of a business attending primarily its own self-interest? ..Maurice.
JR
I didn't mean a shoot out in the hospitals or clinics. That possibly wouldn't bring any kind of victory over our issue because in all likelihood it would be covered up WHY the shooter did what he did.
These people can't be touched on their own turf. Individuals ? A different story!
JR said:
Dr. B.,
I think you might have misunderstood what I intended. It seems to me that the difference in how healthcare is also evidenced by celebrities/wealthy people not having to have medical students examine them like we do. Also, their privacy is better guarded and when there is an incident, action is taken. Money and fame makes a difference. Also, at least here in Indiana, there are very few community hospitals left. They have been swallowed by the big 4 in central Indiana. Elsewhere, in Indiana, other chain hospitals are doing the same. All of them in their so called consent forms, clearly state they are a teaching hospital but don't specify what type of teaching hospital. They say if you don't want to be used as a teaching object then go elsewhere but there is no elsewhere. They have made sure of that. I believe common people are given any choice but the celebrities/wealthy people are. Community hospitals used to be the place for respectful treatment because those who worked there were part of the community but now they merely are part of a corporation who doesn't care as there are always more patients to make money from if one becomes dissatisfied. Certainly, hospitals are a business. They certainly attend to their own self-interest and they are also a political entity but not in the traditional sense as they have a huge lobbying presence and thus control legislation that affects them. They are like politicians in that they say one thing but do another thing. They act as if they are doing good but in reality are only self-serving. There may be some who truly want to do good and treat patients w/ respect & dignity but they get lost in the crowd of control and money seekers. JR
JR, supporting the possibility of inequality of medical diagnosis and treatment based on patient's insurance coverage is supported by this article in Medical Bag based on a current article in the JAMA Internal Medicine. Researchers examined the discharge, transfer, and admission rates of patients presenting to the emergency department with common pulmonary conditions and analyzed that rate against their health insurance status. Hospitals that had both an emergency department and intensive care capabilities and patients who were diagnosed with acute pulmonary diseases such as pneumonia, chronic obstructive pulmonary disease, and asthma were included in this study.
... ...
Hospital transfers occurred in 1.6% of uninsured patients, 1.3% of Medicaid covered patients, and 1.2% of privately insured patients, which meant both uninsured patients (adjusted OR, 2.41; 95% CI, 2.08-2.79) and Medicaid covered patients (adjusted OR, 1.19; 95% CI, 1.05-1.33) were more frequently transferred than privately insured patients. Hospital discharges occurred in 88.8% of uninsured patients, 80.2% of Medicaid covered patients, and 78.5% of privately insured patients, which meant uninsured patients (OR, 1.66; 95% CI, 1.57-1.76) were more likely to be discharged.
My take: Further studies may support the idea that these days the medical system is oriented to $$$ rather than patient's immediate care of their symptoms and illness. ..Maurice.
Dr. B.,
I don't know about other states but the people I know of who have the Indiana Medicaid-HIP-have fewer issues than people w/ regular insurance. Also, the elderly on Medicaid have fewer restrictions than those on medicare and private ins.
It seems to me that the health system is rigged against older people. The Service UnExcellence Director told me that as a man getting older my husband should become use to having his control taken away and being exposed as he was going to have more and more medical encounters as he aged. She said everyone should suck it up and get used to it. I think that older American males are especially abused by the system. Older women are not too far behind. This country has an attitude of disrespect for the elderly. There was an article on Medpage today about how the elderly suicide rate has increased. With the attitude of Service Excellence, it is no wonder why older people would rather die than be treated so abusive and feel so violated. However, there is a difference in how the wealthy, famous are treated an average people like my husband are treated. Money does indeed talk as well as publicity. No one cares if the average person is abused especially if that person has private insurance and/or Medicare. JR
Elderly are ABSOLUTELY milked by the system. I have also seen elderly who are actively dying be prescribed 15 sheets of meds that they won't live to use. But they'll be charged fof tbose meds.
I have always worked at nursing homes as a CNA and in recent years I've been a med tech for assisted living.
I have a theory that elderly , once they can no longer be financially raped, will be put to sleep.
Ray: I believe many male patients are sexually abused by female medical personnel. Male patients are much less likely than female patients to speak up when they are abused. I believe that this is why we do not hear much about male patients being abused. I’ve heard many accounts of female nurses making fun of male patients’ genitals while they are under anesthesia. Men tend to suppress their feelings. Male patients are less likely to be believed than female patients.
For everyone: I wanted to let you all know we have put up a new video, Surgery and Your Modesty . It is 39 minutes long. I think every patient should listen to this video before they have surgery. We talk about both male and female patients in this video. You will notice there is a part about men going to urologists in this video.
Misty
Recently I received a Press Ganey survey from my hospital stay for a hip replacement. My stay was so lacking in integrity in several cases that it would influence my giving poor scores in every dept. I have decided not to complete the survey. I'm still so pissed off that my responses would not be fair.
Besides I suspect my health care was so typical of the medical community culture that the hospital administrators would say to each other "What's the problem? That was business per usual."
In the comments section, I could describe the most egregious failure. I have no stomach to do this because I think it's a waste of time. And if a form letter response was the reply that would really irritate me.
BJTNT
Besucher aus Berlin, was halten Sie von den Themen, die hier diskutiert werden
Und wie wird die Lebenserfahrung und Würde in Ihrem Land behandelt?
..Maurice.
?
JR said:
JF,
I have long thought what you said about once the old are no longer useful. My husband was a vibrant, productive 67 yr old man before he was hospitalized. They treated him as if he was a naughty child missing part of his brains which is really funny bc they have drs. on staff older than him who still treat patients. Seems to be a different standard there?
He went in one man and came out a man who no longer has a smile on his face. They made sure they took that away. No, he's not depressed about the heart attack as he is a cancer survivor so a heart attack was not really the worst that has happened as far as illnesses. However, it was the standard of care that was the defining difference--the demoralizing, dehumanizing, abusiveness, uncompassionate, controlling, etc. Is the treatment still successful if they ultimately force the patient to never seek treatment again because of their actions? Is the treatment successful if it was done against the will of the patient?
Misty,
We are going to do our best to get his story out there. As much as he doesn't want others to know about how they abused him, he feels it has to be done. As long as men don't speak up and tell their stories, this type of thing will still happen. They count and thrive on silence. I have been doing research into how they are taught to provide patient care. Everything I have found and noted, says patient privacy is of upmost importance. Keep them covered and don't expose them unnecessarily. So what goes wrong between the time they are taught to when they actually are practicing their craft? Why does it go wrong and why are they okay with what they do? I guess they aren't smart enough to know the means doesn't justify the end? Or maybe they are too high on their pedestal of self-importance to realize how their actions actually cause more harm than good?
Dr. B.,
I have been thinking about cameras being used to in OR and patient rooms. Not as you might or have suggested but as a means of documenting patient care standards. The recordings would serve as a memo of care so the patient could view the entire event(s) and decide if their standard of care was acceptable. It could be sent directly to the patient's phone for monitoring or storage or wherever the patient wanted. The videos would help staff be aware that mistreating patients would be monitored more closely so they wouldn't be as likely to do it and get away with it. These videos should have audio too. In a patient room, the patient once not sedated could operate the controls so any contact w/ medical staff could be recorded. These recordings would also protect the staff if any issues arose that they weren't guilty of committing. These recordings would also serve as evidence in malpractice for one party or another. JR
A female writer for MensHealth magazine obviously thought it funny to write an article about a man who bought a stool from an
IKEA store. The man purchased the stool so he could sit under his shower. The stool had perforated holes in it and as the man was taking a shower one of his testicles became caught in the hole of the stool. Of course anything about men’s health becomes funny especially if
written by a female. I suspect if there is another sinking of the Titanic a lot more women will drown.
PT
JF, "?"
Well, I am trying to get the visitors from other countries who are identified as landing on our blog thread to contribute their experience and their country's views of their medical system and how it is the same or different than what is described here.
In this case, the visitor was from Berlin Germany and had our thread translated into German and hopefully Google translator program which I used will present my offer to communicate, if the viewer returns.
As I have indicated previously, I think viewpoints from other countries will provide important insight for all of us.
Has any of our current contributors had experiences in other countries?
..Maurice.
Good Morning:
I don’t believe most men and women went into nursing school predisposed to embarrassing and humiliating their patients. I believe nursing schools try teaching dignity and respect of all patients.
I see the change coming after they graduate & are hired at their first “real” position.
Now they are in the “real world”. No more mannequins to test proficiency on. Now its real people.
I believe the change in their attitudes comes from the people that have been in the system for years and now will be guiding these new recruits. They were taught the ropes by their teachers now they will pass on the good and the bad to these new recruits.
As I see it, the area to place the blame for patient abuse is all levels of management within a doctor’s office, clinic, imaging center, outpatient surgical center, and hospital. These people know it’s going on and do nothing to stop it.
Senior management may not know it’s happening because supervisors and department mangers keep it contained knowing if it got any higher, heads would roll including their own.
They also know they can get away with it with the men due to the male stereotype. They know probably 98% of men will never open their mouths out of fear of being made fun of.
The only way as I see it to clean up this mess once and for all, it for men to say “you’re not going to abuse me and get away with it anymore”.
If you’re a man or boy and a healthcare worker makes you feel uncomfortable, embarrasses or humiliates you, you have an obligation to get names of the individuals involved, make sure your facts are straight, then report it to senior management of the facility and all regulatory state and federal bodies that can act on your behalf to take corrective action.
I know its very embarrassing to air your “dirty laundry” in public but until the authorities, and the public are made aware that bad things are happening to patients, NOTHING WILL CHANGE. Senior management needs to know these things are happening right under their noses in their facilities and if its not corrected, it could cost them money.
Men have to bury the stigma attached to talking about the way they are treated if we are to change the healthcare system.
Guys, we don’t deserve to be abused and it’s time we did something about out for ourselves and our male offspring.
Regards,
NTT
"I also have a problem with doctors making MORE money when they don't do their job right the first time."
Fair point.
But you need to devise another system with correct incentives. Not that easy to achieve, but worth a try.
Maurice,
I see medicine as a medieval guild, the modern day equivalent are unions, the police and prison guards (which are also unionized), religious orders, a fraternal organization (Freemason, college greek, Rotary), military, etc.
They have exempted themselves from the rules, mores, and governing of society. Look at the atrocities and abuses that these groups commit when they have absolute power.
I think that a very good analogy The Church of Scientology. Look at the abuses committed by The Church of Scientology.
Perhaps an even better example would be some "Orthodox" sects of the Church of Jesus Christ of Latter Day Saints (the Mormons). The most heinous of abuses being child sexual abuse (including child marriages).
As an organization, they have exempted themselves from governance by society (claiming only God can judge). The best example is what happens when Mormon leaders treat child sexual abuse as a sin, not a crime.
The ultimate taboo would be child sexual abuse.
I would argue that medicine has even justified sexual abuse of children. I have come across so many stories by physicians that require GEs as part of the annual physical. In past volumes here, I have pointed out the AAP's guidelines that REQUIRE GEs.
Thankfully many pediatricians realize how distressing these exams are for many children and they do not increase mortality, and thus forego them.
On a lighter note...
I also see that you are from the era when German was just as much required for a medical education as Latin (before Babelfish or Google Translate).
-- Banterings
Banterings, can you believe it, I came from a generation prior to learning Deutsch. As I was preparing to go to college and be a pre-med student, I took latin in highschool. As it turned out, it was hardly necessary as I moved on in education and medical school and beyond that the latin in highschool was rarely used in daily patient clinical disease descriptions or prescriptions.
Welcome F68.10 to our thread. With regard to "devise another system with correct incentives", how is that goal attempted to be accomplished for a system requiring so many parameters to change? Do you think it is realistic to call in a computer engineer to help with changes? ..Maurice.
By the way for those interested in the now "outdated" Latin expressions in the history of medicine, take a look at this link. ..Maurice.
My mother has overstepped every boundary imaginable when she started considering me and my siblings as her patients. While my situation is not one where I was sexually involved with my doctor (hell no!), I can't help but shiver at the thought of a doctor confusing these roles. The minimum I'd request of a doctor who wants to be romantically involved with a patient is that the doctor/patient relationship be terminated ASAP. I'd have more stringent requirements on top of that, but given the current state of affairs, I'd be willing to settle for termination of the doctor/patient relationship.
A mathematician would likely be a better choice. It ends up being ultimately an optimisation problem. Sure there are many unknowns, and statisticians are the people best equipped to assess these unknowns. I could speculate more on the topic of who would be needed, but I'll leave things at that.
The first thing to do would be to accept that healthcare is a continuous and ongoing process, with hidden costs almost everywhere. We first have to refute the idea that paying for individual acts is the right way to do things.
I do not see this cultural and philosophical shift happening any time soon. Quite the contrary.
F68.10, I truly appreciate your concern about your physician mother since finding boundaries limiting the professional role of a family member with regard to other members of the family, particularly their children is still a professionally unsettled issue. Where is the line drawn in terms of symptoms and potential diagnoses regardingf workup and treatment.
There is the natural instinct as parents, despite being also physicians to attend to their children's physical and emotional problems but it is not clear when such attention including diagnosis and treatment should be turned over to another non-related physician. And there are, frankly, no specific professional rules in this matter. When does accepted parental duty become unethical? It is a difficult emotional and practical decision to make for a parent who has the medical knowledge and skills to apply but has a responsibility and limitations as a parent or family member. Important issue and yet no absolute answer, as yet. ..Maurice.
Misty: What you wrote regarding the likelihood that male patients will speak up compared to female patients is consistent my findings from research I reported in this blog last month. I also found that male patients were more likely than female patients to be dehumanized, a measure that included indicators of abuse. (I use and have used the term dehumanized in the past because readers readily understand that concept. Actually, the concept I measured was one coined by Erving Goffman – mortification of the self. There are a number of indicators of this concept among which are dehumanization and objectivization). Regarding the tendency of authorities not to believe patients, especially male patients, some people would urge patients to wear voice recorders when they obtain healthcare (unless state law outlaws it), especially if they are anesthetized. The gentleman who was awarded $500,000 after taping what physicians said while he was anesthetized and receiving a colonoscopy might be one of them. Here’s the URL; it includes the verbal exchanges that occurred among physicians during the patient’s procedure. https://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html?utm_term=.4cf413dac4a7 -- Ray
I could elaborate on how to disentangle this conundrum. But as a patient, I learned the lesson that whatever I may claim, I'll always be wrong, anti-science, or under whatever cultish influence my physician mother may fantasize. So, I'll stick with "accepted" "science", and calmly claim the following self evident truth: factitious disorders imposed on another are simply not acceptable behaviour.
Maurice: You ask F68.10: “With regard to ‘devise another system with correct incentives,’ how is that goal attempted to be accomplished for a system requiring so many parameters to change? Do you think it is realistic to call in a computer engineer to help with changes?”
Some scholars suggest that the U.S. does not have a healthcare system; it, instead, consists of many vying systems that compete for hegemony. I won’t detail their arguments here, though. The same and other scholars suggest that the U.S. should do what England does – focus on prevention not cure. This focus has resulted in physicians being remunerated based on the number of their patients who are healthy rather than the number who are ill, as we do in the U.S. Socialized medicine in England is noted for its success at prevention. If England can do it, so can we. -- Ray
NTT
Possibly people don't go to school specifically because they want to see and touch naked bodies. And don't specifically go to school to embarrass and humiliate other people.
That doesn't mean they don't get pleasure from doing those things however. Some of what we have experienced for ourselves and seen on this blog very blatantly shows med workers getting gratification from it.
I have long suspected that misandry rather than any type of sexual aspect is the foundation of the problems with male patient dignity discussed here. Regarding the Tiffany Ingham case, noted by Ray, the recorded remarks certainly suggest that she hates men so much that she falsified medical records; not even Tawana Sparks stooped that low. Of course, medicine refused to cleanup in both cases. There's always another state I guess: https://health.usnews.com/doctors/tiffany-ingham-70437 Attorneys have been disbarred for less egregious legal conduct. I believe medicine needs to "man up" and actually deal with one of these cases.
REL
JR said:
Ray,
You do have a point. My husband, at first, wasn't going to say anything as he was ashamed of being sexually assaulted. However, after many memories came flooding back, he wasn't able to keep it in anymore. I also witnessed the sexual abuse but at the time I was so numbed I didn't make the association. I too think men don't speak up as they feel they won't be believed. However, whether it is an ambush in an office for an exam or lying drugged and vulnerable, it doesn't matter as it is sexual abuse. I think men are dehumanized more than women as men as perceived to be more of a threat to the medical community's power and control issues as well as having a reputation as being the silent victims. I also use the term devalue because they absolutely have no consideration of the individual's rights or even quality of life except for what they determine to be of value. As I have likened being in the clutches of the medical community is like being sentenced to a prison term only prisoners do have basic rights that groups such as the ACLU will fight for and represent them. Patients have no such help.
NTT,
I believe that too many become nurses or doctors for the wrong reasons. There are some fields like medicine, teaching, the people fields where if your heart is not in it for the right purpose more than money and prestige than you are not going to do justice to those you are to help. The middle management of the medical community really protect their own so the higher ups think there are no problems. In our situation, it will be a he said/she said type of thing. I have no doubt the nurse(s) will deny the accusations but they happened. The electronic medical records also protect them and don't tell a true story as everything related to care of a certain condition is already there just for their choosing so all they have to do is go through and click. It is way too easy for them to falsify records and leave out mistakes.
On another note, the hospital from hell finally acknowledged they had committed fraud in billing. No, of course they didn't admit to fraud but merely sent a new bill showing a credit for the room they tried to charge for twice in one day. It only took 8 months of bulldog persistence to get them to correct what should have been done immediately. It is only about money, power, and control. Even when they are in the face wrong, they still defend their actions. Do they have any boundaries that they will not cross? JR
REL
If a certain number of female staff can/do get gratification from looking at female patients. then in all likelihood an even larger number of females will/do get gratification from seeing naked males!
F68.10, in the third of your postings here yesterday, you wrote the word "behavior" in the British (and as in some other countries) spelling "behaviour". My initial reaction was that you have a background personal history from England or elsewhere beyond the United States. And this is what makes you so important to me. If my assumption is correct, you may have personal experience and knowledge in the way the medical system is practiced in that country and can educate us about that practice, especially in terms of differences or similarities regarding the issues discussed here. I hope my assumption is correct because I have been hoping to identify a visitor to comment here about that very matter. Maybe you are the one. ..Maurice.
JR
You have said repeatedly that “ prisioners recieve more dignified respectful medical care than non incarcerated patients” in so many
words. It’s true, I believe you! The ACLU should replace the Joint Commission, the ANA, the AMA and Press Ganey. I’d love to see
that happen.
PT
Maurice. I indeed have some experience of the French and Swiss system.
F68.10, could you tell us your understanding or experience with regard to the medical systems and/or your medical care in these two countries and how they may differ from what you know or what you experienced here in USA? ..Maurice.
I don't believe things are comparable. A lot boils down broadly to political and cultural issues.
France is fundamentally a country where paternalistic ethics are the rule. The commitment to medicine as a science is overshadowed by lots of pseudoscientific bullshit that cannot be criticised because of corporatist impulses of the medical profession. The health care system is overall rather good and socialised, but doctors have almost priest like powers.
Switzerland is a very diverse country. Medical ethics are rather liberal, though underpinned by rather strong christian morals. More consideration of science as fundamental in healthcare. But the country can also be considered as an "ultrademocracy" where day to day power has been devolved to quite a prominent combination of medicine and police. You have to be Swiss to like it. Healthcare system is really expensive but provides safety nets for everyone. Health insurance is private but compulsory and heavily regulated by law.
Maybe you could ask more specific questions.
As Moderator of this blog, I should first let my visitors ask their more specific questions about your understanding and/or experiences, if any. ..Maurice.
My question for F68.10 is how male exposure and modesty in general is handled in France and Switzerland. Are men expected to just shut up and drop their drawers for any woman in scrubs that demands it? Is any attempt made to provide same-gender staff for intimate procedures?
In France, there was an issue with some muslim women demanding that they be examined only by female physicians and nurses. The reaction was an immediate and full scale blowback from almost all segments of french society: no room allowed for any such accomodations. No religious objections or gender based objections were tolerated to interfere with healthcare delivery.
I do not see any provisions being made for same gender staff in medicine. French society would be in uproar at the mere idea.
Patients are expected to shut up and comply with medical staff's directive. So much for "male exposure and modesty".
However, most publicised issues about patient's right to intimacy has been polemics about medical doctors routinely making pelvic examinations of anesthecised women without their consent for educational purposes.
I still believe that women tend to have it worse than men in the medical system. However, there is no doubt in my mind that men and women have different expectations of healthcare and that they react very differently to medical abuse. And I also believe that male patients are more often than not at risk of easily being branded as "difficult patients". I personally do have a grudge against female nurses and even more against female physicians: I do not believe that they value the male perspective on autonomy, and they end up behaving even more paternalistically than their male counterparts.
Switzerland is a country with more liberal medical ethics and a place where privacy is highly valued. I had less problems with intrusive behaviours over there.
Another question for F68.10 concerning France. Are women equally supposed to be OK with males providing their intimate care or does society only expect that of male patients with female staff? Also, are healthcare staff (nurses etc) below the physician level overwhelmingly female in France?
A worthy brief read: "From Personhood and Patienthood" by Harvey Max Chochinov from the Oxford University Blog. In that brief article I learned a worthy knowing Latin relationship: "The word patient comes from the latin patientem meaning someone who is sick or suffering. The word patience--to bear or endure without complaint--shares the identical Latin etymology. Perhaps this common derivation suggests that it takes patience to be a patient."
Read the brief article for it sets out exactly what we are discussing here. Oh.. also what happens when you go from health to illness and settle within the medical system? You become a "P.I.P" ("Previously Important Person"). The article ends with "For those of us who work in health care, the message is clear. We must do all we can to see our patients for who they are and not just what they have. Is that really asking too much? I think not." ..Maurice.
"Are women equally supposed to be OK with males providing their intimate care or does society only expect that of male patients with female staff?"
In a hospital setting, yes, women are equally supposed to be OK with male staff (that was explicitely the issue with muslim female patients). Outside of the hospital, you're theoretically free to choose your practitioner, so it doesn't apply there.
"Also, are healthcare staff (nurses etc) below the physician level overwhelmingly female in France?"
Yes. But more so in Switzerland. I'm speaking from personal experience here, not publically available statistics.
Thanks F68.10. Outside of the hospital we are free to choose our doctors, and even for most elective procedures in the hospital, but what we have long discussed here is the staff, both in and outside the hospital. When it is overwhelmingly female, women by default get most of their intimate care by females, and men by default also get most of their intimate care by females. That most urology and dermatology practices for example only hire female staff and ultrasound depts usually only hire female staff is the problem.
My guess then is that if female staff in France choose to add a sexual component to their dealings with male staff, that they get away with it in the same manner as occurs here.
Cannot claim to have witnessed this in any way, so I cannot really comment. Personally, it's the mental association of "care" with female smugness that makes me want to puke. I cannot even touch a woman nowadays, much less allow myself to be touched nor lectured by a woman. Trauma manifests itself in different ways in different people.
However, what worries me when talking about medical ethics is that we tend to concentrate on our pet peeves. In a sense, I wonder how these biases may be overcome. I wonder if some kind of evidence based medical ethics has been academically developped or not.
As we compare practices between countries as it relates to this blog there is a component I believe that is unique to American healthcare culture, the component of bullying. All nursing associations admit it is a problem, however, they don’t delve into it and do very little in admitting how it negatively affects the patient. Coupled with the misandry ever so associated with the feministic movement in healthcare in our country I don’t think other countries can come close in this hate driven, hate my job nursing healthcare so present in the United States.
This is an expensive hate driven organization against men funded by 1 out of every 5 dollars spent in our economy. Armies of young future nursing hags are marched in ever present numbers ever present to carry out the previous hateful generations that came before them. The hate is thus magnified by medical organizations that have lost sight of patient advocacy in favor of profits and all the arrogance that it encompasses.
In our medical society the elderly are tossed and forgotten about in these self-styled Abu Ghraib nursing homes. I’ve many many friends from France and the French take very good care of the elderly, I’ve seen it first hand. But in the US, they are tossed and forgotten about, abused and left for dead but, not before extracting every last dime that can be had.
Yes, we can get insights from other countries, their insights and perspectives. Is it going to change anything, our opinions, never. You can’t compare apples to oranges, particularly when it involves healthcare in the US. Our system is corrupt from the top down, greed, hate overflow and perpetuate from the inner core out. Healthcare quality is continually dwindling yet increasing in cost as we see more and more Americans with less and less access to healthcare.
PT
JR, Thank you for your comments about my friend’s awful experience in a cath lab, where the female physician (foreign) abused her by calling her a fat, gluttonous American and so forth, and also told my friend she “put in the wrong stent.” My friend left in tears. However, her abuse pales at what happened to your husband. No words can express my horror at your tale of assault and battery, and of sexual abuse, outright fraud, deception, ad infinitum. THIS OCCURANCE IS THE FACE OF “HEALTHCARE” TODAY! I totally understand why you write for your husband. I noticed decades ago when I was teaching university composition that writing is difficult for many, not so much on a technical basis, but more a personal one. It seems, and indeed is, a rather intimate action to pour forth one’s innermost thoughts or strongly held beliefs and there is no reason your husband should not use you as his mouthpiece. And, I want to commend both of you for your courage in pursuing the criminals masquerading as “healthcare” providers. This is not an easy course. You both have endured so much suffering.
I agree with many regular contributors here that the majority of makemsick providers are sociopaths, and many, mostly the female nursing heifer-hags (like you, JR, I use a euphemism to describe these creatures, for what they really are makes “hag” [and yes, heifer works well too!] a nice term ) are sexual predators.
Now, they may not have started their jobs as predators, but they very quickly become part of that sexually abusive culture. And of course, it’s not just the sexual thrills, but the control, the humiliation of their customers that keeps them thirsting for more! And of course most of the sexual abuse and humiliation falls upon male customers as most of the hags are female.
I had wondered what had happened in the Rachel Shaper case, and I believe it was PT that let us know that she was only given a reprimand for raping a very ill man while hospitalized!!! and as she was fired from the job previous to that one for boundary violations, I am sure she is busy sexually abusing male customers at whatever hell hole she currently works at when she thinks she can get away with it. WHY DOES AMERICAN CULTURE LET WOMEN GET AWAY WITH RAPE?
Thanks, PT, for bringing these interesting cases to our attention: “One nurse gave her patient the wrong medication, did not follow the five patient rights to receiving medication, her patient died an agonizing death. The nurse currently has her nursing license and is still working. A nurse in Missouri poisoned her husband, he died. She burned the house down in an attempt to cover up the murder all because she wanted to marry a murderer in a men’s prison where she works. The nurse still currently has her license and is still working. A nurse in Idaho assisted a man who murdered his fiancée by hiding her cell phone after the murder. The nurse still currently has her license and is still working.”
Gee, the nasty Denver 5 pale in comparison to these criminals! I agree that it is getting worse across the board as BON and other entities including hospitals don’t do jack about these criminal hags! Right, the most trusted profession!!
JR, I’d like to return to one of your comments: “We trust no one now in the medical field. We now look at all of them as potential terrorists think that unnecessary exposure is assault and battery.” Your term of terrorist is most apt. And, let’s add to this what Banterings reminds us of, that power corrupts, and absolute power corrupts absolutely. Finally, Maurice you stated: “I don’t want to turn this blog thread into a political battle, but I was wondering whether all the "bad behavior" throughout the medical system described here has a political origin and political sustenance. Is there an existence of political cruelty toward citizens and specifically patients or patients-to-be which is responsible for all the humaneness [sic] repeated described here?”
EO
Yes, the inhumanity and outright acts of cruelty, sexual abuse, covered up/ignored medical mistakes, and little things like covering up murders, and so forth are just one ugly tentacle that the makemsick industry uses to control people that fall under their criminal hands. But this arena must be looked at in a much broader scope. Yes, Maurice, there is a political origin to this behavior. Right now, authorities in New York are terrorizing an Orthodox community that does not vaccinate. All their hullabaloo about a few hundred cases of measles when there are equivalent numbers of malaria at this time – but wait, there’s no vaccine for malaria! The media were instructed to maintain a complete blackout a winter or 2 ago when college dorm students, all fully vaccinated, came down with the mumps! MOST PEOPLE WHO FALL ILL FROM CONTAGIOUS CHILDHOLD DISEASES ARE VACCINATED, SUCH AS THE DISNEYLAND TALE! I’d also like to thank you, Banterings, for agreeing that comments about forced vaccination should be included here as this area is the black heart of the makemsick industry. It’s all about the money and control. It’s not the billions the criminals make from mandated vaccines for our children, it’s about the trillions the criminals (providers) and the Ministry of Truth (Big Pharma) will make down the line as all vaccinations harm the immune system and that’s why over 50% of vaccinated children have diseases such as allergies, life threatening asthma, many cancers, autism (yes, studies from all over the globe now prove this) and so forth. The makemsick industry now has a ready supply of lifetime customers for the Ministry of Truth’s dangerous drugs.
The Ministry of Truth has so corrupted our congress critters that forced medical procedures are now totally accepted by most American sheeple. I commend the Orthodox community for standing their ground, but now fines of $1,000-$2,000 are being leveled, and vaccine thugs are going door to door looking for the unvaccinated. BABY STEPS TO ENSLAVEMENT: The new mandate requires cooperation with investigators from the Department of Health. Failure to comply will result in fines up to $2,000 per violation PER DAY." ****** WHICH would you pick: 1) $2,000/day, 2) Jail, 3) Vaccinate? The unvaccinated are not allowed in their places of worship. In Oregon, a bill is proposed that would mandate 3 home visits when one has had a child, not only to force vaccines but to check on the parents’ mental health! WTF. Look it up! Here’s a good one; medical “experts” now contend that breast feeding infants leads to obesity! I wonder what product their going to push for that!
Actions such as the above by state authorities are taking their cues right out of the Nazi (and many other tyrannical regimes) playbook! The same old tired lie “for the greater good” and stoking an irrational foundation of fear for a relatively mild disease, stoking los sheeple’s fears of the terrible “anti-vaxxer” as a dangerous “other” to be ostracized and criminalized. You might be next, reader! Again, look at the stats. Almost all deaths from contagious childhood and other contagious diseases were eliminated a decade before the advent of vaccines. Research a little deeper, and you’ll find that all the crap about the wonderful polio and smallpox were outright lies. They are now going so far as to re-label diseases, an extremely dangerous precedent.
EO
Perhaps because around the globe, people are waking up to the true terroristic nature of mandated medical procedures. Sweden has banned mandatory vaccines, due to serious health concerns; Japan is suing Merck for the many HPV vaccine deaths (super fast tracked after the losses with Vioxx – only 60,000 killed!), numerous groups of people are now filing lawsuits in other countries for vaccine injury, and so forth. Marches against mandatory vaccination takes place in many countries now.
The terrorism is right at home down under. In Cairns, a health care worker can now be imprisoned for 10 years for speaking against vaccination!
So, to return to PT’s point that if “a nurse can kill her patient by administering the wrong medication, murder her husband and burn the house down, assist her secret lover in murdering his finance and still maintain her nursing license and stay employed. I doubt anything else they do in regards to the issues of this blog will ever matter. Remember, they are the most trusted profession.” I must concur, and it is in the Ministry of Truth's and makemsick providers' interests to keep the male population docile and obedient.
If the Ministry of Truth can terrorize those who refuse to use their for profit, not able to sue against products via government thugs, how can we expect that the makemsick industry would treat any of us with respect and preserve our human dignity while trapped in one of their, as I believe Ray put it, abattoirs?
I will repeat my mantra until I pass: The makemsick industry is the thinking man’s enemy! Reeducation is now being pushed on parents who are still able to opt out of having their children poisoned for profit. Shades of North Korea. And, every sheeple who bends over and takes it is gravely endangering our freedom!
EO
As a physician, diagnostician and ethicist , I am faced with a interpretational dilemma. I hope everyone is aware that the diagnostic code F68-10 is for a "factitious disorder imposed on self, unspecified (including the title "Munchausen Syndrome").
Now, I don't know if our Comment writer named F68-10 is someone who is a new or is a regular participant here who is suffering from "Munchausen by Proxy" or "Munchausen by Internet". For those who are unaware, click on these last two links to go to each of my two previous blog threads to learn more about these disorders from the ethical point of view. You will find my interaction with PT and others on the "Internet" diagnosis thread.
By the way, I am in no way implying that PT is F68-10.
The form of Munchausen which I dislike the most is "by proxy", often by a mother with respect to an "illness" of a child. And for a period of time, the physician is treating the child when it really is the mother who needs treatment. ..Maurice.
If F68-10 is the true (not concocted) victim of a physician-mother.. this is truly a matter of F68-10's patient dignity and demonstrates the damage which can be done in that respect. Very pertinent to the revised title of this blog thread. ..Maurice.
Banterings obviously knows nothing about the LDS church. I am very offended by his lies. Any improprieties against children would mean instant excommunication from the church, not cover-ups. The Mormons have nothing to do with the RLDS church. Why is Banterings using a medical ethics blog to express his hatred for the Mormon church anyway? CL
I am not PT.
I have been faced myself with the interpretational dilemma when I started to investigate what really happened to me and my family. Loooong story...
I am not interested in achieving victimhood status. I've wasted enough years battling the idea of being a patient that I'm not willing to be cornered into the victim label.
Whether or not what happened in my family really is a form of factitious disorder or a personal concoction of my twisted mind seems to me beside the point. There definitely was a factitious disorder behaviour involved at some point, whether or not it fully fits the diagnostic criteria.
Having thought about the issue for many years now, I came to two conclusions. 1. Factitious disorders are a blind spot of medicine, whose ellucidation cannot but have impacts on how medical ethics are conceived. 2. The moral repulsion it triggers in healthcare providers is paradoxically one of the biggest reasons that this issue is so poorly understood.
I'll leave it at that, unless clarifications are demanded.
(By the way, I fully disagree when I read people blaming vaccines for every ill in the world.)
Good Morning Everyone:
Hope all had a great Easter/Passover with family and/or friends.
EO, I've been following the case of the RaDonda Vaught the Vanderbilt nurse who mistakenly gave her patient an injection of the paralyzing drug vecuronium instead of versed to relax her so they could perform a PET scan on the patient. Needless to say her patient died.
Authorities have charged her with reckless homicide for a fatal error.
What really fries me is three-fold.
1. She is saying it was just a medication error and she shouldn't be criminally charged for at.
2. The nursing industry is also saying she shouldn't be charged criminally for making a mistake that directly took the life of another human being.
3. The Tennessee nursing board didn't think she did anything wrong to warrant the loss of her nursing license.
If the prosecutions case can be proved she allegedly made at least 10 mistakes that caused the death of the patient.
These people think they should be above the laws of this country and that's scary.
She made a mistake that cost another person their life and she's basically saying live and learn from it.
A doctor ordered 2 milligrams of Versed, but inspection reports say the nurse instead administered 10 milligrams of Vecuronium.
CMS should have cut off Vanderbilt's Medicare reimbursements as punishment for their part in this death but Vanderbilt appeased CMS by submitting a corrective plan designed to prevent future medication errors and they fired the nurse.
The nurse that kept her license to make more fatal mistakes elsewhere because she gets distracted easily.
She shouldn't get off with a slap on the wrist and the justice system needs to send a message to the entire medical community "we'll be watching".
Regards,
NTT
NTT
I’ll tell you what is making my blood boil right now. This nurse in Tennessee that killed her patient, ignored the 10 rights to patient safe
medication administration believes she has done nothing wrong. The Tennessee state board of nursing has taken no action against
her. Yet, I know of a physician who lost her medical license, her livelihood, her savings and her home because she wrote medication
scrips to help her 2 children who were addicted to meth and heroin.
This physician didn’t kill anyone, yes she illegally prescribed without proper record keeping and lied to the board and for that her license
was taken away. This physician is basically homeless and in a rut. There is no uniformity across state nursing boards or for physician
boards for that matter. Recently, I’ve described 3 nurses who in some way or another killed people, along with other crimes and still
retained their nursing license.
You wouldnt know who these nurses are should you visit a hospital and if they killed someone you wouldn’t know it. So much for nursing
boards protecting the public. If they have committed a crime, ignored safe practices that results in a patient death I doubt they care about
anything which include your privacy and the dignity that you rightfully possess as a human being.
Excellent posts NTT
PT
F68.10, I am aware that you are not PT, since in all the years PT has contributed to this blog in many topic threads, I never have read nor interpreted PT's writing with your expressions or foreign spellings.
This blog thread, "Patient Modesty" and now "Patient Dignity" has always been open for personal emotional ventilation about life and reactions to personal experiences. However, in recent years, attempts have been made to discuss approaches for resolution of the medical system misbehavior.
F68.10, do you think the medical system itself failed in some way injuring you further and that there might be some changes in the system that could be suggested? Your suggestion may lead to constructive discussion. ..Maurice.
I definitely believe the medical system failed me and injured me further. However, I know how criticisms fall on deaf ears, with subsequent accusations of being antiscience, so I'm not willing to indulge anymore into criticisms. Moreover, I believe, as far as factitious disorders are concerned, that there are no practical ways in which the situation may be improved, as it touches upon way too much medical taboos.
As things stand, I believe that the role of science in medicine should be more reflected upon: attacking patients with accusations of being antiscience is rather counterproductive, and only alienates them further. However, MDs endorsing pseudoscientic views are themselves more of a threat to patients than they imagine. And more generally, the role of science in medicine is to criticise and improve medicine. Not to serve as a way to silence patients.
In a sense, I believe we need more science whose role would be to investigate medicine itself, and not only investigate diseases. Believing that only MDs are legitimate scientists forbids criticism of medicine itself. There are scientists who are not medical doctors and who should have a say in medical matters. They should be listened to more.
I do not believe that there are quick fixes to factitious disorders involving only normative ethical considerations.
In my opinion, long term cohort studies of the evolution and lifelong development of abnormal illness behaviours would be of huge scientific interest. And may yield useful clues.
And moreover, doctors will not listen to criticisms of patients unless there's overwhelming data challenging their viewpoint.
That's in my opinion the sad state of affairs.
F68.10, I agree that more time should be involved by physicians in coming to a conclusion for non-emergent patient conditions. Unfortunately, in these days of "necessary" rapid diagnosis (because the physician is administratively burdened and then use of really "error-prone rapidity through heuristic decision-making) diagnostic errors are being made throughout medicine certainly with regard to identifying and treating underlying "factitious disorders". The solution is first for physicians to "slow down!" Here is a link to my thread on this blog regarding heuristic behavior in medicine.
That is why physicians spending more time listening to the patient and not "jumping" to some conclusion is the best medicine. ..Maurice.
CL, I am not defending what Banterings wrote but instead of an ad hominem remark about him, why not present, in detail, what you know about the issue in terms of how any religion, in practice, responds. Do you see a better reaction in religion than what has been repeatedly written here about how the medical system responds to practices deemed unethical by, for example, the American Medical Association or even our State medical boards. Does anyone know if there is a better, more ethical response, by the legal profession to principle ethical or legal deviance by lawyers? ..Maurice.
I indeed witnessed some of the biases you mentioned in your post about medical heuristics.
Your criticism of doctors not slowing down is indeed legitimate. However, the time pressure on doctors is also a result of attempting to balance quality of healthcare with cost efficiency. To criticise this balance, we have to acknowledge the existence of hidden costs, such as the one induced by misdiagnosis.
What I find lacking in your presentation of medical heuristics is that it isn't evidence based. Don't get me wrong, these criticisms are rational, but they fail to account, both in terms of cost and in terms of health outcomes, for the difference between fast paced heuristic diagnostic procedures and slow paced more exhaustive diagnostic procedures.
I know few papers who explore this topic. Research is lacking. In the context of factitious disorders, I'm aware of this one (which doesn't address hidden induced costs but only precalence of the problem in a clinical setting):
https://journals.sagepub.com/doi/abs/10.1177/1367493512462262
But slow paced diagnoses would only be part of the solution, not a bullet proof methodology. In my opinion.
JR said:
EO,
I agree w/ you wholeheartedly. I really like your add-on to heifer w/ hags. Do you mind if I start using it in my blog articles? From when my husband had his prostate surgery 12 years ago, we have seen a major change in the way he was treated. He had some things done by this same hospital and they acted differently. However, his cath nurses were a mixture of 2 20-30 year old females to 2 40-50 years old females. His cardiac ccu nurse was in her 30's w/ a social media profile of lots of partying, vanity (she thinks she's beautiful and w/ movie star looks). We have concluded the cath lab acted the way they did for power, control, and they simply didn't care about him or that he was human. They had a job to do and wanted to get home as fast as they could so properly caring for all aspects of patient care was not important to them. As for the ccu nurse, we have concluded she just enjoys victimizing sedated males. She is a healthcare terrorist with no redeemable qualities. The 2 older cath lab nurses need to be fired as we are sure they were the leaders as the older one was the scrub. The younger ones need to be retrained on how to properly care for every patient, male or female. The hospital should be fined and have some Medicare/Medicaid payment withheld as punishment. They should also have to establish new guidelines that would prevent such abuse in the future. I think the environment they work in is so toxic because of the godlike attitude and sexual harassment from drs. they take it out on innocent male victims and feel they are justified in doing so. In the age of #MeToo, females feel empowered to react and know there are any consequences for their actions.
Misty,
Saw the article in Outpatient Surgery. Good job in getting the message out there! I am still trying to find time to watch the video. My husband has me go everywhere with him as he is afraid of being taken to a hospital and having things done against his will and knowledge again. He also is having very bad nightmares of late bc of what happened.
Dr. B.,
The catholic hospital my husband was sexually abused by will not participate in women's healthcare by allowing abortions even to save the mother's life or even tube tying. If a women is taken there in an emergency situation she will have to have another procedure to get her tubes tied. However, they do allow sexual abuse of patients and force procedures on patients they deemed appropriate. It seems they use their religious beliefs to hide behind. They also object to LGBT rights which they had mistakenly labelled my husband as being. They feel perfectly justified in their twisted beliefs and their false sense of self-righteousness. Most religions have in their backgrounds periods of terror and murder of innocent people. It is whether or not they have learned from those dark periods. The hospital from hell apparently has not as they still abuse and still do not treat every type of medical procedure needed for both sexes. They still sit in judgment deeming what is right and what is wrong according to them. Mistreatment of patients not worthy of them is acceptable and still practiced. It is indeed still the Inquisition. I have the letter where they said they practice their religious beliefs through healthcare delivery and all their literature affirms this too. I am sorry if I have offended anyone but this is what this one Catholic hospital has done. It is my hope that not all are like this one. As you know, I also do not like teaching hospitals. Again, it is the experiences we have had with the one here in central Indiana. JR
Considering the individual's human dignity, which is worse in terms of sustaining human dignity: malingering vs presenting a factitious illness? Should one look at malingering (intentional fabrication of medical illness for the purpose of external gain) undignified vs factitious disorder(intentional creation or exaggeration of symptoms but without intent for external gain) as an illness which does not diminish individual's dignity. Or should a patient's dignity be considered by the medical profession irrespective of the results of investigation of the patient's motives? ..Maurice.
I do not know how to answer your questions.
My understanding of factitious disorders us that they are of a potentially criminal nature, but they also constitute behaviours devoid of free will. Whether or not it should be considered an illness is in my opinion a rather subjective question. What is objective is that factitious disorders are a massively self defeating strategy...
Malingering can overlap with factitious disorders, but there's more free will in it.
That's all I can say.
JR said:
Wouldn't either point to another illness that needs to be diagnosed--mental illness? And yes, anyone with mental illness should be treated with dignity too. Wouldn't a thorough dr. question the reasoning behind such a scheme? Or are they too judgmental in dealing w/ people who have mental health issues. I have seen such judgmental actions by medical people in dealing w/ alcoholics and drug addicts in the past. They sometimes think those people are beneath them and don't deserve treatment let alone humane, dignified treatment. The last laugh may be on them though. Many of them are suffering from addictions themselves so I guess the mirror doesn't always like what it sees.
Some good news. Medicare is investigating what happened. We will keep working so we can achieve some satisfaction as neither of us want to be just another victim either.
Just bc a patient is considered to be emergent does not mean the dr has the right to bypass the opinion of what the patient wants done. If the patient is conscious and/or there is family available, they should be consulted. The dr is not god and has no right to totally be in charge of making decisions for the patient. Bc this is part of our issue and my husband experienced medical assault and battery, he will never voluntarily go for emergency care again. Emergency care rationalization is truly the sewer of all care. This includes the helicopter crew to the emergency room to the cath lab. The STEMI alert system is just another way to gain total control over the patient totally on the terms of the medical field. If the wait time is bc of them, it is okay. If the wait time is for patient/family consent, then time is muscle and can't wait. BS Also, having the helicopter crew drug the patient to shut up his resistance is also assault and battery.
I read an article on Very Well justifying nurses attitude on patient dignity. It was a horrid piece that basically said we shouldn't care as they save our lives. Again, the end result should always justify the means is their slogan even if the result and means devastates the patient. JR
There is an article on KevinMD titled “ stop the unnecessary questions.” Now you are all wondering how or in what way does this affect your dignity in healthcare as a patient. Imagine you are in pre-op and the nurse starts asking you questions, lots of unnecessary questions, such as, “ what are the names of all your brothers and sisters and what are their occupations? What is your occupation? Who is picking you up today? My answer is “ Shannon is picking me up today” Nurse continues with the unnecessary questioning, what is her relationship to you?
Are these relevant medical questions or are people just being nosey? Is this a way to simply categorize you? What does the names and occupations of all your sibling have to do with the price of tea in China or your surgery for that matter. Would you consider it an interrogation and if so wouldn’t you perceive it as an undignified manner? When you schedule you surgery initially there are some relevant questions they ask but being asked unnecessary questions. I’ll ask everyone to read the article on KevinMD along with the 19 comments and once you’ve done that I’m sure you will agree that we’ve turned the page on how nurses and medical staff further abuse the privacy of their patients, by asking UNNECESSARY QUESTIONS.
PT
PJF here.
Recall my posts of about a month ago (Vol. 95) that I was “ambushed” when a urologist brought a young female into my exam (this was a simple exam and no need for an assistant). The doctor vaguely introduced her and I thought he said a scribe. I was too shocked to say anything and ended up being embarrassed and mortified during the intimate parts and the entire incident has been hard for me to get past. I ended up writing a letter to the doctor describing my displeasure, in particular that he did not ask for my consent for her to be there.
Well, the doctor finally called me a few weeks later and left a voicemail – full of apologies. He said that he was “upset” that this happened and said he was sorry 3 or 4 times and he hopes that I would accept his apology. However, I found some things wrong with his overall response.
First, he emphasized that the problem was he did not introduce her adequately. Turns out she was not a scribe but “a student in the last week of medical school and was spending some time doing urology for a week and just graduated so she is actually a doctor now.” Well that was better than an untrained pre-med that I had feared, but still I did not wish a female in the room regardless. He also added “its your prerogative to refuse anybody else brought into the room.” There was no mention or apology that he did not ask for my consent – he seemed to skip over the key message in my letter. My take was that his approach is to just bring the student into the room, do not ask for consent, and hope the patient does not protest. In between apologies, there was a pitch that “do you know that half the doctors are women and they need to know a much as men.” It came off like a rationalization statement on his part and maybe trying to put a guilt trip on me.
Given the above, and the fact that I wanted to hear from him personally, I decided to call. The call lasted only a few minutes - but it did not go well. It started with him basically reciting the voicemail, so I got frustrated and went right into why didn’t he ask me for consent for if he had, I would have said no. He responded I could have just refused – at which I lost my cool and said “It is hard to speak up a when you are in a 8 by 12 room facing two white coats and tell one of them to get out.” Well the discussion went downhill from there, me on the offense, him on defense, especially when I added “you essentially put the student ahead of your patient.” He really did not like that and he said that was certainly not the case, blah, blah, blah and he had to get to his appointments and time to go. End of discussion.
BUT – I do think he was rather shaken by this event – especially the written letter - and that he will change his ways and ask for consent in the future, at least in a female student case. He did mention in the phonecon that my comment about asking for consent was a constructive criticism. At least I hope I changed this one doctor.
PJF
PJF, 3 CHEERS for "speaking up". A fact: that physician is human and will remember since it is very likely you were the first patient to provide this feedback however I doubt you were the first patient to have an "undisclosed" individual in the room. Thanks for sharing the update. ..Maurice.
PJF
I think the conversation went better than you thought. It didn't end all warm and fuzzy but I don't think it could have anyway. I especially liked that you told him you would have said No , if he would have asked.
JR said:
PT,
After my husband's medical assault procedure, the hospital sent in a social worker to ask questions. They knew he was still drugged and just out of a major procedure but they knew he would most likely answer the questions. Ordinarily, he would not have answered them. This was during the time he was lying w/ his genitals totally exposed w/ the sexually abusive nurse and the social worker laughing nurse. The questions lasted for about an hour w/ others in the room. Does your spouse (gay) abuse you sexually? Does your spouse abuse you physically? What is your spouses name? (remember they already had that one and thought he was gay and my name is often mispronounced and spelled incorrectly) Where do you live? What do you do? Do you do your own grocery shopping? Do you do your own banking? What type of banking? Do you travel? Do you do laundry? Do you grocery shop? These questions were so important to ask a drugged man less 30 minutes out of a major procedure as he was lying exposed while the life saving equipment wasn't working? He doesn't remember all the questions but he remembers thinking he only wanted to see me and wanted to be left alone. Also, during this time, they had him sign more forms they had no business having him sign as he was still drugged and not capable of making any decisions again which they knew but chose to take advantage of him. However, the captors wouldn't allow my son and I to see him for over 2 hours bc patients rights and needs have no place in a hospital setting. The only thing that matters in a hospital is what the hospital wants done. Patients are merely the tools they use to accomplish their objective of control, power, and money. Patients at least have a chance of maintaining dignity during office visits, etc. but when it deals w/ any type of sedation involved then there is no chance of having patient dignity. More to the point, they know it too. Also, the nursing home scenario is also another area that needs to be addressed bc the abuses there may even be worse.
P.S. Besides making them finally admit they were charging for 2 rooms on 1 day (fraud in billing), CMS and the Board of Health has opened up an investigation. Even though he is not gay, the fact they thought he was gay per his paperwork, the investigators suggest we file w/ Civil Rights. The insurance company has also reopened the investigation into this matter. I had already filed w/ Civil Rights about them denying me my freedom of choice and religion when they forced the chaplain warden on me and he violated my husband's privacy and mine and my son's privacy. It also covered them forcing someone who wasn't wanted to be included in the medical care of my husband especially since he would not leave when told to 3 times.
F68.10 (or should I call you "Factitious Disorder Imposed on Another" as per the DSM),
What you are talking about is gaslighting (link to the hard science).
CL,
I do NOT hate the Mormon Church. I was referring to the more radical sects of the Church. As a Catholic myself, my church has committed many atrocities. RLDS has its roots in the LDS church. If I offended, I apologize.
Please do NOT accuse me of any hatred either. I simply did not make my point clear.
No need for such drama...
-- Banterings
F68-10, I think it is especially necessary for all physicians to be fully aware and at the time of formulating an initial diagnosis that your disorder payment category with all of its possible causes be always considered. I think as a teacher of first and second year medical students, I need to really emphasize this important consideration. Otherwise, it might be a surprise to them as new residents, not learning this earlier, practicing in hospital emergency rooms with the entry of a patient with a true factitious disorder. Here is where the heuristic rush to assumption may prove not in the patient's best interest. ..Maurice.
@ Banterings: do you mean that I am gaslighting readers? Or do you mean that I have been gaslighted?
@ Maurice: You're right. However, in the long run, I place more hopes in research than in clinical methodology to unravel the issue.
CL
A. Banterings simply made true comments and references to the LDS, which is essentially the case with many religious organizations,
abuse with power. Now I was involved with the LDS and a number of Mormon churches for over 20 years, Abuse is where you find it.
There are many references on the web involving the LDS and child sexual abuse, lawsuits and coverups. I assure you from what you find
on the web will never reveal the big picture. Oh and it wasn’t just abuse against children, but against men and women as well!
PT
I was thinking about F68.10's comments that in France it is culturally inappropriate to expect healthcare staff to yield to gender based preferences, even when it comes to female Muslim patients. It will be interesting to watch this culture clash as France's non-French population continues to swell with African and Middle Eastern refugees.
The French do view exposure differently than most Americans. A friend who vacationed in France had to buy one of those speedo type bathing suits to swim at a public facility because American-style shorts type bathing suits were not allowed. At a beach we used to go to in Maine that was very popular with the Quebecois, you could easily tell Americans vs French Canadians based on beach attire. The Quebecois women wore bikinis and the men wore those speedo suits long past the point where age or poundage made it inappropriate, at least under New England cultural norms that still have echos from our Puritan ancestors. It makes me wonder if the cultural approach to patient exposure is different in Quebec and New Brunswick than in the rest of Canada.
JR said:
Misty,
Watched your video. It was really great! I do have several questions. If you use a nurse or someone from another hospital, do you think they would really protect the patient or would let something happen bc they would fear professional retaliation? Also, even if you are awake before prep and the IV, chances are the IV will erase your memory of what happened and they are aware of that. For anything requiring or might require groin access, the Covr garment is the way to go as it protects the genital region while allowing access whereas cotton underwear would not. Maybe Patient Modesty could make up a checklist of items for patients to cover on the consent form as oftentimes in the heat of the moment we forget. One item that may need to be added to that checklist are the types of pre-sedatives they use such as Versed or any others they use to purposely cause memory loss. Any ideas on how to get started on one of the petitions? That would be a good section for people like me who want to do something to change but not quite such how to get started.
Organized religion is no different than any other group that has power, control, and money. The abuse is usually committed by those in control while the average member/person is just trying to do the right thing. People in control always prey upon the weakest or the easiest targets. Even around here, we have had youth ministers molest kids. My son was in Scouts but my husband and I always attended everything and my husband went on his campouts and such. We, as parents, were always aware that molesting could happen. We always went the extra mile to be aware of who are kids were with whereas many parents just dropped off their kids and never knew any details.
However, we stupidly did not think molesting would happen in a hospital. Now we know differently. It all comes back to the control, power, and money issue. Anything or anyplace that has those ingredients also have the ability to abuse and violate. Unfortunately, it is usually the weakest or the sick, injured who are victims. I believe that medical workers feel they have total control and power over patients. I do not believe they see patients as having any rights let alone dignity. Hospitalization is total control of the patient and they are not likely to give this up. Hence is why they use drugs like Versed and even the opiates. Many patients accept this loss of control as they are afraid of bad consequences if they object. They are scared of making mad the person who cuts into them.
It is no wonder there are not cures for diseases. There is too much control and money in the continual treatment (drugs and procedures). A cure would end the control and money stream. One cardiac doctor I watched who had a great piece on why heart caths are being overdone said if only the money spent on advertising was spent on research than things might be different. He said people are misled on what a heart cath actually does. We weren't misinformed--we were not informed but I agree with him. I would also expand to say if only people knew how they would be treated while getting the heart cath done would probably decrease the numbers getting them. But as it stands, heart caths are one of a hospital's biggest money makers so that is what I want to educate people. JR
"It will be interesting to watch this culture clash as France's non-French population continues to swell with African and Middle Eastern refugees."
I, for one, am not really too keen on polemics on the topic of immigration. But as far as predictions go, I am pretty sure that French society will rather uniformly and dogmatically back up the idea that no gender based accomodations of the kind should be made. Multiculturalism, or as it is often translated in french, "communautarisme", is widely viewed as an intrinsic and lethal threat to the concept of a Republic, as it is conceived in the minds of french people.
France as history of crushing down local particularisms (Brittany, Basque region, Corsica, Alsace Lorraine) and will not change its course because of Muslims. Won't happen.
A patient's cultural and religious identity and sexual identity are essential elements to be considered by the medical profession in all diagnosis, treatment and overall interaction with a patient. The profession should never consider that they are working on a "thing" or "diagnosis" but on a complete human being. Medical students should be aware of this requirement from the beginning of their training and should be repeated to them as they move on to become physicians. And this applies to all other participants who work with and for patients. Anything short of this understanding and attention is malpractice and an immoral attack on the patient's dignity. We are not diagnosing and replacing a leaking plumbing object. ..Maurice.
F68.10,
YOU were being gaslighted.
JR,
You have granted me an epiphany: money, control, power.
The control and power are the means to keep the money flowing. Deviants will exploit this system for their own self gratification. The system will overlook and cover up the abuses because the system is only concerned about the flow of the money. It is when the deviance causes an interruption in the flow of money (large settlement lawsuits, loss of clients) that the system takes action. If corrective measures to prevent the abuse from EVER occurring again, the system will just put a band aid on the problem.
There is a psychosocial term for this that currently escapes me. Ray would probably know it off the top of his head.
PT,
Thank you for your support.
-- Banterings
Part 1
Maurice: I read Chochinov’s paper with interest. I was especially taken with his description of a woman he aided “with leukemia. . . Being young and fiercely independent, she struggled, not merely with having to face a life threatening illness, but the sudden assault on her sense of who she was. Almost overnight, she had to relinquish her freedom and submit to strict infection controls, including isolation on the bone marrow transplant unit. Like any patient, she was assigned a chart number, given a standard plastic wrist identification bracelet, and issued the usual, drab hospital garb. Her treatment, tailored according to detailed laboratory findings and genetic markers, was highly aggressive and invasive. One morning after having encountered her share of hardships, including total hair loss, nausea and various nasty complications, she emerged from her room wearing a beautiful, full-length blue satin nightgown. Those of us who worked closely with her realized immediately that this was no frivolous gesture. In fact, this was a way of asserting herself, a way of saying: ‘This is who I am,’ ‘I am more than my white counts,’ ‘Please, SEE ME.’”
Two things struck me as I read Chochinov’s words. First, what Chochinov describes is what Erving Goffman calls “mortification of the self,” the process of relinquishing the self-image one has of herself and replacing it with another self-image befitting the situation. This process is most likely to occur to patients (clients, inmates, etc.) in prisons, inpatient hospitals, nursing homes, and the like. According to Goffman, those patients who do not accommodate by making this change or who try to reassert their old self-image by doing what Chochinov’s patient did, tend neither to be viewed nor treated very kindly by caretakers. The typical response tends not to be a show of empathy, of the sort shown by Chochinov, but a show of contempt for a person believed to be pretending to be what she is not rather than a person pretending to be what she is. If so, then Chochinov’s patient was indeed fortunate. -- Ray
Part 2
Second, Chochinov’s piece, especially his last two words (“see me”) reminds me of a poem written in 1966 by a nurse named Phyllis McCormack whose demonstration of empathy cannot, as far as I’m concerned, be contested.
A Crabbit Old Woman Wrote This
What do you see, nurse, what do you see?
What are you thinking, when you look at me-
A crabbit old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her food and makes no reply
When you say in a loud voice, I do wish you'd try.
Who seems not to notice the things that you do
And forever is losing a stocking or shoe.
Who, unresisting or not; lets you do as you will
With bathing and feeding the long day is fill.
Is that what you're thinking, Is that what you see?
Then open your eyes, nurse, you're looking at me.
I'll tell you who I am as I sit here so still!
As I rise at your bidding, as I eat at your will.
I'm a small child of 10 with a father and mother,
Brothers and sisters, who loved one another-
A young girl of 16 with wings on her feet,
Dreaming that soon now a lover she'll meet,
A bride soon at 20 - my heart gives a leap,
Recalling the vows that I promised to keep.
At 25 now I have young of my own
Who need me to build a secure happy home;
A woman of 30, my young now grow fast,
Bound to each other with ties that should last;
At 40, my young sons have grown and are gone,
But my man is beside me to see I don't mourn;
At 50 once more babies play around my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead,
I look at the future, I shudder with dread,
For my young are all rearing young ones of their own.
And I think of the years and the love that I've known;
I'm an old woman now and nature is cruel-
Tis her jest to make old age look like a fool.
The body is crumbled, grace and vigor depart,
There is now a stone where I once had a heart,
But inside this old carcass, a young girl still dwells,
And now and again my battered heart swells,
I remember the joy, I remember the pain,
And I'm loving and living life over again.
I think of the years all too few- gone too fast.
And accept the stark fact that nothing can last-
So open your eyes, nurse, open and see,
Not a crabbit old woman, look closer- SEE ME. -- Ray
Part 3
I think it’s important to note that McCormack submitted her poem for publication anonymously in 1972. When I first read it in 1980, I was informed that it was written by a patient in Scotland. Everyone I knew, including nurses, who read it believed the same. The nurse who responded to the Crabbit Old Woman via the poem below may have not known that poem’s source. What’s your assessment of this nurse’s response, Maurice?
A Nurse's reply "To the 'Crabbit Old Woman"
What do we see, you ask, what do we see?
Yes, we are thinking when looking at thee!
We may seem to be hard when we hurry and fuss,
But there's many of you, and too few of us.
We would like far more time to sit by you and talk,
To bath you and feed you and help you to walk.
To hear of your lives and the things you have done;
Your childhood, your husband, your daughter, your son.
But time is against us, there's too much to do –
Patients too many, and nurses too few.
We grieve when we see you so sad and alone,
With nobody near you, no friends of your own.
We feel all your pain, and know of your fear
That nobody cares now your end is so near.
But nurses are people with feelings as well,
And when we're together you'll often hear tell
Of the dearest old Gran in the very end bed,
And the lovely old Dad, and the things that he said,
We speak with compassion and love, and feel sad
When we think of your lives and the joy that you've had,
When the time has arrived for you to depart,
You leave us behind with an ache in our heart.
When you sleep the long sleep, no more worry or care,
There are other old people, and we must be there.
So please understand if we hurry and fuss –
There are many of you, And so few of us. -- Ray
True. I was gaslighted. But I never bought into it: I was medically coerced into it. That's not a meager difference. Moreover, it still is debatable whether or not the person that gaslighted me really did believe in the BS I was being fed: I believe the gaslighter was self-gaslighting when gaslighting me. It's just that twisted.
Ray, thanks for your very interesting and pertinent poetry presentation. I think every provider of patient care should read the poems but I would like to add two final lines to the nurse's response.
But I think of you and them more often than it might seem
Since some day I, too, likely, will be joining you and your team.
..Maurice.
F68.10, is this the first time that you have been ventilating your feelings on a public forum? I feel such ventilation is of therapeutic value mainly if the responses by others are understanding, constructive and supportive. As you might have seen within all these Volumes here, there has been much ventilation, hopefully found of value to the visitor doing the ventilation. But, beyond that, it provides an education for those of us who have not had the same experience as well as support for those others who have. ..Maurice.
It's not exactly the first time, though I ventilate very differently depending on the audience. I do not care much whether the audience is supportive or not. Quite the contrary: I wish to attempt to dispell myths, and I welcome both constructive and non constructive opposition to my "claims". In fact, I enjoy debating overconfident MDs and challenge their opinions when they go intellectually astray (on different topics). As I'm now (temporarily?) disabled, I do not have much else to do anyway. I'm living on my grudge, waiting to outgrow it. And I have no shame about it.
JR said:
Banterings,
Well said. The power, control, and money formula can be applied to just about everything. It is what drives an average person who finds power and control to use it to get more money. Our local police chief was recently arrested bc he didn't feel he had enough paid sick days and decided to give himself a couple more for about a grand total of $1000. It is amazing what people who know better will actually do when given power and control = money. I wonder if now he thinks it was worth it? Yes, it goes w/o saying this formula is what drives the world of medicine. We have allowed them to much power and control over us so now it is a major money-making machine which they will not give up easily. As far as religion, not only can it bring out the good in people, it can also bring out the very worst. When talking w/ the service UNexcellence director, she denied their wrongdoings and justified all the treatment he received as being based on their Catholic principles. I am sure this is not the only hospital that hides its mistreatment and abuse of patients behind its religious background. I was always told that talking about religion and politics was a sure way to get into an argument. Both are very sensitive subjects--just turn on the tv nowadays to find that out. I agree the best way to change a hospital's actions are by hitting them in the pocketbook. But that is easier said than done. Because this appears the only way to bring about change to how they treat patients, it makes having contact with them even more scary. It drives home the point there is no compassion and caring existing in today's medical world--it is all about money and their self-preservation of how they deliver medical care. While it is true, there may be a few who are truly conscientious providers, they are few and far behind and difficult to find.
Dr. B.,
Nice ending to the poem. For me, the venting is good. I don't want to burden my husband with all my thoughts as he is dealing with his in his own way. He knows I am on this board and can read what I say if he wants. Maybe he has. Between the venting and kava kava, I feel my "rages" have lessened a bit. I still give the finger to anything associated w/ either hospitals, cannot watch anything w/ a nurse, emt, dr. and feel like slapping anyone in scrubs but I know I cannot. What has also helped is that we are trying to get something done about what happened. Eventually, through perseverance, we will get it done. I recognize that I allowed them to make me a victim and that will not happen again. They strike when you are at your weakest bc that is how they feed their need for power, control, and money. Banterings is right--money is the key to change. JR
F68.10,
What typically happens is when a person goes against the norms and mores of (what Ray refers to as) a deviant subculture you are labelled as "crazy." That is where the expressions "you don't have anything we haven't seen before" and "we have no modesty here" come from.
It is also this line of thinking that makes providers think that medical display photography and pelvic exams on anesthetized women without their consent are acceptable practices.
Look at how the profession has acted with impunity.
The real problem is that these deviant subcultures see nothing wrong with this behavior that society would consider deviant. I have shown on my blog that med school creates sociopaths.
-- Banterings
This is true of a certain number of staff. But the resident complaint is also true. It only takes a few lazy abusive staff members and much damage is done.
Also if and when management pushes staff beyond their strength and/or accepts patients that there isn't enough staff to accommodate? That's a business first and a nursing home second and I've seen it and seen some more. The manager's will say responsible sounding statements but it's a whole lot of hypocrisy.
I wonder if there might be a way of merging a small number of nursing home patients into a business there has enough down time to accommodate them? Somehow organize it so nursing homes can't financially rape anymore. Our assistant living home charges about $7000 per month. Maybe if the families could live their with the patient? THEY could wash their family members laundry! THEY could give the medicine ( possibly some couldn't ) Meals? Either the facility could cook up meals for certain patients or family could. I know there are many laws that would prevent this kind of thing. But laws are manmade. Laws should be voted about by WHOEVER is affected by. Not just people seeking to financially rape other people.
Banterings. Yes, I know that in some sense, we have a deviant subculture policing other arguably more deviant subcultures. And that it is unchecked, largely.
However, we must also understand that this deviant subculture of MDs is also faced with tremendous challenges that warps their minds over time. We cannot afford to think this fact is negligible when addressing our concerns.
In France, there currently is a (mild?) scandal over the way dialysis is performed. It seems that the clinical situation has transformed over to a cash cow situation, where opacity is key to the system. I did not get the details but it seems that kidney transplants are being purposefully postponed as dialysis is a rather lucrative business. The association of patients that disclosed the problem publically, Renaloo, has been barred from participating in high level discussions with nephrologists in France because they were asking for transparency. The were accused of polemicising a minor issue by french nephrologists.
This kind of corporatism must cease once and for all.
All they are asking is some transparency in financial statements and clinical outcomes. To me, this kind of initiatives from patients is typically the right kind of behaviour that should take place in an open society. (I'm referring to Popper's concept of an open society, as I believe it definitely has some value in healthcare criticism.)
In my recurring medically oriented nightmares, I often wish that associations of patients took the time to reflect on what value there would be in an avowedly rationalist association of patients that would advocate for data transparency in healthcare, social studies investigating medicine itself, and who would denounce the most egregiously irrational situations in healthcare. The prerequisite would be that patients be educated in what rationality really is (not a small task) and that they understand that they should not accept being compartimentalised in associations dedicated to their own illnesses and pet peeves. They need to beat the healthcare subculture at its own game: rationality, science and ethics. And do it publically, openly, and shamelessly.
I do not believe it's unfeasible. It's likely tough to achieve. But the other only alternative I've perceived is continuous and unproductive ranting, and ventilation of distress. I can't settle for that.
F68.10, based on your research and personal experience, could you suggest what approaches research should take to provide systems or methods to make prompt diagnosis of your chronic illness? Should one look to some test? ..Maurice.
That would be a long topic. Research is done rather responsibly on factitious disorders. It's just damn slow. They still are accumulating case studies and the field doesn't seem yet ripe to tackle epidemiology properly.
But here are a few thoughts. I'll first deal with factitious disorder imposed on another.
As a diagnostic procedure, there should be a standardisation on diagnostic procedures such as the ones laid out by Donna Rosenberg in her 2003 article. (There may be other sensible proposals for diagnostic criteria that I've heard of but not assessed; and I'd advise reading Thomas Roessler for very sensible clinical advice and case management advice).
I'd advise investigating more seriously the long term impact that this has psychologically. You'd discover abnormal illness behaviours ranging from complete iatrophobia to induced factitious disorders. You need to do that inquiry to correctly assess hidden costs.
Now to factitious disorders, generally (both on self and on another). I do not believe you can deliver a blunt diagnostic test that would not screw up on both false positives and false negatives. That's a fools errand.
However, I believe you could devise monitoring procedures of healthcare consumption that could trigger alarm bells. My idea would fly in the face of patient confidentiality, but here goes anyway: I believe you could devise monitoring methods based on survival analysis. Indeed, the more factitious disorders get entrenched, the more you would see in medical records a growing discrepency between signs and symptoms. You could broadly devise a scoring technique based on three factors. 1. Gravity and invasiveness of medical procedures involved 2. Discrepancy between signs and symptoms 3. Frequency of health care consumption.
Of course such a tool would need to be validated scientifically.
There would also be caveats to such a tool: It casts too wide a net, as somatoform disorders for example would need to be pruned out. It would not catch as easily factitious disorders that are actively induced, compared to factitious disorders that involve more pathological lying than induction of symptoms (when induced, you have less discrepency between signs and symptoms...). Only applicable to factitious disorders happening in a hospital setting, and blind to what happens in private practice, that's a caveat too.
It would be an alert tool. Not a diagnostic tool.
These are preliminary thoughts on the topic. This blog is not the place to lay down a tentative research program, nor to disclose all of my thoughts.
In a nutshell, I believe medical records contain, when aggregated over the patient's history, enough information to construct relevant, though not perfect, statistical estimators of the probability of some form of factitious disorder occurring.
Currently science is not yet interested in supporting such an insight. It's concerned with accumulating and aggregating case reports for the moment.
The following is a Fair Use reproduction on this non-profit educational blog of a article written by George G. Lundberg in the April 24 2019 publication of Medscape.com titled "Capitalism is Choking Professionalism in Medicine"
I am not quite sure whether "sheep" or "lemmings" is the best metaphor for how American physicians have behaved since the corporate takeover took root in the 1980s. Health Care Under the Knife, composed of 13 incisive chapters by 16 distinguished authors, addresses the gross inequities, blaming capitalism-run-amok as the root cause. Although it may be historically impossible, at this late stage, to divorce capitalism from medicine in America, it should be possible, even essential, to stop the pendulum (or rocking horse) at its current extreme and begin the swing back toward a balance.
The United Nations has been ranking "happiness" scores of countries for many years. The report bases its rankings on six key variables: gross domestic product per capita; social support; healthy life expectancy; freedom to make life choices; generosity; and freedom from corruption. The United States has never made it into the top 10. Worse, in recent years our national rank has been dropping; in 2019 it dropped to number 19 of 158.[7] The top 10 are Finland, Denmark, Norway, Iceland, the Netherlands, Switzerland, Canada, New Zealand, Sweden, and Australia. Guess what type of governmental systems they have.
Labels such as Conservative, Liberal, Progressive, Socialist, Republican, Democratic, Independent, Green, Dixiecrat, etc. are short and convenient but, by definition, divide us. I suggest that a better way would be to state desirable national attributes and goals, and work together from and toward those:
Healthcare and education as good for all;
Safe, drinkable water and safe, breathable air;
Government that promotes both robust business and vibrant consumer interests;
A tax structure that enables society to achieve these defining elements for all.
Just as medicine has always been both a business and a profession, it is also both an art and a science. Many have lamented the loss of the art, most particularly because of the mandated use of these devilish electronic medical records that compel the doctors' attention to be diverted from the patient in order to click the buttons to capture maximum payment, provide management with controls over physicians, and enforce a limited number of minutes per visit.[8]
In our current version of "Medicine," the art has returned but as an art form of controlling corporations that fleece the patients, payers, and providers, whomsoever they may be, to maximize profits. For more on this topic, read Dr Roy Poses' magnificent continuing blog called Health Care Renewal.
Healthcare doesn't have to be this way. Change is in the air. We can return to professionalism in medicine, but it will require nothing less than personal internal and national political revolution.
The same diagnosis of the medical system as repeatedly described here. ..Maurice.
Oops! I left out the MD professional title of Dr. Lundberg in the posting above. I doubt none of our Commenters here disagree with Dr. Lundberg's summary of the disorder of our USA medical system. ..Maurice.
Dr. B, I've been a loyal follower of this blog for years, but I can no longer stomach it. If contributors like Banterings and PT can get away with bashing my religion and comparing it to abusive nurses this isn't the blog for me. Thanks for all you've done. CL
JR said,
As I have mentioned before, the EHRs serve as a way to hide errors and protect the medical community rather than tell the true story of what happened to the patient. The EHRs make lying and falsifying easier. The thought behind that was standardized phrases are less likely to lead to malpractice evidence against the medical provider. It also encourages workers who aren't doing their jobs correctly or even at all, to just click on items to CYA and it is in the EHRs forever and undisputable.
The previous ten years has seen a shift in opinions about the elderly. Maybe there aren't actually the red pill/blue pill but there is a definite attitude of just having the old to die. When my father who had Parkinsons broke his hip, the young ER doctor took one look at him and said there is nothing to do for him as he is going to die. My father, who previous to this, was doing fairly well for his condition. Immediately as I was sitting there, I saw the change in attitude come over him. He never said much of anything after that. It was as if the will to live left. They did not fix his hip but rather kept him on morphine. They assigned him the death devils (hospice as I call it) to give him more drugs (a cocktail of 4 drugs plus the one to dry up secretions) and said not to feed him but he would starve. My stepmother listened to them and we had no choice. It was horrible as he was hungry and always thirsty. He had very few undrugged moments. He was trapped like a prisoner sitting on the electric chair while an electrician fixed whatever issues so the sentence could be carried out. The hospital and hospice decided he would die. It is no wonder about the recent article by MedPage that elderly suicide is on the rise. My father still was sharp but that hateful and mean doctor shut down his will to live. What a wonderful healer and compassionate being he was! I hope he receives like compassion sometime in his life for someone he loves.
Seniors are the only group of people required to have 2 forms of insurance--Medicare and private insurance. After 2 years of using one brand of long acting insulin, (my son had tried others that didn't work), his insurance has now mandated that he change as it is too expensive. He is totally dependent on insulin and they want to mess around w/ his health to find something cheaper. His doctor (a compassionate one) is just supplying him w/ samples. His doctor is affiliated w/ no hospital so I believe that makes a difference as he is not controlled or have to do backflips to please them.
I heard on tv about shutting down fentanyl coming into this country across the border. However, if they would put politics aside, they need look no further than local drs., hospitals, & EMTs for sources of fentanyl pushers. Opiates are usually introduced first through medical use than in order to get them more readily, they buy off the street. EMTs give fentanyl too frequently & like in my husband's case, w/o reason or consent. He would have not known why he felt like he did (he thought he had lost his mind) if he hadn't read the med. records from the 1st hospital. No one ever asked him if he had a drug issue. If he had, it would have been more of a nightmare experience than it was. They simply don't care. It is what is convenient and best for them not the patient. JR
CL. You should reflect a bit more on the topic. Perhaps Banterings' comments were insensitive, and in his defense, he tried to point out to point out that he was refering to RLDS rather than LDS, which is true.
I avoid making comments on religions on a medical ethics blog, even though I likely have much harsher views on the topic than Banterings.
Three points: 1. You have to live with the fact that some people will push back severely against any attempt to silence criticisms of religions. 2. You have to acknowledge that organized religions (whether we are talking of LDS or not is irrelevant) have a way of covering up abuses that is indeed quite comparable to behaviours of the medical establishment, so criticisms fatally end up being analogous. 3. You also have to acknowledge that religious views cannot be divorced from a bioethics perspective, as they are major forces driving idiosyncratic behaviours of BOTH patients and doctors.
It's legitimate that you may feel that a bioethics blog is not necessarily the place where we should pick on a religion for the purpose of bigotry. That's a valid point. That however doesn't invalidate the 3 points above. Let's attempt to strike a balance rather than strive to be determined to be offended.
CL, what I allowed my blog visitors their specific church views you named to be published is because their descriptions were previously written and described in the news media and other public presentations. I didn't get the impression from their comments that they implied that all religious members experienced, followed or agreed with the descriptions which has been publicly published.
To be frank, I must say that those writing to this blog thread have "torn apart" a lot of my own earlier concept of the beneficent behavior of the medical system by disclosing documented newspaper presentations of ethical and legal wrongs. They described personal and publicized behavior by the medical system, I just never experienced. It took me a few initial thread Volumes to wonder seriously about my conclusions that those who presented here their experiences may not have been unequivocally "statistical outliers".
In conclusion, my main principles of Moderation here is presenting public documentation, personal experiences and attempting to direct constructive discussion with documentation to the good and bad, true and falsities of the topic itself and to avoid specific ad hominem criticism of the one presenting the topic.
CL, I hope you continue to join us and present your own views and documentations of what supports and what denigrates the concept of patient dignity.
..Maurice.
JR said:
Here is that article I was talking about other day.
https://www.verywellhealth.com/patients-medicine-modesty-healthcare-2615000
Apparently, this woman has not read an actual Patients Bill of Rights because most guarantee patient's personal privacy. The hospital from hell lists "As our patient, you have the right to personal privacy." There are not any disclaimers or exclusions to this so I would think this would prohibit unnecessary exposure or careless exposure. So why do they do it anyhow? Why is there not a method to make them enforce this? Why does no one care except the victim? I am at some point going to put up this entire Bill of Rights as many hospitals don't put them on their website. I will be dissecting it to all the areas they ignored or violated. I might add in this patient information brochure they directly tie their religious beliefs to how they deliver medical care. They even say in the beginning of the brochure, "You can be assured that, in keeping with our mission, we want to make your stay as pleasant and worry-free as possible....Our prayers are with you that God's healing power will bring you a rapid and complete recovery." They go on to say again that "We respect your privacy and dignity." If is not that they don't recognize the concept of patient dignity, it is that that don't practice delivering on patient privacy and dignity. It looks good in the book but it is not practiced.
They also list you "to be free from physical and mental abuse, and corporal punishment." Unnecessary exposure for prolonged periods of time fit this category and refute this claim. There are about 12 or more of these they violated. It is too bad it is impossible to hold them accountable for false advertising.
Based on advice from his insurance company, we have filed another OCR complaint. This one is based on sexual discrimination. We didn't know he could as he was not gay but was rather labelled being gay and treated badly because of when he actually was not gay. They said it is the intent. Maybe this hospital is getting a taste of having both state and federal investigators thumbing through all their business. Maybe they are feeling violated too by this invasion of privacy. Hope so! This service Unexcellence person said too bad for us on the way we were treated so I say too bad for them! JR
CL
No one here is bashing religion or anyone’s beliefs. I was involved with the LDS church for many many years, going on missions, volunteering, contributing etc. There are bad people in every organization and as I said, abuse is where you find it, however as
A. Banterings and I simply pointed out many seek refuge in organizations to seek power so as to abuse others. What’s interesting
is that abuse that occurs in religious organizations tends to spread quickly, disseminates. Whereas in medical facilities it is quickly
and quietly swept under the rug.
It seems society follows the see, hear and speak no evil and it’s this fear monger mentality I suppose that should suppress the behavior
but guess what, it dosen’t. That’s why this kind of CRAP still goes on and on, the abuse, the sexual assaults etc. I get sick and tired
and it makes me want to puke my guts out when people want to play the religious card, the nurse card, the doctor card, the cop card,
the lawyer card, the tv actor card, the movie actress card.
CL, do you get my drift here. People in these organizations play these cards when THEIR organizations are laid open, put on the line
and exposed, “ Oh, we are all soo professional, that kind of stuff dosen’t happen” .
PT
JR,
Trisha Torrey who writes the article that you referenced is a very controversial person to begin with. She bills herself as a patient advocate, yet she lowers the patients' expectations and attempts to keep them as sheep in the medical system. She is the founder of the Alliance of Professional Health Advocates.
Founded in 2009, the Alliance of Professional Health Advocates with 600+ members*, is the largest and most extensive professional and support organization for private, independent patient advocates.
I would suggest that you follow the money.
-- Banterings
You may be a bit harsh, Banterings. Could you pinpoint where Trusha Torrey is controversial, as you put it?
JR
Trisha Torrey wrote a book titled “ you bet your life” . She describes herself as a patient advocate yet she argues against men advocating
for themselves. She has no real world healthcare experience yet she claims to be an expert in patient empowerment. Her contract with
About.com was abruptly cancelled in which she states “ she was kicked to the curb”. Public knowledge on the web.
She engaged in extremely heated arguments with male posters attempting to explain to her that male patients are not afforded privacy
and respectful care. Several female nurses chimed in who obviously were rude and attempted to derail the subject. One of the posters
who goes by “ left Eddie” made some outstanding and remarkable comments that were so eloquent and to the point that had Trisha
Torrey’s panties in a knot and fuming so much so that she closed the comment section.
PT
Not disputing that you're enunciating facts. But I'd love to have a reference to the article so that I could judge for myself.
F68.10
To my knowledge, About.com is no longer on the web although I believe if you use the wayback machine you may be able to view
the debate. Appreciate that Trisha Torrey had a comeback to the first article in which she toned down her position but it was too
late, the damage had been done.
You can’t effectively empower people if you argue with them over facts that you are ignorant about, can you. I wouldn’t be surprised
if after receiving complaints regarding her comments which is what lead to her contract being cancelled.
PT
Found it with the wayback machine.
http://web.archive.org/web/20140413195820/http://patients.about.com/b/2010/06/18/men-medicine-and-modesty-some-fathers-day-advice.htm
Yes. That's a typical lot of female reactions and female lecturing that I personally really cannot fathom and cannot stand. Whenever I read that kind of discourse, I flee and stay miles away from such a person.
Overall, I still do not view her as an ennemy. Rather as a patient advocate that speaks only to a segment of the patient population. Her advice are generally sound, but just not tailored for everyone...
F68.10 et al: You know, I was thinking.. perhaps most all the symptoms and reactions of patients and their families which has been repeatedly described on this thread over the years can be summarized by one etiologic diagnosis: iatrogenesis. The symptoms are not necessarily related to drug errors but due to behavioral errors of potentially any professional participant of the medical profession. JR is, I am sure, attesting to that diagnosis. While laws and courts and politicians might provide a way to prevention, there must be some better way to prophylaxis for this condition. Any new suggestions? ..Maurice.
I believe there is way too much focus and blame placed on drugs. Whether it be pseudoscientific scaremongering about "chemicals" from patients, over whether it be fetishisation of drugs from doctors. The obsession on drugs indeed obfuscates some other very real issues. (Not claiming that drugs are not important tools, far from it).
Whatever the problems in the medical system in the United States the answer is not single payer socialized medicine. I am not sure if some of the posters here advocated that but they seemed to be leaning in that direction. The closest thing to single payer in the U.S. is the VA (Veterans Administration) which has had problems for decades. Either Dateline or 20/20 did a story on the problems in the VA back in the mid 90s. There was a guy on TV a ways back who said that he had to wait 45 days to see a VA doctor. In frustration he finally gave up and saw a regular doctor which he was able to see in just a few days. When you give people free stuff it invariably creates lines. For those of us who are old enough to remember back in the 70s and 80s there were news reports of people in the Soviet Union who had to wait in line for 2 or more blocks to get into a grocery store and even when they got in there was almost nothing there. You hear stories about people in the UK or Australia who had to wait for a year to get an operation and so on. There is no free lunch. We don't need more government oversight. What we need is more transparency in medicine. PA
JR said:
Yes, Dr. B., I mostly agree except there was an error in drugs in that he was given drugs (versed & fentanyl-painkillers) that he stated he had severe side effects with in the past and did not want. They chose to ignore what he said and the result also killed him during his medical assault as they caused the extreme side effects. He does not remember when that happened in particular so even thought it was really bad, he has only read about it when it happened and he survived w/o the knowledge their mistake almost killed him. While something needs to be done about that mistakes, it is the abuse that happened that he remembers and makes him wonder what other abuse happened that he does not remember. It is true the method of how the treatment was delivered during the times he was allowed to have memory of has made this medical encounter what it is--a real nightmare that keeps on recurring. It has really shook both of us to our respective cores why so many awful events happened during this encounter. To me, the answer has been to help bring about change. Normally my husband is a man who suffers silently and goes on about his business but even he has become pro-active. He is starting to tell people who might be able to offer solutions about what happened. He had one such meeting yesterday w/ an attorney who handles elder law that is going to do some research on how best to pursue what happened. She also is going to put me in touch w/ various organizations such as an opiate group as she found it very upsetting that opiates such as fentanyl are given w/o knowledge or consent especially when the patient has already refused such drugs and they fail to note it for whatever reasons. It took a lot to admit he had been a victim of sexual abuse but he did it as I told him I wouldn't talk for him this time. It was up to him to tell his story.
Making a broad statement--I don't know of any laws that can cure the medical field's superior, condescending, patronizing, over-reaching, invasive, sexually abusive, and anything else negative attitudes. I don't think they realize what damage their attitudes have upon people because they see themselves as heroes who save us from death so therefore we must be grateful and follow their orders w/o question. I think the best way is for the patient to have an advocate. Not a paid, professional advocate such as the one we have been talking about who seems to have a definite conflict of interest as she represents healthcare providers too. I mean a family member, friend, or someone else who will be truly be there just for you. I also think the patient should have the option of recording the proceedings. I don't think the facility should have that option if the patient's genital areas are being recorded as that is certainly a lasting invasion of privacy and sometimes recordings have a way of being made public even though they are "securely" stored.
As for the learning process, I don't know. I know from what you have said, you teach about respect. I know nursing covers patient respect and dignity. However, many seem to lose sight of patients are people and start treating them like objects w/ no rights or feelings. So how do you as an educator of medical students think this should be addressed?
Certainly, there needs to be better recourse for patients who have suffered such abuses. The nursing boards and medical boards are primarily there to protect the medical community and to sweep under the rug any wrongdoing. This needs to change. I am sure others on this board have suggestions as they have done way more research than I. I have been so busy just trying not to drown from what happened and to find resolution that I haven't put in the research. My writings are very much from the gut and heart. JR
There are way too much topics in medical ethics to be addressed, and "socialized" medicine is only a small part of the overall picture.
But if you want to argue against it, be my guest, and publish a detailed and argumented rebuttal to the best evidence-based discussion of views opposing your own. I'd suggest this one for starters:
https://www.counterpunch.org/2018/10/12/the-case-for-a-non-profit-single-payer-healthcare-system/
Merely invoking the USSR simply won't cut it as a rebuttal.
(And maybe this blog isn't the perfect place for that specific endeavour).
My view of "iatrogenicity" of the behaviors of professionals and the outcomes to the patients and families as described on this thread is that, in general, the selection and use or misuse of drugs which is the commonly described iatrogenic issue is not the etiology of those outcomes. It is the intended or unintended misuse or misbehavior of the doctor/nurse/chaperone/tech/scribe/shadow.
Iatrogenesis, in the usual context of this blog thread, by generally not being drug related is symptomatically more difficult to relate to a specific etiology, which turns out to be a behavioral cause by the medical system itself.
There are many possible causes of such non-drug related iatrogenesis extending from a primary goal of maintenance of monetary benefit to inadequate time and attention to the patient, to professional ignorance and malfeasance and gross criminality.
So, JR, though on occasion iatrogenesis is expressed through drug erroneous selection or decision for use or frank misuse, the usual use of the term, its basis for use here is one of the causes noted previously.
So now..what is the methodology to prevent such non-drug related iatrogenesis? If, simply professional ignorance is the prevention similar to drug matters--education and/or supervision? Or is this a sociological problem requiring a more complex prevention? ..Maurice.
JR said:
But some drugs are used (versed, benzo, sedatives, etc.) to control the behavior (cooperation, submissiveness, etc.) of patients and their memories or better clarified, to guarantee a lack of memory. It is when these types of drugs are used that gross neglect, abuse, etc. will happen as this leaves a medical provider to carryout treatment in the manner in which they want w/o patient interference. So some drugs are used in a manner in which to better accomplish disrespect and lack of patient dignity. Not always but when you have a provider prone to wanting to harm a patient, the drug is certainly the perfect partner in crime. Years ago mental patients were sedated and abused but supposedly this stopped. Nursing home patients were also sedated and restrained. Supposedly that is no longer allowed. However, for patients undergoing procedures, sedation is almost done. The primary reason for using a drug like versed is to erase memory. Many people are not aware of what versed actually does and the little snippets in the brochures describe it in a totally different way. "You will be awake and you may wear your glasses, hearing aid, etc." They make it sound totally different from what it actually does. Most are in the REM sleep cycle. They may be easily aroused by voice or physical contact. They may be in a sleepwalk state where they may do things they ordinarily wouldn't do. They are submissive, disinhibited, and most likely will remember nothing or little of nothing. Versed is not for pain but is used to erase any pain experienced. But if they are using such a powerful opiate why is there a need to erase pain. So it comes down to versed being used so patients cannot be upset over the manner in which they were treated before, during, and after the procedure. Along w/ the opiate, their cooperation is almost guaranteed so they don't have control but rather the medical staff has control and power. For patients having procedures, these drugs are what gives the medical staff the ability to carry out the lack of respect and dignity that should be the absolute right of every patient. These types of drugs allow for a lot of hospital abuse cases. While it is true that you must have a person willing to commit the abuse, without these drugs it also could be said that some of these evil doers would not commit the abuses if they no longer had a drug partner in crime. Every patient should be fully aware of what drugs are going to be used and full disclosure should be made of what their effects are and what effects the medical provider is looking for it to provide. Every patient should have the right to refuse any drug. It is not the right of a medical provider to overrule a patient about the use of drugs going into their body PERIOD
As for non-drug related iatrogenesis, I think a mixture of more education/supervision (only w/ patient consent as you do but apparently not all do) and better and unbiased studies as to the sociological aspects of why things like described on this blog happens. We know we are only a few as there is more abuse that happens that is not disclosed. First, though they would have to admit there is a problem. So that is the first step. How to get a good, hard look into the secret workings of the medical community? Cont.
JR said: Cont.
For too many years, female medical staff members have been placed on a pedestal. Male patients have yielded power and control to female nurses so naturally they will take advantage of it. Nurses need to recognize that patients are people too. Female nurses need to recognize that they as women want same sex care in ob-gyn wards so keeping that in mind, most men want that same care of dignity and respect. I think the financial aspect of nursing is too attractive and in turn, attracts some that should never be in such a high level of care service for people or really any living being. So for me, it is equally important or more important the nursing/tech staff gets better training. It is almost very important that administrators receive the same education or process in learning about patient respect/dignity. It shouldn't just be something that looks good in a brochure to get someone to come to your hospital where they will actually be abused and violated. It should not be about control, power, and money. Hospitals should belong to the community and not be a big corporation with just the bottom line on their mind. This being said, doctors should go back to a real private practice and not just be part of a hospital's system like they are around here. The hospital corporation offers them too much protection and likeness in their care doctrines. The doctor who assaulted my husband is privately insured by the hospital so he really has no skin in the game. The hospital protects him. In return, he must do as many procedures as he can so they will be satisfied w/ the bottom line. The production line (the nurses and techs) know they are under the gun to do the procedure fast so the drugs make the patient cooperative, unable to defend themselves against exposure (sexual assault) to maybe speeding the process along by a few second, and the patient won’t remember if they were kind or even did what the medical records said they did. The doctor knows he must do procedures if called in whether a patient wants it or not bc someone has to pay for the staff being called in so a patient then becomes the victim of power, control, and money. So reform needs to be from the very top to all the way at the bottom. In most businesses, the customer is always right and supposedly everything is done for customer’s happiness in service so they will return again if they need anything else. However, the medical field is just the opposite. Everything is done for the benefit of the medical community. The patient is only the tool in which is used to be paid by the insurance company or the government. This too needs to change. It is like PT said in an earlier post that "There are bad people in every organization...but in the medical facilities it is quickly and quietly swept under the rug." That is why I think wood floors are great. There is no place for the dirt to hide.
I am not as savvy or eloquent as some on this board are as my ideas are simple. But sometimes the simplest solutions are complicated by overthinking or talking in riddles. Riddles are entertaining for a while but soon wear you out. The medical community speaks in riddles to try to hide the answers they know we won't accept if we knew the clear truth. Just read what their idea of awake during a procedure is. JR
"If, simply professional ignorance is the prevention similar to drug matters--education and/or supervision? Or is this a sociological problem requiring a more complex prevention?"
I think it is simple human nature which is why the problem will probably never be solved short of legislation and court action.
For some this aspect of human nature is their having grown so used to exposed bodies that they fail to recognize necessity vs convenience and/or fail to see the patient as a real person whose perspective as the one being exposed is quite different than theirs. These people have grown numb to the human aspect of their role and/or they have grown lazy and cannot see the patient's needs for privacy/dignity as being more important than their convenience.
For others it is an opportunistic career selection that they would never admit, perhaps not even to themselves. These are the people who chose their careers & specialties for all the wrong reasons. There have been more than a few male GYN physicians who went this route and eventually got caught. At the same time it is a fair question as to what causes female nurses/techs etc to pursue urology careers vs GYN or pediatrics for example.
Many healthcare staff have neither grown numb to the humanity of their patients nor have they chosen careers for the access it gives, but there is no denying that there are some who have.
The last two postings and the many others throughout the 14 years of this thread topic: sad, sad, sad! Now I wonder why did I become a physician and why did my wife become a registered nurse? Why did I waste 30 years of my time helping first and second year medical students move on to such a corrupt and literally inhumane profession?
Maybe, just as TV swallows up the time with drug commercials and the internet provides the cues for self diagnosis and approaches to treatment of the possible disorders, humanity will move on to a world where electronics and computer systems will do the history taking, do the physical examinations, do the procedures as necessary and all will be clean and free of implications of sexual or gender or monetary misbehavior or criminality.
By the way, my grandson has recently started his career into computer engineering. Unfortunately, some day computers will be performing all of their own engineering and if that doesn't include "self-repair", a job for him may still exist.
Looking at all that has been written here over the years, isn't there a large hint of pessimism of humanity, well beyond the matter of human dignity? ..Maurice.
JR said:
Well sure it is a statement. For example, some women get offended when a man opens a door for her because she's strong and self reliant that is until some man lets the door slam in her face. I used to like shopping but anymore I don't bc people, in general, are rude. When I was a kid and I taught my kids not to go into the neighbor's yard w/o permission. Better yet, make sure the ball or whatever doesn't go over there anymore. Nowadays, parents let their kids literally destroy other's yards. They don't watch their kids either. Little kids in big wheels play chicken against real cars. The world is different and maybe not as kind as it was 10 years ago. I see signs in yards that just say, "Be Kind" and I wonder why that even needs to be said but then some idiot does something mean or stupid I wonder no more.
However, that does not excuse the medical care bc it is so personal for everyone who becomes a patient. We are expected to uncover our bodies, thoughts, and everything else. We have things done to us that we don't always understand. Oftentimes, those things lead to additional things needing to be done. We are totally controlled by the medical people and the insurance company. Once you enter into the system, you are no longer an individual but a patient w/ symptoms and a patient record number. You are expected to be exposed for any or all to see w/o resistance. You may be poked and prodded by young students while a more mature dr. looks on. All of this is done while you are ill and would really only like to sleep, mend, and be able to go home to forget about the hospital. We are scared of the system bc we know it is not friendly to us. There is also the added burden of wondering how much is all of what is being done going to cost? Unlike other things in our lives, we get medical care w/o any clear idea of the cost.
However, Dr. B., if good people give up becoming drs. and nurses would that help? No, it would not. How to attract good people and not have them become part of the problem is the biggest puzzle of all. I imagine from what you have said and having this blog, you wanted to make a difference by not only healing as that is only part of it but to give compassionate care and to teach compassionate care. Bc w/o compassionate care that respects patient's rights and dignity, the healing is no good. Listening to what people(patients) have to say is the best instruction of all. As discouraged as I get at times in pursuing justice for my husband, myself, and others who may follow or have been past victims, I will keep doing what I am doing bc I know it matters. It is my hope that someday no one will have to be abused and violated while receiving medical care whether it be in an office, hospital, or nursing home.
One way we can help bring about change is to become organized. The medical lobby is big business and has big money. That is what we need. We need to be organized and raise money to get what we have to say out there. JR
Dr. Bernstein, I have had at least 3 dozen intimate exposure encounters with female staff plus a handful of related encounters in which I inquired about the availability of male staff for intimate procedures.
In 3 of those exposure experiences the female nurses added unsolicited verbal sexual innuendo. For one of them I was rendered unconscious mere seconds later. The rest were totally professional in their demeanor and actions, but with just a few exceptions the protocols they used did not minimize my exposure in the manner that male nurses did for the exact same procedure. After prepping me for cystoscopies, every single female nurse left me exposed no matter how long it took the doctor to come in, and they stayed up close and personal throughout. The male nurses always covered me up while we waited and they busied themselves elsewhere rather than hover right at my waist. One female sonograher fully exposed me for a bladder ultrasound whereas another female sonographer didn't expose me at all for the exact same ultrasound. The female NP that did all of my BCG & Interferon treatments never once made any attempt to not have me exposed from navel to knees while injecting it. She absolutely maintained a professional demeanor and never said anything inappropriate but covering me up a bit was not part of her protocol. The female sonographer that did my testicular ultrasound covered me somewhat with a towel, but exposed me first before putting the towel down. The female nurse that assisted the doctor with my vasectomy never covered me with anything. I was there spread eagle with just a polo shirt and socks on.
Approx. half of my inquiries concerning male staff were received very professionally and the other half met with hostility.
Ignoring the 3 sexual innuendo experiences as outliers, everything else I have experienced, good and bad, is probably the result of female nurses just generally approaching male patients differently than do male nurses, and perhaps more importantly there not being much in the way of standardized protocols as concerns patient exposure. I have no doubt but that the female cystoscopy prep nurses would say they did everything right. It is just that their version of "right" includes leaving their male patients lying there exposed and in their line of sight at all times.
Perhaps I am overly cynical but my experience is such that it just doesn't seem minimizing male patient exposure is much of a priority for female staff. Yes cystoscopy prep involves the direct handling of my penis as did the BCG & Interferon treatments, but it doesn't mean they can't also make an attempt to minimize the extent of visual exposure to that which is necessary.
Most of my experiences are from before I found my voice. I quietly "manned up" and said nothing. Now with female staff I speak up with my expectations before any exposure occurs.
Part 1/2.
"Now I wonder why did I become a physician and why did my wife become a registered nurse? Why did I waste 30 years of my time helping first and second year medical students move on to such a corrupt and literally inhumane profession?"
I hear you, Maurice. And I have to say that you'rr letting your emotions corrupt your judgement. As the son of a physician, and given what happened to me, I have to warn you that you're slipping into a complex delusion very similar to the one I went through. So let me give you some advice and a few hints about myself.
I have been trained in France's top higher education institutions as a pure, hardcore, mathematician. I adhered, when I was younger, to the Union Rationaliste, which is one of France's most rationalist and pro-science association. I never did care much for medicine, but I was unconsciously deeply and naively imbued with values of the Enlightenment and the concept of progress.
I suffered through roughly 30 years of low intensity factitious disorder imposed on another. I won't go into details, but somehow I was conditioned into passivity with the following rationalisation: "my mom's crazy, but that's her nature... I just have to endure her nonsense, and I'll break free later on".
After 30 years of that treatment, I finally blew a fuse, decided that enough nonsense was now decidedly enough. And I decided to ask for my medical records.
When I got hold of them, I was... stunned. There's no other word. I realised that I fundamentally was nothing more than a prisoner in my mother's twisted mind games. My whole life came rushing in memory, with recollection and realisation of everything that she did or said and that was morally wrong.
So I started to try to understand what really happened. How each and every weird obsession of my mother had a translation in medical language that was just in front of my eyes when reading my records. To understand what happened, I spent two years reading medical litterature almost non stop in my free time. I was a rationalist, very well trained academically, and I understood rather well what science is and is not. Things started to click one item at a time, and I was growing horrified day by day.
After two years of constant mindfuck, I finally realised, confusingly, that it was a factitious disorder.
What hurt me the most, paradoxically, was the accusations by health professionals that I was decidedly rabidly anti science. Because of the criticisms and concerns I raised.
At that point, I started seriously questioning my commitment to the values of science and progress, and started becoming a pessimist. I was in roughly the same delusion as you're slipping into: Given my records, I could not see how I could access healthcare I needed (I was very traumatised), and I grew terrified of all authority figures that had let me down, and first and foremost of doctors, whom I now did loath for very complicated reasons.
I lasted 5 years in this psychological no man's land of pessimism. I became a fan of Schopenhauer. It was a way for me to cope with the dissonance of being both a rationalist and a pessimist.
And then one day I rediscovered Spinoza. I subsequently reevaluated my pessimistic worldview, and thought to myself that I had to give medicine a chance, no matter how small it was, to set the record straight and finally break free of the mental cage that my mother constructed around me with her twisted web of medical lies.
I sought "medical care" and brought all my medical records with me. I detailed everything that really happened with the most supporting evidence I could gather.
All that landed me 10 times in a psychiatric hospital. Needless to say, I was not behaving like the average patient... There was no way I could: I made my medical records public. No way I could escape from the consequences of my mother's lies.
Part 2/2
I sought "medical care" and brought all my medical records with me. I detailed everything that really happened with the most supporting evidence I could gather.
All that landed me 10 times in a psychiatric hospital. Needless to say, I was not behaving like the average patient... There was no way I could: I made my medical records public. No way I could escape from the consequences of my mother's lies.
I also unsurprisingly was not satisfied with the medical care there. I was the most difficult patient you could ever imagine. And I was repeatedly brutalised.
At that point, I snapped. And for the first time in my life, I punched a medical worker in the face.
The next day, I quit my job saying I could not bear my personal situation any more. (Yes, I had been holding a job through all that medical ordeal, as incredible as that may sound). I spent one to two years barely leaving my bed, slowly burning away my savings. I purposefully let my health dwindle, both psychologically and physically.
During these two catatonic years, the only thing I really did was reflect on how a situation like mine could be prevented. And as bleak as it may sound, the only solution I came up with is to relentlessly push science and rationality in the criticism of healthcare. There's indeed a lot to be done to fix the system, but it must be done methodologically, by relentlessly documenting and exposing the flaws that exist in healthcare as well as the biases of healthcare professionals that keep these flaws hidden from public sight and from themselves. That thought kept me "sane".
Ivan Illich had an insight into this matter. The way he argued it made him a 1970 ubercranck. We now have to look back, and fact check whether his predictions came true. And yes, they did.
The goal now is to trace a path forward so that these kind of considerations, even if not accepted, won't be shrugged under the carpet with accusations of being cranks. To achieve that, we have to be more rational and evidence based than medical research itself. It's doable. By intelligently picking our battles. And that does include promoting medical sociology as a scientific discipline.
What you have stumbled upon, after all these years, Maurice, is that the medical establishment has the same kind of risk/benefit analysis as Dostoievsky's Grand Inquisitor. Read it:
http://www.gutenberg.org/files/8578/8578-h/8578-h.htm
You're now not really different from this character, and you have to find a constructive way forward. So let me tell you: what you are doing on this blog is great. Whatever you and your wife did in the past that you may regret, you did it for a good reason, and you can hardly be blamed for that, nor should you blame yourself. What matters is the path you will take from now on.
The path I'll take will likely be back to university as I now have a score to settle scientifically with doctors. And I now know how to do it.
Moreover, it makes my daughter proud.
Make your grandson proud.
Pessimism is intellectually a satisfying construct. But it's not worth it. Progress can happen.
Maurice
I’m glad for your Grandson, I’m sure he will have a prosperous life and I wish him well. Regarding the content of this blog Please stop
beating yourself up! None of this is your fault, you didn’t do or cause any of it. If I continue to read about you questioning why you
became a physician it’s just going to make me sick at which point I’ll start throwing up. You did nothing wrong.
Now, I just didn’t roll onto this blog by accident after what? 11 or 12 years ago. I most likely wouldnt think too much if I had a few events
of questionable behavior by medical staff, but Damn, I’ve had more than 10 events of very unprofessional behavior by nursing staff and
2 events that I would describe as sexual assault towards me. On top of that I’ve worked in healthcare for over 40 years and seen ugly
behavior done to other patients.
I did complain once about 30 years ago but I think my complaint fell on deaf ears, but today times are very very different. I believe I’ve
found a voice and have a much broader idea on how to complain and voice concerns which I believe this blog has helped me in that
regard. Healthcare is very expensive! Those who work in healthcare make a very good living, I know, I made a very good living for
many years, so why should patients have to be subjected to this kind of BullSh&t.
I don’t know everyone’s story who comes here and maybe I don’t want to know because it’s painful. We know when we are treated
decently and we know when we are not. There are some things I’m willing to let slide but when it happens over and over you just
get sick of it. There should be no single phrase as “ man up”. That in itself is discriminatory towards male patients. You never read
where women are expected to “ woman up”.
I have never set the rules that nurses abide by at State boards of nursing. They set those rules and those rules were approved by
them within their organization. I’ll use Biker as an example during his cysto and that he stated that he was appropriately draped when
male assistants tended to him but was left exposed inappropriately when female staff tended to him. State nursing boards state that
inappropriate draping by nursing is considered sexual misconduct.
This is what’s written by State boards of nursing. Leaving a patient unnecessarily exposed and inappropriately draped is considered
sexual misconduct. So how many nurses are guilty of this? What further are the State nursing boards disposition on this. Further
more watching a patient change their clothing into a gown and vice versa when the patient does not need assistance is also
considered sexual assault by StTe nursing boards.
PT
F68.10, JR, Biker, PT and all the others who have written their experiences and views on the subjects of this thread, I appreciate your contributions. I want to tell F68.10 specifically that I haven't given up on the role of the profession of medicine in all our lives. I also, from the very beginning of this thread, even though there has been full anonymity of the writers, I never expressed any doubt about the validity of the writers' presentations even though I expressed my opinion regarding them as "statistical outliers" (but never meaning that they were "liars" in what they wrote about their experiences.) I empathize with all of you despite not personally experiencing what all of the writers here have observed or experienced.
Certainly F68.10, I was encouraged to read about your upcoming "path", hopefully with some resolution of your symptoms and contribution to the betterment of others who suffer from factitious illness either spontaneous or initiated "by proxy".
To all, thanks for your continued contributions and a repeat thanks to Banterings who initiated the worthy change in our thread title. I wonder if F68.10 would have joined to contribute if the title remained only "Patient Modesty". ..Maurice.
Curious about the mental ward?
Psychiatric hospital is the place where mental patients get treatment of their mental problems. You should know about the psychiatric hospitls in detail.
OK..here is my request to my regular visitors who are aware of the orientation, content and non-commercial content of this thread and the blog itself. Read the Comment and links associated with today's posting here by Shivank Agrawai (above) and let me know whether you think the material presented in the associated links is pertinent to what is being discussed on Patient Modesty, constructive, pertinent and essentially non-commercial. If the consensus is that it is NOT then I plan to delete the posting. What does this posting and its links tell us constructively about, for example, the issues of mental illness, treatment in a realistic and truely educative and non-commercial fashion.
I think in our type of non-commercial and hopefully aiming for a supportive and constructive blog, those who are regularly participating should have some say in its content. So follow the links in that piece and come to some conclusion. ..Maurice.
Well, concerning that post, I must say that I'm not surprised. It's "not even wrong". It simply is the age-old semi-truths and platitudes. I'm not the one who's going to discourage people to get mental health treatment, but I know psych wards inside out, and I can simply state that this post doesn't give the full story about psych wards. As to removing that post, I do not really care either way. I'd advise to keep it there, to make the point that we're not anti-psych bigots. We can tolerate some little "pollution" once in a while. If we get inundated with these to the point that we cannot further discussion, then action may be in order. I'd advise to keep it, even if it may offend some readers. After all, who knows, someone may benefit from that advice.
I do not personally care much about patient modesty. But I do care that other people care. So I perhaps would have contributed ti thus thread.
(If anyone is offended that I comment too much, please tell me, and I'll slow down).
This may be a bit "off topic" but maybe it isn't. Read the relatively current professional article about both men and women who are performing their own "intimate body piercing", an activity fraught with potential complications requiring inspection and treatment by physicians. Wouldn't this activity be a "no no" or it is not a modesty in medical practice issue since those patients who perform this activity on themselves probably do not have "intimate organ modesty" unlike those writing to this thread. ..Maurice.
JR said:
When I have written about my husband's experience, I have spoken about unnecessary genital exposure. There is a difference when the exam is necessary and done in a respectful and dignified manner. What my husband suffered was sexual abuse as there was no need for genital exposure and certainly prolonged exposure. They were doing a heart cath w/o a foley cath so there was no need for the exposure. He was even given a gown or a sheet and was not allowed to remove his own clothes. As he has had prostate cancer, he thought nothing about the doctor having access to his genital area or even during prep bc they did it in a respectful manner and the aftercare was delivered in the same respectful manner. Since they are doing self piercings, I would imagine they may be a bit modest to start with and don't want someone else to have the prolonged contact. However, if there is an issue they should realize the genital area will need to be examined but it should be done in a respectful, dignified manner and they should not be treated as a freak show at the medical facility.
I have said, I don't like the term modesty as it doesn't correctly identify the real issue. Everyone whether they be modest or not should be treated w/ personal dignity and respect. We wear clothing to cover so evidently humans are meant to keep certain areas covered. It is our right as free humans to be able to choose who sees those areas and who don't. If females want only female medical staff, then that should be honored. But it is important if a male only wants a male staff, then that should be honored. In any case, exposure should be kept limited and only when necessary no matter what. Doctors like being called Dr. So&So as they think it shows respect. Why is it such an outlandish idea that patients shouldn't be exposed unnecessarily to show common respect and dignity to another human being. Also, doctors should address their patients by Mr. Smith, Mrs. Smith to show their respect to their customer. I think addressing patients by their first names in the first step in the slippery slope of disrespect. The addressing of patients by their first names and doctors by their title sets in motion a relationship order that makes the patient inferior to the doctor. It also implies a feeling of familiarity that really doesn't exist.
As for the commercial post, it is really more of a pest interference rather than anything else. He probably just trolls for possible advertising spots. What he had to say wasn't important to what we do or say on this board. If he keeps it up, then by all means, shut him down if he is not contributing to what this board covers. JR
Dr. Bernstein, the "mental hospital" posting does not seem related to anything discussed here. It is inherent on the poster to make the connection to modesty/dignity which he did not do.
The body/genital piercing folks might not have much physical modesty but that would not preclude their still having an expectation of being treated in a dignified fashion in a healthcare setting. If members of the LGBT community have historically been treated badly by some in the healthcare industry, it is not much of a stretch to think people with body/genital piercings might be judged harshly and/or treated badly by some of the healthcare staff.
PT, the difference between the male & female nurses for cysto prep is not the actual prep but rather what they do when they are done. The males cover me with a towel while we wait for the doctor, but none of the female nurses have ever done that.
The larger issue here is that the healthcare system has allowed each staff member considerable leeway to define for themselves what constitutes proper protocols as concerns patient exposure. I mean if the accepted protocol for bladder ultrasounds ranges from full exposure before a towel is placed to no exposure at all with just the pants unbuckled and scootched down slightly, State Nursing Boards are hardly going to quibble over whether a man is left exposed or not during that interim waiting period for the doctor to come in and do a cysto.
Relative to the discussions on this blog thread, is genital or breast piercing a sign to the observer of the individual's expression of self-dignity? ..Maurice.
JR, please feel free to use any term such as hag on your blog, which I have read and hope many also read. You are doing an excellent service for humanity. I myself had a very negative experience (to put it euphemistically) at a local, small hospital run by a massive “health” care organization, this one based in Texas. As a boomer, I learned the hard way that I share a health concern that affects over 50% of the population over 65 (diverticula, and some 15-20% of said individuals go on to develop diverticulitis ,an infection of these small pouches, usually in the large intestine). After a week of unrelenting pain and bleeding, I went to a local urgent care, which sent me to the local ER. It is “interesting” to note that said ER triage left a senior with severe pain and rectal bleeding in the waiting room for most of the night, while mild problems such as a hand wound in a 20 year old that needed stitching were seen before me; however, seniors are seen as expendable by our current system of abuse. By the time I got a cubicle, I was severely dehydrated and almost unable to walk. I have never experienced such an intense level of pain; it was off the scale. So, I got some nursing hag that kept trying to get an IV in, but, they had left me to dehydrate whilst others in the waiting room with less severe issues were seen. So, this particular heifer had, it seems, NO critical thinking skills – nor compassion. Take an 60 something individual that hadn’t eaten for 24+ hours, and couldn’t even drink water without bringing on on the floor in fetal position, can’t even moan because the of intense pain kind of pain, and then try over and over again with a large needle to get in an IV! Finally, the moron hag got the brilliant idea of using a smaller needle, and the IV went in, not to hydrate, but as a port for the CAT scan tech to insert the iodine contrast medium. I was in much distress, from severe pain, a week of this, and blood loss, as well as hunger and thirst. What really pissed me off later (I was in too much pain to say anything at the time, as many people are that find themselves at the mercy of the makemsick industry), was that EVERY TIME that hag inserted the large needle, I moaned or cried out at the pain, and, get this – THE HAG CHIDED ME, STERNLY INFORMING ME THAT MY PAIN COULDN’T BE THAT BAD! Basically, the hag told me to shut up!
EO cont.
To add insult to injury, being underinsured, I was charged $7,400 for being abused and permanently injured! I looked up the costs and both private insurance and Medicare/Medicaid pay some $1250 for the ER visit and CAT scan, etc. So, after going through 6 months of torture via the CFPB (Consumer Financial Protection Bureau) as an intermediary, first with numerous nasty, threatening letters from the hospital and then their headquarters, oh, we made a mistake, your bill is now $1250! This “health” care organization tried to frighten and extort funds from me which were not due. This sort of CRAP happens every second here in the good ole fascist states of america, the last tired gasp of the ugly imperialistic violence which was the British Empire…
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.
Do we own our bodies, or does the State? The Ministry of Truth is hard at work trying to force medical procedures (not just vaccines, but medical kidnapping, mainly to kill children with cancer with chemotherapy, but oh the profits!!!) upon the populace. I believe the blog here had some discussion of medical kidnapping, which seems now to focus on unvaccinated children and their parents, a new type of terrorist tactic, going so far to break down doors and remove children from their parents’ care. The Ministry of Truth is running a bit scared, as Italy has joined Sweden in banning mandatory vaccines. I won’t bore anyone with this black heart of the makemsick industry, for if individuals do not understand what is really happening here in the US, that we are being groomed to accept ANY medical procedure, then the terrorism which will eventually knock on their door will be a nice twist of karma! What’s to prevent laws being passed that require we take pharmaceuticals and endure medical procedures deemed “for the greater good?” Freedom is lost in small steps, so as not to awaken los sheeple. Reader, if you live in New York state, Assemblyman Burke has introduced a bill that would automatically list everyone 18 and older with a driver’s license as an organ donor – one would have to opt out. Gee, nothing could go wrong here, considering how compassionate and efficient the makemsick industry is!
Connect the dots, for they are as wide as the Hiroshima crater and just as bloody. THIS IS WAR, and who will win, The Ministry of Truth and its thugs in the makemsick industry, or will freedom prevail and we will maintain the right to own our bodies, and to protect our children from private companies pushing poisons? For both the Ministry of Truth and the makemsick industry, we are all just pork bellies to control and profit from. JR’s horrendous story is a superb example of the thuggish mentality, arrogance, ignorance, and sexual proclivities of the makemsick industry. I don’t believe I will ever visit another ER; I’d rather die at home than be abused!
EO
Unless we have more evidence of what genital pearcings mean to people, we have to tentatively take people word at face value.
https://cora.life/blogs/day-one/jeweled-for-her-pleasure-genital-piercings
Quote:
"But for many women (including myself), genital piercings are about more than just better sex. They are also a powerful symbol of owning your body and your sexuality. Indeed, women around the world have reported that their intimate piercings have enhanced their self-esteem and sexual confidence. One woman states that after she got her nipples pierced, she “felt pretty invincible.” Another reveals that her genital piercing was a “declaration of independence, and freedom of expression, regardless of what anyone [else] thinks.” Still another regards her intimate jewelry as a way of “honoring [her] sexuality.”
I feel similarly. In a time when women are still made to feel ashamed of their bodies and of their desires, piercing your private parts feels like an act of rebellion, a small, personal “fuck you” to the patriarchy. Choosing to bejewel my vagina was for me and only me -- an homage to my body and to my femininity. It represents a beautiful, sexy secret that no one knows about -- unless I choose to reveal it."
It seems it's mostly a sign to themselves rather than a sign to an observer.
I've always thought the real reason anybody gets piercing or tatoos on butts or private parts is so they can show them off. Nobody that is modest is likely to do it.
Biker
I’m aware the prep for a cysto but the exposure aspect of it should be reported to the Bon. If the female nurses do not cover you as the
males do then it’s called lack of draping, wether you wait 5 minutes or 35 minutes. The board of nursing has an obligation to adequately
investigate and follow up on every patient complaint. It is the bon that outlines the standards for appropriate care as delivered by your
physicians nurses. If you complained to your physician that the draping process differs from the females nurses versus the male nurses
it is also his responsibility to ensure appropriate professional care was delivered wether the cysto was performed in his office, an out
patient facility or the hospital. Personally, I think it bizarre and reprehensible that you have female nurses that dont properly drape you
with a sterile towel to preserve the sterile field yet the male nurses do. I would have reported that behavior immediately and sounds like
a gender discrimination issue, disturbing on many levels.
PT
Biker
Another thing, considering what that cysto cost which by the way is $$ thousands of dollars, how much does 1 little sterile towel
cost. I know the answer but I won’t tell you because it will really upset you. You see, healthcare in this country costs 6 times more
than what it did 40 years ago! That female nurse is making a very good salary but not enough to take 5 seconds to preserve the
sterile field and show respectful care to the patient she is advocating for. You were paying her salary and the physicians salary
but that dosen’t matter to them. You were just their 10 o’clock appointment. They have plenty of sterile towels, I know they do, but
none for you.
PT
We have reached 177 Comments on Volume 97. NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME BUT COMMENTS CAN CONTINUE ON VOLUME 98
. ..Maurice.
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