Preserving Patient Dignity (Formerly: Patient Modesty):Volume 103
There is no doubt that, in these modern times of medical system-patient interaction where we have taken away autonomy from the medical system and delivered it to the patient while scrubbing off the eons-long paternalism, a previous hallmark behavior of the physician and the medical system, we face clinical interactions, reported many such clinical interactions and behaviors, that tend to diminish this decision for this switch of "who is the decider". Some of this unethical "switchover" is based on medical professional "monetary greed" and some nationally publicized or otherwise patient-experienced based on sexual or other self-interest "greed" or just plain ignorance of ethical professional behavior. So, currently, here in America and perhaps to various extents in other countries, those of us, active or potentially future patients who believe in ethical medical professional behavior should see these professional misbehaviors or "worse'' and should require action started now to contribute to make changes in the medical system to prevent destruction of the inherent dignity properties of all patients. The methodology to promote and make these changes should continue to be the goal for discussion here. Yes, "ventilation" of one's past noxious experiences may be personally therapeutic from an emotional point of view but unless the discussion includes approaches to prevent these traumas from recurring (GETTING RID OF THE BAD APPLES AND BAD APPLE BEHAVIOR) should be the goal of this blog thread. ..Maurice.
Graphic: From Google Images
NOTICE: NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME BUT CAN BE CONTINUED ON VOLUME 104.
posted by Maurice Bernstein, M.D. @ 10:12:00 AM
171 comments
171 Comments:
On the other hand, maybe it's not the apples (medical professionals) themselves but the boxes (the behavior of the medical system itself) which holds them. In that analogy, you may be interested in reading my blog thread from October 29 2006 and a poem I wrote after photographing a pile of old apple boxes: "Growing Old"
Maybe that is a valid analogy to what is happening to the medical system (boxes) holding their professionals (apples). And we should be looking primarily to the boxes for repair.
Anyone want to challenge this analogy? ..Maurice.
Maurice,
The article you referenced, Canary in a Coal Mine, Dr. Cathleen Greenberg London states:
Physicians need to develop strategies to protect each other on social media. ...
Her solution is the white wall.
It is amazing that we need to do a study on patient dignity in 2017. As I have stated , the profession is infested with sociopaths that have no concern of patient (human) dignity.
PT,
In Iran, if a patient files a complaint, the provider gets executed...
We should have that same process here.
-- Banterings
Hello,
Could the encouragement of patient dignity/modesty be incorporated as a subset of shared decision-making (SDM)? With their shared decision-making patients could indicate that I want my dignity protected, my genitals covered at all times, etc., etc. Could this be a first step in Preserving Patient Dignity. The following is a comment from Realizing Shared Decision-Making in Practice
https://jamanetwork.com/journals/jama/fullarticle/2740056.
"Shared Decision Making, To The Extent That Patients Desire, Should be Routine and Not an Add-on
Andy Tan, PhD, MPH, MBA, MBBS | Dana-Farber Cancer Institute
The suggestion in this Viewpoint that SDM should be prioritized for certain decisions and not others could be an impediment to realizing SDM in routine clinical practice rather than enhancing the practice of SDM. We need to create the normative expectation that offering SDM, to the extent that patients desire, is simply part and parcel of routine care, just as widely as we use the SOAP note (Subjective, Objective, Assessment, and Plan) to document history, signs, findings, and care. SDM should not be something special, optional, or an additional burden to the responsibilities of clinicians and providers. It is well within their duty of care owed to their patients to ensure that patients are involved in decisions about their care, as much as they wish to be involved, bringing together both clinicians' expertise of evidence-based care and patients' expertise of their own bodies as co-equal partners. Medical, nursing, PA and health professional training and also continuing education and accreditation could ensure that SDM is taught, assessed, and reinforced just as all other clinical skills are treated. By embedding SDM as a routine skill that is expected of all clinicians and providers, we will have a higher likelihood of achieving "No decision about me, without me" as the norm rather than the exception."
The UK is incorporating this "No decision about me, without me" as a national health care cultural change. Please see
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf.
Maybe cultural change Preserving Patient Dignity is actually possible, even in the near future.
Reginald
Reginald, "shared decision making" is exactly what is needed and, to me, that means discussing alternate approaches for up coming treatment including surgery with physicians and "shared decision making" with nursing staff regarding toilet use or cleansing of the patient's body. Each side should have the opportunity to present their view or their concerns or their facts.
Such "shared decision making", of course may not be possible in an emergency situation where the patient is unconscious. But this is where an advance directive or POLST document or presence of a knowing surrogate if available, can help in such "sharing".
"Sharing" means communication in both directions, the patient expressing their original technical understanding, concerns and desires and the professional presenting the facts or clinical or institutional procedures. "Shared decision making" takes a bit of time and, if no emergency, taking the necessary time should be an important component of "shared decision making".
PT, I look specifically to you with your great institutional practice knowledge. Do you think that "shared decision making" is or would be acceptable by administration and its employees? ..Maurice.
An area of medical practice regarding the need for preservation of patient dignity is the role of the patient in medical research, both receiving the drug/clinical procedure or practice under experiment or the other patient receiving the placebo, inactive drug or "simulated but not the actual procedure".
The ethical and clinical issue is not so much related to "shared decision making" (asking the patient to decide whether to be the recipient of the drug or procedure vs being subjected to the placebo treatment including the "simulated" procedure.) It boils down to "how much should the patient who is presented with the opportunity to be a research subject be told about the research especially since the results are still unknown, even to the researcher. And, in addition, the physician or researcher offering the patient the opportunity to participate may not be the one to select the patient as the recipient or the control subject.
Read the 2015 article written to the Health and Human Rights Journal whose title is "Setting a Minimum Standard of Care in Clinical Trials: Human Rights and Bioethics as Complementary Frameworks".
In this matter of professional to patient communication there may be no true "shared decision making" except "do you want to be a research subject without full awareness of which treatment you will receive?" since the professional making the offer may not, in advance, have that awareness. ..Maurice.
I’ll put my vote in for continuing this blog. If nothing else, it is of help to those who have been abused by the makemsick industry and need somewhere to tell their story, and/or to read the stories of others who have suffered. I believe some regular contributors have mentioned that this blog helped them to know their rights, and to find their voice in standing up to makemsick minions hell bent on their sociopathic yellow brick road of power, control, and greed. And, the new title, “"Establishing (or Maintaining) Patient Dignity (Formerly:Patient Modesty)” might be an apt one if the industry wasn’t chock full of sociopaths. Thus, I agree with Banterings:“Changing the name of this thread to "SEEK SOLUTIONS the dismal failure of the profession of medicine's treatment of patients. It acknowledges that MOST physicians and other providers still espouse the morals and conscience and operate in a slightly better manner than those physicians who ran the Nazi concentration camps.” I couldn’t agree more that today’s physicians and lesser minions operate at a slightly higher level than those experimenting upon Jews, Gypsies, Catholics, those deemed too handicapped to be kept alive, and so forth.
I also agree with this, and sorry can’t recall who first penned it here (Banterings ?): “We are not the outliers, this is business as usual. The profession of medicine is a dismal failure.” Indeed it is. And as JF tells us overcharging is stealing. Yeah, and PT you’re right about Tenant being more like a ruthless venture capitalist. I guess overcharging sick customers by 1200% is biz as usual. And, BTW, JF, I love your fantasy stories of revenge. I have some such, but they are too violent (or proprietary) to be put here. Instead, let’s DO SOMETHING FOR REAL, as Maurice keeps saying. My FOR REAL is a process of getting rid of providers such as the one that turned a friend into a guinea pig in front of 4 females for a genital/rectal lesson!!! That N quack is going down! By the time I’m done, she’ll be lucky to get a job picking up dog shit in Chula Vista! We all must do what is necessary, and whatever can be done at this point of corruption, sexual abuse, and potentially fatal, over drugging by makemsick minions, such as was done to JR’s husband – CRIMINAL! And these sociopaths think we should trust them? JR, I support you in anything you may say about the criminal actions carried out against your husband and yourself at the Catholic abattoir. Jealousy? Absolutely not! Keep letting everyone know how nursing hags routinely rape and ridicule male customers – hell, it’s their stock in trade!
JR, you are correct that your son more than likely developed diabetes from vaccines. This has been documented for over a quarter century (for example, Harris Coulter was writing of the vaccine/diabetes connection decades ago). But apparently pedillers and others of like ilk can’t read; they read the words, but cannot understand the meanings behind them. This perfectly actuates with their anywhere from devious to blatant disregard for customer, i. e., HUMAN rights. These people, like many of our youth damaged from vaccines, are alliterate - they can read, but don’t really understand the content. This equates with their morals – they are amoral, they don’t feel guilt or shame or any other normal human emotion after damaging customers, but stay on their high horse of greed, power, and control. These are the creatures that are being churned out by New China’s “medical” schools. These little monkeys are great at memorizing, but have not the ability to think critically. This non ability is, of course, is foundational to being admitted to med school!
EO cont.
JR, as you are an educator and possess research skills, I urge you to research natural methods of not only controlling but entirely reversing both types of diabetes. It is being done with great success, with alternative, i.e., non Big Brother, non allopathic, non poisonous methods of healing! If your son is taking Pharma drugs for diabetes, he is at risk for much greater ill, as the useless FDA is now investigating links (after decades of harming/killing customers) between diabetes drugs that are DDP-4 inhibitors and pre-cancerous changes to the pancreas. Additionally, previous studies have also indicated a connection to thyroid, colon, melanoma, and prostate cancer. But we see how this sort of deception plays out in the makemsick industry – one physician will make bucks writing deathly pharma scripts while his/her colleague will make bank off the cancers and other ills initiated by pharma poisons. It’s a great vertical business model!!!
As I noted before, we have discussed that drug studies are fraudulent and that physicians seem to be entirely ignorant of this fact. But, aside from trauma care (also rife with human right abuses) writing scripts is about all most of them can do. Super hyped “screening” tests do more harm than good: for example, “enhanced” MRIs deposit the heavy metal gadolinium in brain, bones, organs; the great prostate hoax has ruined countless men’s’ lives, and one of the newest cats out of bag is that chemotherapy causes cancer in healthy cells. (Oh, but let’s continue to allow our masters to kidnap children and subject them to chemotherapy!) EBM (Evidence Based Medicine) is essentially a scam as it relies on fraudulent studies. As I noted previously, John Ioannidis’ 2005 article “Why Most Published Research Findings Are False” shows intentional fraud behind pharmaceutical “research” (choke) and how the public and physicians have been hoodwinked into believing that dangerous drugs/devices are the solution for just about every ill, and that for the most part these drugs are safe, or, at least better than the “disease” they are supposedly managing (never curing of course, for it is foundational to profit that people remain ill). We’ve seen that the makemsick industry is founded on the principle of poisoning as a path to “health,” and it is a vicious monopoly that actually attacks, mainly in the legal arena, those who practice other forms of medicine. The report entitled “Death by Medicine” by Gary Null, Ph.D., PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD, explains how our medical system is the leading cause of death and injury, and this review is 15 years old!
However, to really understand the medical monster that passes as “health” care one must return to the roots of the allopathic scam, as noted in above literature: “Basically, the “fortunes of Carnegie, Morgan and Rockefeller financed surgery, radiation and synthetic drugs. They were to become the economic foundations of the new medical economy…The takeover of the medical industry was accomplished by the takeover of the medical schools…The doctors from that point forward in history would be taught pharmaceutical drugs. All of the great teaching institutions in America were captured by the pharmaceutical interests in this fashion, and it’s amazing how little money it really took to do it.”
Now, so many parents of vaccine injured/dead children are speaking up, even showing up at town halls and so forth and are being SILENCED. As I noted previously, the masters of New China HAVE CHANGED ALGORITHMS SO AS TO MAKE IT VERY DIFFICULT TO ACCESS NOT JUST TRUTH ABOUT THE DEATHS AND INJURIES PRODUCED BY THE VACCINE CULT, BUT WEBSITES THAT CARRY INFORMATION ON OTHER METHODS OF HEALTH MAINTENANCE, ESPECIALLY AS RELATES TO NATURAL SUBSTANCES AND LIFE STYLE CHANGES THAT PROMOTE HEALTH WITHOUT PHARMA POISONS. Let’s just take statins and stents, for instance, HUGE profit machines, that destroy the body in precisely the way they are supposed to help it – all LIES, LIES, LIES TO SELL YET MORE POISONS AND DANGEROUS PROCEDURES.
With the censorship of the internet in New China, we have entered a new era of a systematic erosion of our civil liberties as espoused in the Bill of Rights, part of that formerly known as the US’s Constitution. Our masters are telling us in no uncertain terms that the Constitution and Bill of Rights is not worth the paper it is written on!
Per usual, EO bringing you updates on New China and the fascist policies enacted by our masters and readily available to Boobus Americanus in the makemsick industry. Now, why in the hell would anyone care about respecting the rights of one half of New China’s population, i.e., males, when they are so busy making customers sick for life? I will repeat myself – forced vaccination is the spearhead of medical tyranny and watch out for waking up on the operating table as your organs are being harvested for a “more productive worker.” What a paradise…
EO, but..without a medical system.. then what? Home remedies and peritoneal dialysis by the patient at home (who created the dialysis system?) and oh! Google a disease or confer with your next door neighbor over the fence but then what? We need some medical system but we also need that system to preserve the patient's intrinsic dignity as it attempts to return and preserve the patient's good health. ..Maurice.
PLEASE, PLEASE.. EO AND EVERY CONTRIBUTOR TO THIS BLOG THREAD..PLEASE BE SURE THAT EACH SEPARATE POSTING IS IDENTIFIED BY YOUR PSEUDONYM AT THE END OF THE POSTING IF YOU ARE NOT IDENTIFIED BY THE BLOG SYSTEM AT THE ONSET. ..Maurice.
Okay, I'll bite. Some sort of medical system is needed but the present one can't be used as it's founded on false principles. If the foundation of a building is rotten and said building is full of mold/rot/vermin (most makemsick minions) then it must be burned to the ground and built from scratch. A new medical model would involve real healing based on non poisonous methods. No, one can't do one's own kidney dialysis but looking at the broader picture much kidney disease is caused by allopathic drugs, so, one has to really look at the root causes of illness in the later 20th and now the 21st centuries. You stated previously that we should do our due diligence and research as regards our own health issues and thus be prepared for what we may meet in a clinical setting. I wish I had done that before I took cipro and flagyl and ruined my eyesight. I am getting a refraction on the 7th and will let all know if eyes are better and the alternative method I am using, which I plan to expand.
We must also consider that censorship of the internet is being done precisely because people are waking up and seeing the great harms done by vaccines; now 54% of New China children have debilitating diseases ranging from autoimmune, cancer, autism and other neurological disorders. Our masters are fearful of New China citizens accessing true information and as far as possible, avoiding the makemsick industry. Anything mandated medical drug or procedure is fascism, is terrorism, and the asinine show btn republithugs and demobleeds is naught but smoke and mirrors for the masses. Recall, the CDC has the legal authority to kidnap, imprison wout counsel, and force procedures and vaccines upon one, including use of electronic monitoring afterwards. I can only hope climate change burns this fascist, violent, authoritarian nightmare to the ground! I see no other way, as most citizens of New China are fearful of real information and yeah, it's scary what is really going down! It's just so much easier to remain in ignorance, at least until they knock on one's door in the middle of the night!
Yes, I have gotten much valid and useful health info from the web and of course I rigorously check references and so on, as there is so much tyrannical BABBLE out there.
I hope you are feeling better and again I thank you for having the tenacity and courage to run this blog over so many years.
EO
Maurice, thanks for letting me and others vent. However, by some of your responses lately I’m pretty sure that you have not experienced dreadful, life changing medical errors/abuse as some of have, so it is difficult for you to comprehend the level of our anger. And, you’ve been in the industry for your entire adult life. Rick, JR, I, and others have psychological and/or physical damage that will last our lifetimes. Yes, some of us are using that anger to spur change in whatever way we can, and as an artist I hope my next project can reach, not just thousands, but millions of people as to subjects we have covered. A child’s life destroyed and ruined eyesight makes me angry, as well a plethora of other medical error and abuse not just for myself but family and friends. You see, the makemsick industry is batting real low in my experience. I’d say at least 3/4s of encounters have ended in negative results, some minor, others major. We keep our anger
close, closer than our enemies, to provide energy to keep up the fight!
Today, I reviewed some major, dangerous flaws of the makemsick industry that I had noted before because it must be understood that the industry ‘s very foundation is based on a false model of healing, i.e., that poisons will lead to health. Don’t worry, I won’t go over those points again (and any lighted environment/surface, even a computer is a b*&%h on the eye with cataracts), suffice it to say that at least I am trying to do a little to educate whatever readers are out there as to the foundational, duplicitous nature of what passes for medicine in New China. When Rockefeller and like pathologicals built up the allopathic medical model, they were also building the beginnings of Big Oil and Big Ag, which today are threatening not just the health of all carbon based life forms, but the entire globe as we know it. If one explores agriculture in New China, one sees it is essentially the same as Big Makemsick and Big Oil – greed, control, and power are the true “core values.”
You mentioned sarcastically chatting with a neighbor or using google for health information. But, with massive censorship that promotes allopathic goals, and seeks to hide all other health information and seeks to silence all other voices but its own in the cyber world, which is the new marketplace, the google reference is meaningless. I’ve had trouble tracking certain subjects down, and I am a bull dog when it comes to that. I’ve noticed the circuitous and changed routes I’ve had to take to track certain info that previously I could bring up in seconds.
Censorship is a primary tool of tyrants, and I hate the makemsick industry not only for the great damage it does to so many lives, but for its support of censorship and loss of informed consent. I find it terribly ironic that an arena that is supposed to heal in essence does the opposite. All the makemsick morons stating that they will exert a presence on social media to counter “misinformation,” are protecting their bottom line and care nothing for the pork bellies they poison. Like other boomers with a mind not altered by pharma poison, I will also say that I am glad that I will be out of here before it gets too much worse. No chips for me! Another week in New China, another shooting, with one of the three victims a 6 year boy, just starting his life. Here’s one for you, readers. How many mass shooters were vaccinated, had brain inflammation, and subsequently were put on psychiatric drugs?
So, thanks again Maurice, for letting us not just vent, but put some useful info out there in New China! Let's hope some sheeples wander this way. I can certainly say that most of the parents in my group were sheeples before they lost a child to vaccines, but now they are warriors. We will not back down. Make no mistake, reader, this is a war.
EO
Shared decision making is touted as the pinnacle of patient centered care. Patients have always shared in the decision making process, thats what you call dnr, non-teach etc. Patient centered care is just another fancy phrase, think about it. Who else besides the patient is getting the care.
The question is how does this subject matter fit into the equation. Now if you want to get technical it’s the female patients who for the most part have always had access to the concept of patient centered care, if there is such a thing. If you want my opinion the healthcare industry evolves on the basis to some degree with the current political correctness.
Political correctness is the driving force for the outside image of the healthcare industry, accommodating more to the gay community as well as race. Although there has been some kickback when patients don’t want a black nurse caring for them. Yet nothing is ever challenged when females ask for female nurses only in intimate exams. But if a male makes the request is when the insults start flying.
PT
Will "Medicare for All" better or worsen the medical system/insurance behavior towards the "All"? If the insurance companies are out of the medical picture and medical care costs financed by the government meaning "by the control of the people", would that be helpful in our concern regarding preservation of patient dignity? ..Maurice.
You must read the current article in Medscape about an Australian male endocrinologist who was banned, by the medical board, from performing breast exams.
And you must read the multiple Comments to the article from medical professionals.
A big question brought up in the article and Comments is whether teaching medical students how to perform a complete physical exam (and touching the patient) is in my interpretation "unnecessary" in view of the host of diagnostic tools available beyond any necessary skill of "palpation" (laying on of hands). Oh.. how about getting rid of inspection, auscultation and percussion too by governmental regulatory order because one never knows what lurks in the mind and behavior of that physician. Am I getting a bit to skeptical about what we have been teaching for years. Yes, I have palpated breasts and nipples of both men and women as part of a physical examination. I do think that despite the isolated cases of possible sexual misbehavior and possible "universal" dependence on technology, that other "tool"..laying on of hands should not be forbidden if it is as part of clinical diagnosis. ..Maurice.
Oh, I forgot to mention in my last post, that we teach the students to inform the patient, in advance, what inspection technique is about to be used and as I have mentioned previously the student must be attentive to the response of the patient to that part of the exam before and during the procedure. Obviously, despite education, if the patient rejects that part of the exam despite being educated with regard to its value and patient reason for rejection, it should not be performed and the omission documented in the chart.
What experience has my visitors here had with physicians attempting an exam unwanted by our visitor? ..Maurice.
Maurice,
The profession has attempted to exempt itself from the norms, mores, and governance of society through its social contract. Yet, medicine exists within the confines of society.
What the profession fails to realize is that it is subject to the norms, mores, and governance of society. One such more is informed consent. This is a shining example of the problem of asking asking consent and explaining not only what is proposed, but the options including "NOT TO DO IT."
I think that this justified. I would love to see this in the US.
-- Banterings
I think Medicare for all would be a huge mistake for many reasons. It would make patient modesty violations worse. It is important for all Americans to have the choice of private insurance. I think Medicare should only be for 65 and older. Look at this article about why Medicare for all would be a mistake.
Medicaid patients are so limited in choices of their doctors. In fact, one Medicaid pregnant patient who contacted Medical Patient Modesty years ago was upset that she was told by the receptionist that she had no choice of who would be her ob/gyn for the birth of her baby because she was on Medicaid. She wanted to have a 100 percent guarantee that her baby would be delivered by a female ob/gyn or midwife. Medicaid has been a problem for some women because in some areas only male gynecologists accept Medicaid. The truth is many doctors limit the number of Medicaid patients they will accept because they get lower reimbursement from Medicaid than private health insurance.
It is wrong to do an “one size fits” approach for healthcare and Medicaid For All is not for everyone.
Misty
As for the male endocrinologist who was banned from doing breast exams on women, I agree completely with the medical board in Australia.
I looked at all of the 81 comments and found the below comments by a male family practice doctor interesting. I am glad he refers women to female gynecologists for annual female exams. I have bolded his name and comments. I wish there were more male doctors like him who opted out of doing intimate procedures on women. I agree with his decision to refer women to female gynecologists.
Dr. Armand Gallanosa | Family Medicine
with today's guilty until found innocent culture, I refer my female patients to female gynecologists for their annual female exams. even with my MA or nurse chaperoning, there is nothing that can protect us against the anguish of false accusations
Misty
Thanks Misty. obviously financing the Medicare for All and defining All as "all" potential patients (including those now on Medicaid) and even having something like this to pass a Senate which we have now is impossible to conceive--but something that is finally re-written may include a host of other requirements including criteria and regulations regarding professional behaviors.
With regard to the male Australian endocrinologist story and the professional responses to the article.. why shouldn't female physicians and female nurses have the same concern about "accusations" expressed by male patients when "sensitive" areas of the body are being exposed and attended to? ..Maurice.
Maurice asks,
"With regard to the male Australian endocrinologist story and the professional responses to the article.. why shouldn't female physicians and female nurses have the same concern about "accusations" expressed by male patients when "sensitive" areas of the body are being exposed and attended to?"
Male patients are not inclined to make false accusations against a female provider. That fact is well known among female providers. It is also true that male patients do not make accusations of impropriety even when the patient is genuinely violated. They are just too embarrassed to admit being taken advantage of by a female. This is a major double standard. Female physicians, nurses, and ancillary staff have no reason to be concerned.
58flyer
Dr. Bernstein,
There are actually some female family doctors who refer their male patients to male doctors for intimate procedures. There are also some female nurses who do not want to do intimate procedures on male patients either. In fact, some female nurses purposely go in Labor & Delivery department so they would not have to work with male patients.
Yes, male patients could also accuse female doctors and nurses of sexual abuse too. The truth is abuse of male patients by female medical professionals happen more than we imagine. It is more likely to be unreported because many male patients are too intimidated to speak up when they have been abused.
I know of a case where a young female nursing assistant at a nursing home was inappropriately touched by a male patient who she helped. I think modern medicine should reconsider their gender neutral agenda (meaning that they focus on the skills of a medical professional rather than gender) for intimate procedures. There are so many problems with modern medicine being gender neutral.
Misty
Misty
This same female patient on Medicaid wants the nicest birthing suite as well. She will likely stay longer than is recommended, get the free baby car seat and milk the system for everything she can. As well as dictate the gender of everyone in the hospital. It’s all about entitlement.
PT
Misty wrote: "The truth is abuse of male patients by female medical professionals happen more than we imagine. It is more likely to be unreported because many male patients are too intimidated to speak up when they have been abused. "
MY QUESTION TO MEN HERE: WOULD YOU FEEL "TOO INTIMIDATED" TO SPEAK UP WHEN YOU HAVE BEEN ABUSED BY A PHYSICIAN, NURSE OR OTHER MEDICAL EMPLOYEE? IMPORTANT QUESTION PERTINENT TO THIS BLOG THREAD: Would that have been a feeling or non-action in the past and WOULD NOT OCCUR NOW after participating on this blog thread? In this regard, has what has been going on within this blog thread activated some readers for personal reactions which now which wasn't present in the past? If so, this might indicate to all who come here the value of the presentations and discussions here. In conclusion: "It is more likely to be unreported because many male patients are too intimidated to speak up when they have been abused." is this no longer a valid statement applied to those who are participating here? ..Maurice.
Good Afternoon:
The fact is, a lot of guys are afraid to or won't speak up because without irrefutable proof of the abuse, men are just NOT believed by today's medical system. So if it's verbal abuse, without a non-medical person hearing it, your complaint will fall on deaf ears. Especially is the abuse if coming from a female healthcare worker.
Another reason guys won't speak up is they are afraid of retaliation from the individual or their colleagues. Sad but true. I know some guys that were doing PCa treatments & just stopped because they didn't like the way the ladies were treating them but were afraid to speak up.
It's sad that the system has stooped so low but most of today's medical system operates without compassion, empathy, morals, ethics, or caring where male patient's are concerned.
I fear for any male who needs medical attention especially intimate care these days.
Regards,
NTT
Maurice
I think a more pertinent way to answer the question is what are the consequences when you do complain. As a example the Denver 5 got 3 weeks of paid vacation. Nothing happened to Sparks nor the operating room staff and in Ricks case,nothing. You have a nurse who disregarded the 10 patient rights to safe medication, the patient died and nothing happened. You have another nurse acting as an accomplice in a murder, another nurse who murdered her husband, burned the house down and engaged in sex with her inmate patient and she too kept her license. What’s the license for? The nurse practice act, oaths, core values. Why?
PT
NTT, I presume from your many postings that you are male in gender. If you wish to tell us, have you too been "afraid" in the past but actively "speaking up" currently? Thanks for considering this personal question. ..Maurice.
Maurice,
Let us not forget that females also abuse females and males abuse males.
Just like the Australian endocrinologist banned from performing breast exams, it is about INFORMED CONSENT. Informed consent will help avoid the issues faced by the Australian endocrinologist and many allegations of abuse. Many allegations of abuse come because the patient PERCEIVES the procedure as ABUSIVE and they file a complaint.
That involves discussing with the patient their values, goals, and preferences, explaining what is proposed, what will happed, who will perform it and who will be present (and who will see), options INCLUDING NOT DOING THE PROCEDURE, alternatives, THEN ALLOWING THE PATIENT TO CHOOSE THE COURSE OF ACTION AND RESPECTING THE PATIENT'S CHOICE.
Providers must realize, that even though they are desensitized and the procedure is routine, it is NOT for the patient. This is for ALL procedures that the patient is asked to undress for or requires exposing an intimate body part.
Providers must also watch their language; they must NEVER say "...I NEED TO..." It MUST be "I want to..." (and give a valid reason why as not to sound like a sexual predator).
Providers must avoid paternalistic tactics such as those described in Joan Emerson's "Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations".
Providers MUST learn to practice Trauma-Informed Care with EVERY patient because (even life saving) medical encounters can cause trauma.
Perceived or actual powerlessness can incite strong psychological responses, including PTSD, depression, and anxiety (Jones et al., 2007). While adults do have the ultimate authority regarding decisions about their care, the experience of being “under the care” of others can affect perceptions of personal power.
In regards o Maurice putt the onus on the patient to "speak up:"
...While we are not devoid of all decision-making power when we enter the hospital setting, we still are expected to acquiesce to procedures that are in our best interest, as deemed by our physicians...
...For some (especially adult) clients, medical trauma is disenfranchised trauma. We are socialized to cope with whatever we experience in the medical setting without much thought given to the psychological impacts of treatment and of the medical environment...
...In other words: “Experiencing medical trauma can be dehumanizing; treating patients as competent, resilient people restores their humanity” (Hall, in press)...
One critique of this paper: NO MENTION OF PREVENTING TRAUMA IN THE FIRST PLACE.
-- Banterings
Maurice,
You ask:
WOULD YOU FEEL "TOO INTIMIDATED" TO SPEAK UP WHEN YOU HAVE BEEN ABUSED BY A PHYSICIAN, NURSE OR OTHER MEDICAL EMPLOYEE?
The abuse will not happen. I will get up and leave. I can die with dignity, I can't live without it.
If it comes to a physical altercation, I will protect myself if I feel threatened. Do you think that I can NOT demonstrate to a jury valid reasons for me to fear with just the research on this thread?
And these such learned people in the profession of medicine should know that "fight or flight" is a natural human response to be expected and the reasons for trauma informed care. I will physically fight my way out if I must, AMA.
Either NOT KNOWING or DISREGARDING iatrogenic trauma is malpractice and gross negligence.
With what I do professionally, I have defense law firms that I use regularly in 15 states. I can call a lawyer at anytime from a facility and have one there within 2 hours. From my legal background, I will ask that certain information be included in my medical record (I would even do this with my lawyer on the phone as a witness, info that will set the facility and providers up for civil and criminal legal action.
My friend up north is a web developer. I will have him launch a digital campaign of terror against the providers (individually) and the facility.
I would wage a war with the individuals that creates self doubt, self loathing, fear, guilt, and hopelessness within their psyche.
-- Banterings
Banterings, you may disagree with what I am about to write if you are healthy and asymptomatic now. However, I wonder whether you feel all that "powerful" (legally or otherwise) potential when you are very sick and very symptomatic. I know that when my e-coli septicemia struck me symptomatically suddenly and I mean suddenly almost a month ago I wasn't feeling as "independent" and "in control" as I felt before or as I feel now. And that continued during the hours in the emergency room and for the couple days that followed. Being a physician, myself, didn't help.
What I am saying is that when one is very sick one's potential power and intention for self-control over what is happening or what is about to happen is definitely diminished. Now you may argue that this loss or diminished psychic strength in a very sick patient is not universal in all patients to the same degree but whatever degree there is a change and that change may well interfere with the independence and self-control of any and all
issues which arise in the medical system-sick patient relationship. Just a thought. ..Maurice.
Maurice,
In my 20's I did something very stupid in the winter. I was alone in the cold and dark in a vehicle that would not start. I called my (future wife) to come get me. She was 2 1/2-3 hours away. During that time I made peace with God and accepted my fate. I thought that I was done. I lay there curled in a ball, having accepted my fate. At that point I stopped fighting, just was ready for that long cold nap.
I don't know how long that was asleep when I was awakened by the opening of the truck door. My joints were stiff, the body was slowly shutting down the extremities. Dragging myself to her warm car, It took 2 days before my body fully recovered. Ever since then, the fear of death is not in the equation.
It was not only the situation, but my faith in God that allowed me that peace. I asked forgiveness for my transgressions. One other effect of that experience was that I became a better person. Anyone would have feared the ruthless person that I was. I had done some very bad things that I am ashamed of and I still ask forgiveness for to this day. (I believed that God has forgiven me, I am having trouble forgiving myself. I will try making amends the rest of my life.)
Now doing something stupid like doing a wheely on a motorcycle at 100 mph on a busy road without a helmet frightens me because of the fear of being maimed or ending up in a hospital. Climbing a frozen mountain where a fall is certain death does not frighten me.
I am not saying that I am suicidal, it is just that the fear of death is not a motivator.
In regards to healthcare, what ever happened to me when I was 5 or 6, is still blocked in my mind (probably for good reason). I also know that the iatrophobia that I suffer from keeps me away from (sometimes needed medical care.
Over time, untreated iatrophobia can cause you to avoid needed medical care. Which can put your health and well-being at risk, and may ultimately result in difficult, complicated medical procedures for conditions that would have initially been easy to treat.
I have had stitches and a root canal done without anesthetic due to this fear. I have cauterized a wound myself before I bled out for fear of going to a hospital ED.
I am sure there are others who have also suffered so bad, that they can die with dignity but NOT love without it.
-- Banterings
And then there is Nosocomephobia, "fear of hospitals" which I think, as a general term of its participants could also include beyond the general physical appearance, include its operations policies, the nursing, technical and other employees.
Banterings, I appreciate your emotional ventilation. It is to allow these expressions of personal history that I find that writer personal anonymity through pseudonym is of value. ..Maurice.
Maurice,
Just to follow up, if I had something like CA, I would obviously seek to treat it. If I could not find a facility that meets my requirements, I would have my tech savvy friend up north stream my death on the internet. Imagine how many would tune in just out of morbid curiosity. I would reenforce the reasons why, that medicine could not protect my dignity. I would name names and facilities.
Imagine the PR nightmare that would create. Old guard congressmen looking to hold on to their power and newcomers like Alexandria Ocasio-Cortez looking to make a name for themselves would finally introduce legislation that puts patients in absolute control.
-- Banterings
Banterings, that is exactly why now is the time for participation in congressional Town Hall Meetings and put out your advice to the congress and see if other voters speak up and support you. ..Maurice.
Well..you probably all expected what document "to fill out" I received yesterday from Press Ganey, South Bend Indiana and part of the "a national initiative sponsored by the United States Dept. of Health and Human Services relative to my two and half days hospitalization almost a month ago for my urinary tract infection with e-coli septicemia. The previous time I was hospitalized in 2004 for West Nile Virus infection, I don't recall later receiving such a survey.
On looking through the questions presented in the current survey, I looked specifically for questions to patients which related to the professional practice issues described here on our blog thread.
With regard to nurses (gender preference of the patient and gender of the nurses not asked), the questions asked relative to "nurses" and the answers to be selected: Never, Sometimes, Usually, Always involved
"treat with courtesy and respect", "listen carefully to you","explain things in a way you could understand", "after pressing the call button, how often did you get help as soon as you wanted it"?? About doctors, the questions asked related to "how often" being treated with "courtesy and respect", "listen to you", "listen to you", "explain things". With regard to general issues, scales "very poor" to "very good" in terms of various professional activities such as "friendliness","promptness", "attitude towards patient requests", "attention to personal needs","keeping patient informed" and "skill of the nurses". Similar questions applied to physicians.
Grading "1.Very poor" to "6. very good", was the following: considering "time spent","kept patient informed" "friendliness and courtesy" and "skill".
Finally, related to "Persona Issues": staff concern re patient privacy, pain control, addressing patient's personal needs, emotional needs, responds to patient's concern/complaints, including the patient in decision making, compassion."
Personal questions included a category of "mental or emotional health", "highest grade of school completed", "Spanish or Latino origin or descent" "race" and "spoken language at home".
I found no category for the patient to write a personal summary of experience.
Was the "nitty gritty" of the observations and concerns which have been written by visitors to this blog thread incorporated in the survey? Probably not or not fully.
So there you are. As you can imagine, based on questions asked and my understanding of hospital practice, I probably will give them a general thumbs up--anyway their medical management saved me from a serious or deadly consequence. But that's it. Any comments? ..Maurice.
Maurice
You forgot to mention the question “ how was the taste of the food in the hospital” . That is such a very very important question, now as you know hospital food is not supposed to taste good. It was formulated by a dietitian mainly for diabetics, but you can’t explain that to most Americans. That’s why ordering from a pizza delivery place is done frequently by patients.
PT
PT, I will respond with the exact words of questions related to "meals" which the patient is to grade between 1 "very poor" to 5 "very good":
Temperature of the food (cold foods cold, hot foods hot)
Quality of the food (very poor to very good)
and finally
Courtesy of person who served you food (very poor to very good)
Considering each of the 3 questions, Comments describing the "good" or "bad" experience.
That's it..about hospital food.
From a clinical point of view, I am not sure how significant the first two questions are when evaluation is by a former "sick" patient, sick at the time the food was offered may have affected how the temperature and quality of the food was characterized. I, frankly, at the time was not feeling well and feeling thoughtful about characterizing the food. I didn't enter the hospital for delicious meals and in many cases, other clinically symptomatic patients probably would feel the same way about these two questions. ..Maurice.
Maurice
Have you ever heard that song 🎶🎶 “ you deserve a break today🎶🎶. Well, you are off the hook. You see Press Ganey is located in the Bible Belt of the US, southern Indiana. Home to big mammy and little mammy. Big mammy weighs 600 lbs and could not fit in any wheel chair. No this ain’t Southern California, this is in the corn belt. Big mammy would not fit into any cat scanner nor MRI scanner. So when hospitals in Cincinnati, Ohio have big patients that are too big for the scanner they call the Cinncinnatti Zoo. Fact!
Because the animals need medical attention too the emergency room calls the zoo cause they know which medical centers have the high weight capacity scanners. Most of the older CT scanner tables would only support 350lbs. Medical equipment manufacturers have taken note of this so now hospitals know to buy the high capacity equipment. Cat scanners whose couch can support 600 lbs. open MRI units and double wide wheelchairs. Patient beds and weight scales that can weigh a 1000 lb patient as well as support that kind of a load.
You see hospitals have become smarter than they look but they hire agencies that are dumb at asking you how the taste of the food is. If a hospital gets a very low rating on the taste of the food they know the dietitian is doing their job. Yes, hospitals spend big bucks on equipment but do they hire staff that really care about your privacy and well being, not really unless of course you are female. They just make sure Human Resources hire only females techs and nurses in mammo and L&D. No monetary investment there is needed to keep female patients coming in.
PT
Dear Doctor B. Your last response to the question about the food service while in the hospital was typically male. I find this very often in your comments. Having a close friend who spent 42 years in hospital administration and as a CEO for more than 25 years during that time; quality of meals is very important as it is hopefully one enjoyable and pleasant thing to look forward to during a stay no matter the length of time. Need to take of the myopic glasses of being male and think and see reality without tunnel vision.
Mitripopulos, I agree there are a host of patients who enter the hospital for tests and procedures who are not feeling multi-systemically "sick" and, of course, the character of the hospital meals are as important to them as if they were "eating out" and some restaurant.
I think what was missing in the hospital survey was one "beginning" question:
"During your hospitalization how interested were you in the served meals?" If uninterested, skip to the next category."
Mitripopulos, if you are a new comment writer to this blog thread, which I suppose you are, be welcome and continue your input. Maybe your "close friend", if still around, could also contribute comments here. ..Maurice.
JF started her current attempted posting to this blog thread with "Too much division and pitting against each other." but then continued with her own interpretation of the basis for the current mass murder in Texas.
As Moderator, I don't see JF's opinion, which she has every right to express blame in some other site or topic thread, to be pertinent to the concerns discussed with regard to "Preserving Patient Dignity". JF, I appreciate all the great pertinent postings you have provided us but, as Moderator, I cannot accept this one. ..Maurice.
Dr. B,
I realize the blog has been a tremendous amount of work for you so it can’t be expected to last forever. Nonetheless I think you have provided a forum for discussing the long standing discrimination of male patients and the inappropriate treatment of patients in general. It’s rather unique in this respect. To that end I think there has been real value to those treated inappropriately by the medical profession who sought some answers on the internet & found your blog.
Sorry I haven’t contributed for quite some time, I peruse the latest entries now and then but there are just so many issues in the country right now that my attention and efforts have been directed on some of those other matters.
I do continue to take every opportunity to champion for further changes at the large teaching medical center where I receive all of my care.
A short story from last year: I attend a teaching internal medicine clinic for my primary care. So I always deal with a resident in training and then (for the first six months of their training) I also get examined by the Attending too. The Attendings (like the residents) are both male and female and that is fine (I’ve had equal numbers of both sexes as my primary care physician over the years). When the last resident graduated I was assigned to a new resident who was female. That would not have been a problem but I wanted to see if I they would accommodate a male patient’s preference. So I called the clinic after the new assignment was made and asked to be assigned to a male resident instead. The registration clerk who answered said, “no problem” and reassigned me.
BUT, interestingly when I had my first visit with the new male resident there was a note that I had requested a change of resident because the resident asked my why I had switched assignment? So I took the opportunity to tell him women generally get their preferences met in healthcare and I prefer to have a male physician to discuss male issues (so they would understand YES, men do have preferences!). Will they enter this in my record and assign me only to a male resident when this one graduates? Hmm, we will see.
For those who contribute here or just read the entries - you have rights. They aren’t always awarded fully, but you have rights in health care. And your health care providers may not know many of them. So participate, advocate, question. — AB in NW
AB in NW, thanks for presenting your experience and your final conclusion. I, fully agree with the concept of patient's rights within healthcare. In fact, I look at it as "patient rights" and not "citizen rights". To some, this concept has real meaning.
I have noted here that I have continued to volunteer as a physician in a "free" medical clinic twice a month--last attendance was yesterday. You should know that a number of the patients to this clinic are not American citizens and they may not even qualify for Medicaid. For communicating with most, I need to use an interpreter. But I treat them with the same quality of attention as I would an American citizen, considering their rights as a patient are "patient rights" and so I listen to them only as "my patient" knowing that one can have the rights of a patient in healthcare in relationship with their physician or other healthcare providers regardless of their c\citizenship. ..Maurice.
Sorry Dr B. My mind sometimes jumps from one topic to another that to other people, it's hard to follow. PT was talking about treatment of male patients vs treatment of female patients.
I'll admit that there's inequalities but even though male modesty violations make me very angry at times it wasn't what brought me to this blog. Partly because growing up half of my brothers had zero modesty around the house. As an adult certain of my nephews never did either. One stepson did the other didn't.
Also I had no idea that a lot of this garbage was going on. I knew what happened to me. I knew what happened to a couple of friends, both female and both violated. One horribly. As horribly as any story any guy on this blog has talked about.
I just don't think we should be pitted against each other. What is escaping people's notice at times is girls have their moms AND their dads backing them up privacy wise. Women often have a husband who will put in his two cents about his wife's privacy being respected. Women will NEVER say she is turned on by a male doctor or nurse unless she actually is! That's probably untrue of a guy however.
The point I'm TRYING to make is female patients aren't the problem. Female staff are. Also male/female doctors who insist on having only female staff around and have zero regards for male patients.
JF
You know, I was thinking. reading standard text, one sentence after another may tell us somethings but sometimes placing the something in the format of a poem may present more of a picture and through its potential "openness" in interpretation may widen our understanding of what is being offered.
So with that concept in mind, I just wrote the following poem to hopefully start off a little poetry competition here regarding the issues found in "Preserving Patient Dignity". I am sure others here could do better..so give it a try. ..Maurice.
THE HAPPY PATIENT
bY Maurice Bernstein MD
The Happy Patient
See that patient over there
His smile tells something about his care.
He discovered a doctor, a great reward
Who listens to the patient’s every word.
But not only listens but acts in stride
To show the patient the doc has nothing to hide.
Each is open and each is fair
And that has led to that patient smiling over there.
..Maurice.
Does anyone here find any more than sympathy (if even that) for those who work in a hospital attending to patients? Can one empathize with the stresses which are applied to them as they attempt to perform their duties? Is there another side to preserving patient dignity? Is there a need to preserve the healthcare provider's dignity?
I was trying to put together a poem to express something related to this "other side" of the dignity matter. I didn't accomplish the task but I did come up with the two final lines.
And my experience in the hospital is even worse
You see I am not a patient here, I am the hospital nurse.
Can anyone here find merit in my question on professional dignity and maybe complete the first part of the poem? ..Maurice.
Maurice asks
"MY QUESTION TO MEN HERE: WOULD YOU FEEL "TOO INTIMIDATED" TO SPEAK UP WHEN YOU HAVE BEEN ABUSED BY A PHYSICIAN, NURSE OR OTHER MEDICAL EMPLOYEE? IMPORTANT QUESTION PERTINENT TO THIS BLOG THREAD: Would that have been a feeling or non-action in the past and WOULD NOT OCCUR NOW after participating on this blog thread? In this regard, has what has been going on within this blog thread activated some readers for personal reactions which now which wasn't present in the past? If so, this might indicate to all who come here the value of the presentations and discussions here. In conclusion: "It is more likely to be unreported because many male patients are too intimidated to speak up when they have been abused." is this no longer a valid statement applied to those who are participating here? ..Maurice."
This blog reenforces my belief that I am not alone. As such it has empowered me to speak up for myself. I did let myself get caught off guard during my last dermatology visit, but I addressed that with a letter to management. I am sure this blog contributed to my excellent care during my recent round of urology visits. I stood my ground when it came to insisting on a male nurse practitioner for some of the more intense procedures.
My abuse experience occurred in 1973 when I was 16 years old. I didn't speak of it at all for for the next 29 years. It wasn't because I was intimidated, I just didn't know who to tell about it. I had lost my father the previous year due to a sudden heart attack, and with only a mother and sister left, I had no male role model to look to. Plus I thought I was to blame. Being a juvenile at the time I did not yet have the social skills to advocate for myself. Juveniles are an easy target for sexual predators. Had it happened in adulthood, that nurse would have been arrested. In fact as a police officer I did arrest 2 nurses for being stupid, one for inappropriate touching and the other for making threats.
58flyer
A lot of jobs require hard work and lots of it. Even minimum wage jobs. Many workers work excessive overtime. Where I work possibly half the staff either works overtime or works two jobs. I work at an assisted living home.
I kinda think that hospital staff seeing too much nudity plus being too overwhelmed is the cause of the unintentional dignity/ modesty violations.
It ISN'T the cause of all of it however. I know you don't want to believe that doctors would work and study long hours for years for any reason other than pure motives but I don't personally buy it. It's true that these people aren't lazy. But some people have thought that ambition and sex drive are connected.
And just because they're not lazy doesn't mean they don't have character defects.
JF
Hello Dr. Bernstein,
Responding to your question re changed attitudes after visiting the blog, I have already mentioned how I was given the impetus to ask for and receive an all-male team for a recent hip replacement. (Again, thank you!) What I find depressing is the constant need to ask for male personnel for intimate procedures. It would be so uplifting to be asked, "Will a female nurse be acceptable or, would you prefer a male nurse?" This simple interrogative would show immense courtesy and individual respect. I'm afraid that I'll never hear it in my lifetime. I still can't understand why I must seemingly "fight" for this accommodation. Why isn't this question on all medical intake forms?
Reginald
I want to let Reginald and 58flyer know that I appreciate their comments supporting the value of this blog thread and that it's presence ("powered" by the other writing participants) provided personal support in their own issues relative to interaction with the medical profession.
I do feel sorry that I or "we" were unable to provide the same support to Rick. It is important to remember that what "I" write or what "We" write here is "absorbed" differently by each reader since that reader has their own story to retain and deal with and much of that story we all don't intimately know or fully understand.
But that is the way it is when operating in a "public forum" and not sitting directly across from the patient as their personal professional psychologist for example.
What Reginald and 58flyer also reminded me was that I KNOW from the StatCounter program that others who do not write here are visiting, some repeatedly and therefore I have no idea as to the degree of support this blog thread gives them except the "repeat" visits may tell us something.
Again, thanks. ..Maurice.
Maurice,
As a consumer, I do not care about the working conditions of those who provide me services, especially from those in an industry known for the abused of patients (their customers) and a disregard for human dignity.
If providers were compassionate (...and as EO so eloquently stated) still espouse the morals and conscience and operate in a slightly better manner than those physicians who ran the Nazi concentration camps.
Personally I feel that the physician suicide epidemic is due to there are some who cannot completely disregard the norms of society, their own conscience, OR common sense. They can not continue to abuse patients themselves or witness the abuse silently.
Of course, those who speak up are punished and shunned by the group and/or excommunicated as a means of a social control mechanism.
Medicine is a cult. It started with the Flexner Report frightening the American people to grant the AMA monopoly status over medicine (via education) which evolved into a monopoly like a medieval guild.
It is interesting to not, that comments such EO's that I quoted above have some validity because the recommendations of the Flexner Report were based on the German medical education system.
Milton Friedman warned back in 1961 that the American Medical Association was a government-sanctioned guild or trade cartel that would raise health care costs and diminish quality.
Let me pose this question: We all concede that pelvic examinations on anesthetized women are morally reprehensible.
We also know that the practice was universal and widespread and still exist TODAY.
It only stands to reason that there are many physicians practicing today that learned PEs in this manner.
HAS ANYONE EVER HEARD A PHYSICIAN ADMIT THAT IN THEIR MEDICAL TRAINING THEY HAVE COMMITTED THIS HUMAN RIGHTS VIOLATION AND PUBLICLY ACKNOWLEDGED IT AND ASKED SOCIETY FOR FORGIVENESS???
NO SYMPATHY FROM ME!
-- Banterings
I served in the military during the Vietnam war. As a service member during that time you were required to wear your service uniform when traveling from one duty station to another. Getting spat on at many US airports was common and now is an urban legend so much so that a college professor did a research project on the matter. Believe me it happened, so I know what it means to have served for an ungrateful nation. Please don’t thank me for my service, I’m way past that.
Since the events of 9/11 I believe the public has a much better perspective and appreciation of our military but it wasn’t always so. I don’t have sympathy for anyone in their job. The only comments I’ll make are that the general population needs to understand is that the emergency room means just that. You should not go because you have a cold or the sniffles or that you need a refill on your medication. The ER physician is not your family doctor and if you are hooked on opioids hospitals know you are a drug seeker now because they share patient information.
When I joined the military I was paid $164.00 a month after taxes and that’s for a job that is 24/7. Healthcare workers are among the best paid in our economy so that should be thankful they have a job. Be respectful of patients, we are paying your salary, this stupid blog should never exist if people were respectful of other human beings.
PT
PT, I think you mean "blog thread" rather than blog which is the entire publication of over 900 different topics not all involving issues of disrespect.
In fact, this blog thread actually begun in 2005 with the thread title "Naked" in which I started out with "This topic is discussed in the Perspective section of the current New England Journal of Medicine August 18, 2005 issue with the article “Naked” by Atui Gawande. M.D. Dr. Gawande is two years out of his surgical residency and has had the opportunity to talk with physicians who have practiced in other cultures around the world describing how the concern of modesty is handled in their country. He also discusses his own initial reaction about how he should examine a patient with strict attention to patient modesty such as avoiding the patient using a gown and simply or not so simply moving around the clothing. This action clearly became awkward and he resorted to gowned patients. Finally after noting the real professional problems of physician sexual misconduct but also false patient accusations due to misinterpretation, he concludes that explicit standards of what is a “normal” physical examination be set up or tightened so that both doctors and patients know and better doctor-patient relationships can be established.
I would be interested regarding what experiences you have had either as a patient or as a physician/nurse in the area of patient modesty and how the situation was managed. No names please."
This was followed by the very first Comment
At Monday, August 22, 2005 10:28:00 AM, Anonymous Anonymous said...
I recently had surery and was pretty upset when my first discussion about my general anesthesia was while I was lying in the pre-op room in a gown. Laying down and not being in my own clothing put me in a very compromising position. No one discussed the anesthesia with me before hand, so I had looked up a lot of information on the internet. Of course, I had a lot of questions. Unfortunately, I was practically naked trying to discuss whether or not to get pumped full of drugs. I really did not want to go under, but I was too flustered when I was talking with the anesthetist to push for a less risky alternative.
So, PT, I think you are correct, this patient demonstrated here for the first posted Comment to what turned out to be the "Patient Modesty" thread, potential disrespect or disinterest in surgical communication with a patient. ..Maurice.
Oh! All my visitors should go and read a posting by a male and an issue with a female dermatologist which was written on "Naked" thread.
The posting presents an interesting dilemma of a male patient who has concerns about an area of his body that the female dermatologist just didn't uncover and feared being considered an "exhibitionist" if he had asked her to inspect.
Also read the comments followed by other visitors regarding this male's concerns. What would be your comment to that male patient? ..Maurice.
Maurice
Yes, I remember reading that and I went back to read it again. He is an exhibitonist. He was soo mad that he didn’t get his money’s worth. What can you say about people like that. I suspect the female derm knew he would enjoy it and therefore rejected the need. That’s her decision, he needs to get over it.
PT
PT, I accept the poster's concern about being called an "exhibitionist" but even if he held such a description, couldn't an exhibitionist also honestly provide a history of skin malignancy and concern about current suspicious skin lesions in the genital-rectal area? Exhibitionists have no immunity from skin cancer--in fact, if they are nudists, increased sun exposure (UV light exposure) to more skin is much more likely. On the other hand, nudists may be more attentive to their skin and skin lesions than non-nudists (based on my reading). I take the writer at his word. Didn't he provide a reasonable explanation regarding his history and his concern? ..Maurice.
Banterings, I just have to respond to your passage here: “With what I do professionally, I have defense law firms that I use regularly in 15 states. I can call a lawyer at anytime from a facility and have one there within 2 hours. From my legal background, I will ask that certain information be included in my medical record (I would even do this with my lawyer on the phone as a witness, info that will set the facility and providers up for civil and criminal legal action…My friend up north is a web developer. I will have him launch a digital campaign of terror against the providers (individually) and the facility..
I would wage a war with the individuals that creates self doubt, self loathing, fear, guilt, and hopelessness within their psyche.”
This is wonderful! This is empowering! And especially, considering that we all need such a support system to protect ourselves against makemsick abusers, POINTS TO HOW CORRUPT THE MAKEMSICK INDUSTRY HAS BECOME.
And didn’t Banterings also previously mention about how providers are to be more like Walmart employees, whom one can so much more easily prosecute the moment they start abusing. Love it! Knock them off their high horse!
I also, have no fear of death (I’ve had several incidents where it would have been easy to die but it wasn’t my time)but I have an intense fear of being under the rule of makemsick workers for being old and ill – and being abused, whether medically or in terms of personal modesty, by the system. With the exception of being forced to see an optometrist for a new refraction (an AI here would be vastly preferable!), I have no intention of seeing any makemsick provider for anything. I joke to my friends that my dogs will find me and I might serve as a meal if no one notices I’m gone in a certain amount of time. Works for me!
To answer your question, Maurice, if one can find anything more than sympathy (if even that) for those who work in a hospital setting tending to customers? Of course my answer is a resounding ABSOLUTELY NO! PT is correct in that so many individuals going into the makemsick industry are there for the paycheck (and they think glory but that is SO OVER!) and these individuals are, as PT noted, devoid of caring, of compassion, of empathy. I think this statement applies to a huge percentage of the new makemsick workers (and this one is from a nursing hag): “I just can’t stand taking care of those rotting old boomers.” Well, miss hag, who do think is going to need the most care, rotting seniors (remember you’ll be one some fine day!) or young males in need of depantsing? We know the answer to that one!
EO cont.
Again, I agree with Banterings that medicine is a cult, and has been thoroughly destroyed by the allopathic model of poisoning to address symptoms, but rarely healing a customer. KNOW THAT THIS MODEL OF “HEALTH” CARE IS INTENTIONAL, AND CREATES AN ENDLESS LOOP OF SICKER AND SICKER CUSTOMERS. MONEY – POWER – CONTROL - UNDERSTAND THIS FOUNDATIONAL FACT, AND YOU’LL ACTUALLY HAVE A CHANCE TO SEEK REAL HEALING OUTSIDE OF THE MEDICAL CULT. NOW, THAT’S HOW TO EMPOWER ONESELF! Here’s just one example out of thousands: SRO (Rick Simpson Oil) is curing diabetes 2, and is some cases diabetes 1; many have had cancers cured as well. This is precisely why Big pHarma fought against legalization of marijuana – full spectrum indica has the capacity to cure many illnesses. We are just at the beginning of investigating what strains/doses/methods of ingestion work for what illness. No, physicians are not healers, and more and more individuals are waking up to this fact, and seeking other forms of care, especially those that ADDRESS THE REAL ISSUE, NOT THE SYMPTOMS.
Unfortunately, the medical cult banished many types of healing modalities, and now, we have a nation, really a globe, of peoples that are both mentally and physically very unhealthy. The Pathologicals’ plan is proceeding just as planned. But, as said above, many are waking up to this fact, and that physicians are not healers, rather, pharma sales reps. I am sure that this fact alone contributes greatly to the anger we are seeing from customers in greater and greater numbers. Even los sheeple awaken when their children are killed or made ill for life. Add the prurient nature of the nursing hags to the mixture, and well, not much left to save, maybe trauma care but we see how dangerous that is, especially for the male customer! A host of voyeurs to share one of the worst days in your life!
For me, one of the worst aspects is the hypocritical nature of makemsick workers, especially physicians. I viewed a short clip of 6 or so white coats calling for stricter gun laws after El Paso and Dayton. However, before the assault of the vaccine cult upon our youth, young males were not obtaining military style weapons and randomly shooting strangers. Unfortunately, most physicians have drunk the kool aid of the allopathic model, and are fine with FORCING PEOPLE TO ACCEPT THEIR DANGEROUS PRODUCTS. FORCING ANYONE TO SUBMIT TO DRUGS OR PROCEDURES IS MEDICAL TERRORISM, AND IT’S ALIVE AND WELL HERE IN NEW CHINA! Above all, I don’t understand how makemsick workers can be so blind to the fact that they are the ultimate tool of the Pathologicals, for abolition of the Second Amendment is high on their list for New China. And you can bet with the house that male dignity is not even on their radar.
EO
EO, teaching first and second year medical students who they are and what they will become in the medical profession and how they should behave with their patients, if I follow your view, I just spent over 30 years of my life creating a cesspool of ugliness and patient harm. Should I have said to my students "you Dummies, you selected the wrong profession (if it can even be called a "profession") and should have entered law school so you could handle all those medical malpractice suits.. or maybe studied pharmacology and create a host of expensive chemicals to enrich your pockets but only hinder the lives of the potential patient populations.. and maybe even more possible "jobs". But becoming a medical doctor or over there in nursing school becoming a nurse is wading into a "makemsick" pool of pharma "cheerleaders" or a prurient health industry worker. And then what? What a wasted 30 years! Why? Because, I just never told the students their prognosis because I was ignorant to the pathology which was starting or more accurately progressing over the generations and longer and accelerating over the years to "modern day" today. It is truly sad to consider all my wasted years and then on top of all that I was simultaneously "practicing" medicine on year after year of live patients and hoped to be a constructive example to the students learning but all I was doing was showing them the reasons for advising them transferring into law or drug making. What a waste of time and more! ..Maurice.
Maurice
He wanted to complain about her. Who would he have complained to, the state medical board? Would he be satisfied if he went back and a male derm performed the exam? Odd that he didn’t mention these “ dangerous” moles on his buttocks from the get-go to her but then that would take away the surprise which is crucial for the fetish to be a fetish, that she deemed it not necessary. That he was denied the experience. Guess he will have to look for one in his new state, but then he could have already done that if he in fact is soo concerned for these “dangerous “ moles on his buttocks!
PT
Dr B,
Of course you didn't waste 30 years of your life. Medicine is a mixture of decent people trying to make it better for their patients AND themselves, and the woekers who are only out to make it better for themselves and their families.
Even though I agree with much of what EO says, we probably disagree about ratios. I know I greatly benifited from my gallbladder surgery.
My mom greatly benifited from surgery also. The pills she was given afterwards, I don't think were good for her. There HAS to be a certain amount of patient recovery or there would have been a bonfire made already..And medical workers thrown in it. JF
PT will you then admit (and the others here agree) that the source or instigator of problems between patients and the members of the medical system may well be the behavior of the patients themselves manipulating what could be a smooth and satisfactory therapeutic relationship. And those affected members of the medical profession should be attentive to patient "misbehavior" and be able to "speak up" (not "down") to the patient about the patient's issue and attempt a constructive and ethical resolution?
By the way, I do miss Biker who has not contributed a comment on this Volume 103. I hope his health is not a current significant problem or that the narratives presented by folks in this Volume hasn't discouraged Biker from participating. ..Maurice.
I mentioned a week or so ago about my wife's experience with the mammo clinic where the tech asked her to completely remove the gown. I decided not to write a letter preferring instead to ask to speak to the supervisor in person. Experience shows that letters don't get answered or just ignored. It's hard to ignore a face to face discussion.
I met a lady who introduced herself as the clinic manager. She was very concerned about the conduct of the tech and said she had never heard about the patient being asked to completely remove the gown. She said that was definitely inappropriate. She agreed that while things are easier for the tech to not have to work around the gown, it is still standard of care to provide for the patient's comfort. I suggested this could have been the start of that tech becoming lazy or casual about patient comfort. She agreed to talk to the tech and make sure that is not the case. If the tech is becoming lazy then a change will be made. The manager said she did want any patient to feel uncomfortable and that it was important for patients to return for their annual exam. She thanked me for bringing this to her attention and that it will be properly investigated and changes made accordingly. She invited me to ask my wife to call back if she wanted to talk further or if she had other concerns. I thanked her for her time and left.
At my suggestion my wife did call back and speak to the manager after a few days. My wife told the manager that it was appreciated that her concerns were investigated. Of course my wife was also curious as to what the tech said about the incident and at that point the manager became very elusive with her answers. She just wouldn't say what her investigation revealed, only that the problem has been taken care of. It was a short conversation. I was disappointed that the manager got so elusive but I guess that's normal so as not to admit wrongdoing which would put them in a liability situation. So maybe is was just the start of the tech becoming lazy and we nipped that in the bud.
58flyer
Dr B,
There will always be a certain number of patients who are out of line. And get pleasure from intimate care and examination.
But for you to say what you just said confirms to me that yoy don't remember our accounts two minutes after we tell them.
You have multiple times said none of your patients have showed signs of being embarrassed by intimate care/ examination. Maybe you just don't recognize embarrassment. JF
JF, maybe I don't recognize patient embarrassment from the many "intimate care/examination" which I had performed. I have repeatedly implied over the years on this thread that what was written here were from "statistical outliers" simply because I haven't had, in my own practice, evidence of such emotional trauma expressed in one way or another by my patients to me. And, further, I made an assumption that other physicians had similar "non-experiences". But later on this thread I have suggested that perhaps I was in error defining those writing here as "statistical outliers".
And this is where I currently stand..with the latter assumption of my error.
I would now suggest to all patients, if you feel that you are emotionally uncomfortable with the loss of physical privacy..follow the advise many times written here:
"Speak Up!" If the patient says nothing nor by motor activity does nothing, then vital communication of displeasure, anxiety or worse cannot be transmitted to the physician, nurse or tech. None of us can read the patient's mind. There has to be clues. And again, I state, I have never experienced that input from a patient. But time has elapsed, no professional paternalism now (maybe) since my more active practice and I would assume now patients, hopefully, will feel more confident to do some direct communication of their concerns. ..Maurice.
If you are interested in the life of a resident physician (usually in the hospital environment but also may be practicing elsewhere), click here for a Medscape 2019 survey of 2200 residents. Remember, their own life experience and their reactions may affect how you are treated by them if you become their patient. ..Maurice.
Hello Dr. Bernstein,
Thank you for your Medscape reference. Some of the stats were disconcerting. My comments are bracketed. 10% of the residents were afraid of failure or making a serious mistake.[Either they're lying or totally, foolishly self-assured.] Almost 50% had doubts of being a doctor. [Should this really be the case as you start your new, exciting career?] 5% felt they were too tired due to long shifts.[Unbelievable, since this is probably the most difficult part of the job.] 15% had experienced harassment with 82% not reporting it.[Horrendous! Nothing more needs to be said about this failure.] 66% felt a stigma for asking for help.[What does this say about the process, if one is afraid to ask?]
I sincerely hope that this survey is not indicative of how our new doctors really feel. Thanks (I think) for sharing it.
Reginald
Hello,
The following is a recent article from Outpatient Surgery Magazine. Maybe this "humanity" can be spread to larger organizations.
"At the end of pre-op clinic appointments, I hand patients a business card that includes my personal email address and request that a family member send me a message about the patient. What do they like? What makes them tick? What do they want my surgical team to know about them? I respond to the email, thanking them for their thoughts, and copy my assistant, who prints out the exchange and adds it to the perioperative paperwork. A member of the surgical team reads the message aloud during the pre-op time out. The words remind us of our calling and help us refocus on what matters most in that moment: the patients in our care and the loved ones waiting for them outside the OR.
Many messages are lighthearted. A husband revealed his wife was a Pink Floyd fan, so we played “Comfortably Numb” — fitting, right? — when she was wheeled into the OR. Other messages have moved us to tears. A 13-year-old boy named Daniel had recently endured the sudden loss of his mother. His grandmother, who had become his maternal figure, was laying on the table in front of us. In an email, Daniel told us his grandmother makes the best meatballs, and asked us to be at our best that day because he couldn’t live without her or her signature dish. We cried together, collected ourselves and began the case with renewed purpose and focus. At the end of the successful surgery, the entire team gathered around a speaker phone and called Daniel to tell him, “Grandma’s OK. More meatballs are coming.” You can imagine the impact his tears of joy had on everyone in the room.
Something magical and powerful happens when you ask for emails from patients’ family members. It’s helped me connect with patients and their support circles in ways I never thought possible and has reinvigorated my career and personal outlook in ways that are impossible to describe.
Benjamin Schwartz, MD
Southside Hospital Northwell Health
Bay Shore, N.Y."
Reginald
Thanks Reginald for your postings. In any evaluation of physician behavior (except for the most chronically grievous) one must consider the work environment, work limitations, goals anticipated by the physician but also others including employers, other staff and of course the patient and the patient's family.
The physician's goals of most doctor-patient relationships, from the outset, is to develop as quickly as possible a correct diagnosis and an effective treatment for that diagnosis, all the while providing comfort for the patient and his or her family AND attending in the same manner to other established but active patients and new patients who are in the Waiting Room to be seen or patients already hospitalized.
Beyond the work environment and work requirements and demands, there may likely be the physician's non-professional personal life which "looms" in the background of his or her thoughts while working their profession.
All of these elements come together and set what one sees as the physician's behavior in a one-to-one physician-patient interaction. It is a lot more complex work than being a mailman or even a bus driver.
That is why it is so important that patients under care of a physician should have this "physician's burden" in mind and within the patient's physical and cognitive and emotional limits be an active participant in the doctor-patient interaction and relationship. "Speaking up" but with explanation and advice to the physician would be a necessary participation that every patient should keep in mind and carry out as appropriate and necessary.
Reginald, I think the last statement by Dr. Schwarz you posted sums up my "speaking up" beyond that of the patient but also of the patient's family:
"Something magical and powerful happens when you ask for emails from patients’ family members. It’s helped me connect with patients and their support circles in ways I never thought possible and has reinvigorated my career and personal outlook in ways that are impossible to describe."
"Connecting with patients", that is the goal every physician should aim for and "connecting with their physician" should be the goal, if possible, of every patient.
..Maurice.
I am taking vitamins, minerals,herbs,and spices.I am avoiding
fluoroquinolone antibiotics. I hope I can avoid the hospital and female nurses. I hope the local hospital adds 5 more male nurses and 5 more male nursing assistants in the next 3 years.
Donald
Good Afternoon:
Hope all is well with everyone. Nice to see AB in the NW back posting.
For over a half a century now the United States medical community has ignored a male patient's right to his dignity & privacy in an intimate medical setting. If any healthcare individual says different, they're lying & those that have had to seek out medical attention ALL know it.
Men that have had contact know that most female medical staff are voyeurs & will stop at nothing to nonchalantly get that one look. And if that one look is worth looking at, you can rest assure the rest of the female staff will also know.
The medical community likes to think they're up to date with society when they're no where near being in tune with society.
For instance, they're constantly telling everybody ya gotta get checked for colon cancer. Okay. But then when you go, you're told ya have to be checked OUR WAY. The patient isn't allowed to wear the colonoscopy shorts they spent their own money buying.
If the American healthcare system has any hopes at all of one day truly caring for the public they serve, They MUST get rid of the idea that EVERYTHING has to be done their way ALL THE TIME, or don't seek medical attention.
For instance, Dr. Bernstein your recent stay in prison, you had the catheter placed & she took a peek, under the premise she had to check for leakage.
In that type of situation, I see NO reason why if the patient is aware & can take instructions why in that scenario she could not have just said "I need you to check the catheter for any leakage at the entry point & verify that the tubing isn't kinked anywhere. I'll step out while you check that for me".
By doing it that way you further strengthen the patient/provider relationship rather than destroying it further by embarrassing him more that he already is. If the patient is capable, there's no reason not to let them do.
Forget about the "way you were taught" & ask yourself what's best for my patient?
Its simple things like that which in turn makes the male patient feel better making for a more positive outcome to his stay.
Another "simple thing" like Reginal said. Healthcare created this situation with men. One way they can really see how many men are really asking for same gender care is to put the one simple line item on intake paperwork.
Question. Do you require same gender care-givers for intimate exams, test, and procedures?
By putting that line item on there, you get men start thinking why is this here? Don't they automatically use male workers for male intimate care? And it also tells the female staff they have a patient who doesn't want them for intimate care so just find a male instead of trying push yourself on the patient & possibly making their stay worse than it has to be.
Simple, how hard can it be unless you don't really want to know because it might cost money god forbid.
I really don't think any healthcare workers or administrators today give one thought during the day as to how they can help their male patients get a positive outcome to their medical needs.
Today's medical culture needs a complete reworking. The people in administrative positions need to be replaced with workers who have people skills from the top in down the line.
Maybe Medicare for All or universal healthcare would be the spark that makes change for the better for the system & men.
Healthcare needs people who care & can think on their feet. Both, are lacking in the healthcare system we have in place today.
Regards,
NTT
I would define "Medicare for All" where "All" does represent "all" which means that this revised Medicare system also revises the population and distribution and availability of both genders of healthcare workers. I base this potential for change by recalling the potential creative change which the American government was able to produce lifting humans, defeating the power of gravity, from the surface of the earth to actually put their feet on the surface of the moon. Yes, it was expensive but the intent was there and the goal accomplished. When you think of that major governmental accomplishment one would think that with a little cash and a little intent to provide the best and ethical care for All, that a goal of patient-selected gender for physicians, nurses and techs should be no greater challenge than defying gravity and bringing humans to the moon. Again, the word "All" in Medicare for All should apply not simply to patients but also "all" of the healthcare providers. ..Maurice.
Maurice,
You state:
If the patient says nothing nor by motor activity does nothing, then vital communication of displeasure, anxiety or worse cannot be transmitted to the physician, nurse or tech.
What you are doing is victim blaming. If the provider really cared, THEY WOULD ASK!!!
Do not current teaching guidelines (on the topic of informed consent) warn of patiens that acquiesces without asking questions or expressing concern?
I would be leary of a male patient allowing a group of medical students perform an invasive intimate exam.
Would you say that if a patient is allergic to penicillin that they should speak up? Is it not negligent for the provider to prescribe/administer penicillin without inquiring if there is an allergy?
WHY ARE DIGNITY ISSUES ANY DIFFERENT?
You ask:
Does anyone here find any more than sympathy (if even that) for those who work in a hospital attending to patients?
HELL NO! This sounds like the type of person who physically abuses their spouse and says to them, "Look what you made me do."
As to you never experiencing patient discomfort, it reminds me of the ending to the 2010 movie "Shutter Island."
The question asked (in the whole movie) becomes most evident in the end: Is ti better to live as a monster or die as a good man?
Just as my mind blocked the indignities that happened to me when 5 years old, it may be that your mind could block you recognizing patient discomfort. It is possible that as you have become a patient with an intimate issue (the prostate), you are beginning to see what happens.
Perhaps that is why you questioned shutting the thread down: go out as never seeing the indignities in healthcare. "Retire a good man."
Let me pose this question to you, what would happen if you were to find out that healthcare is bad as we say it is? What if you found out that former students went on to be the next Larry Nasser or Twana Sparks? If they told you that all you taught them about patient dignity and comfort were just correct answers for interviews or legal depositions? What if you were part of the problem?
It is not within the realm of possibilities that your mind blocked this out so as not to view yourself as complicit?
-- Banterings
Banterings, obtaining a history of penicillin allergy from the patient PRIOR to prescribing penicillin is what we do, a professional requirement. Explaining the basics to the patient of an upcoming examination or procedure is what all physicians, nurses or techs should do. It is then the responsibility of the patient or, if needed, the patient's surrogate to follow through by asking for further information or expressing personal concerns to the professional and expect further explanation or resolution of issues presented. In the case of a 5 year old patient, it is expected that the patient's mature surrogate is present to understand the interests of the child and to express those concerns to the professional and, as appropriate, to be present to receive the responses and observe and react.
Of course there will be "indignities" as seen by the patient in healthcare and it is the responsibility of the patient to be made aware and 'SPEAK UP' with regard to be educated by the professional and for the patient to set their limits. Every patient is different and every professional is different but each must listen to and inform the other and this is what medical students are first taught before the 'laying on of hands'. ..Maurice.
Hello:
I agree with Banterings in that they won't ask your preference in a female provider/male patient secenrio.
I suspect they are taught in nursing school due to the current disparity in female to male numbers of nurses to not bring up the subject unless the patient asks. Just go in introduce yourself, explain why your there & what needs to be done. Pause a few moments to see if there are any questions then get on with the job at hand. If you need help just bring in another nurse.
I further suspect that the same lesson taught in nursing school is further reinforced on the job.
It all comes down to their current credo.
Time is money & money is time therefore if you waste time you are wasting some greedy investors money.
I wish it was different.
Also in those town hall get togethers with the candidates, when they talk about healthcare ALL they want to talk about is Medicare for all. I haven't gotten one yet to address male healthcare alone.
Regards,
NTT
NTT, it would be very appropriate to this blog thread to present to us your actual experiences in attempting to present your (our blog thread) case to "Town Hall" meeting or meetings. How was "Medicare for All" presented and by who (only Democrat?). What opportunity did you have to present your ("our") view of the way medicine is practiced for male patients? And what was the reactions? It would be great to read your experience in this regard. I am sure that you should be congratulated for attempting to move this issue out from this blog thread to public political forums. ..Maurice.
You may want to read a posting on KevinMD titled "Before you vent about your doctor on social media, read this" I know, I know all your views of that site. But read the presentation from a wife of a physician but also importantly read the currently 12 reader feedbacks!
You know, I don't think I ever asked this question of my visitors, beyond this very blog thread where else are you regularly "spreading the word" within the social media? And what kind of feedback are you getting there from where you post? ..Maurice.
That man is a wonderful dedicated doctor and his patients are blessed to have him in their corner. I hope you're not thinking that we think all doctors are #$& holes. We know that it's a mixture.
Just like you probably know that many patients work hard. Work long hours and are subjected to ingratitude. We're not in a contest about who works harder or more. We know there's a mixture.
Our main complaint here on this blog are dignity issues. I'd like to add that I'm not one who said I don't have sympathy for anyone in their job. I just don't except it as an excuse for modesty violations. People's lives are seriously injured by those violations. Some lifelong. Permanent damage is sometimes caused amongst family members who saw what they never should have seen. JF
Misty Roberts of Medical Patient Modesty fights for modesty of both men and women.
Donald
Good Morning:
JF, I agree with you that doctor is one of a kind. He belongs on the endangered species list as there are few of his kind left.
One way I feel there could be more like him is is doctors didn't fall for the promise of a BIG paycheck that the mega hospitals throw at them.
Those mega checks come at a steep price. They lose individuality & the freedom to be the kinda doctor they wanted to be in the first place. It's no longer a career, its a job. Get them in get them out & get to the next one.
It becomes production line healthcare.
Advice from a patient. Stay in your own independent practice. You may not be richer but you'll be happier & your family with thank you for it.
At the town hall mtg. a democrat presented medicare for all as the answer to the healthcare problem. More coverage, pre existing conditions covered, less insurance company interference.
I presented male specific issues after the meeting where I was told they'd have their staff look into it. Which I replied I'd see them at their next mtg. for the answers if someone didn't contact me.
Regards,
NTT
Donald, I agree with your comment on Misty. since her comments are also supportive and productive of what is being discussed on our blog thread too. ..Maurice.
IMPORTANT ETHICAL QUESTION REGARDING ETHICAL EQUALITY AND JUSTICE: As a non-LGBTQ (and all the other letters currently being added to the characterization) potential patient would you support the views and requests by the LGBTQ (and all the other letters currently being added to the characterization) patient to be included in a "Medicare for All" program which would HOPEFULLY, by law, meet all the needs and behaviors by the professionals and medical system set by patients who consider themselves genetically, functionally and behaviorally purely male? OR do you look at "ALL" to exclude LGBTQ (and all the other letters currently being added to the characterization)? Should "they" have the same personal "patient dignity" and autonomy over professional behavior as long described on this blog thread? ..Maurice.
Dr. Bernstein, all patients deserve to have their dignity respected. Male, female, or whatever else someone may deem themselves to be. Gay or straight. Young or old. Rich or poor. Whatever color or ethnicity or religion they may be. Be they a Mayflower descendant or a new arrival. Everyone.
While it seems there is a growing awareness that healthcare needs to more attuned to the sensitivities of certain communities, the LGBT and Muslim communities in particular, I do not detect any awakening to the fact that male modesty exists or that there is a need for more male staff below the physician level, especially in sensitive areas like urology and dermatology.
Biker, welcome back after almost a month away. Your response is much appreciated.
Thanks for reminding us about Muslim male medical care. Does anyone know whether, in practice and reality, Muslim male patients are attended to their provider gender requests any differently than all other male patients? Any Muslim male visitors here who would like to educate us about your experiences?
In fact, I currently have a Muslim male patient in the "free" medical clinic where I volunteer and I will ask him about his gender experience with healthcare providers in the past, a question I had not previously asked. ..Maurice.
Good Morning:
I totally agree with biker. I don't care about someone's lettering system (LGBTQ) We're ALL human beings. Medicare for ALL means EVERYONE.
Regards,
NTT
You know, I have been trying to find information regarding the popular exposure of the entire naked body to the opposite gender within nudism organized activities. I wanted to find if women are much less likely to become a member and participant. If this is true then this might be corroborating evidence of why female patients are being treated differently than male patients with regard to bodily exposure. That is, if it can be shown that males have a greater population in nudism than women when exposed to the opposite gender, that might be related to the differential approach to intimate exams in the medical profession--more attention to the gender of those attending to women. This concept might then explain the lack of males or incentives for males to be working in the medical profession.
What I am getting at is that the proportion of males vs females in bi-gender nudist activities might be a clue. Can anyone find for me the proportion of gender in bi-gender nudist activities? I Googles and I couldn't find the data.
Some may find this search worthless in the consideration of the differential treatment of men and women by the medical profession. However, I am interested. ..Maurice.
It is of interest to go back to March 2009 "Patient Modesty Volume 12" and read what was written then about modesty and nudity starting out with an excellent historical background by MER beginning with "One point I’ve tried to consistently make in my past posts is – how we feel about nakedness is contextual, depends upon the situation. The same person who may frequent nudist events may be embarrassed or even humiliated being naked in other contexts. "
You will find on that Volume 12, worthy comments by women but also by PT. Here is what Suzy wrote which I found of special interest: "Modesty is about controlling who has access to viewing or touching our bodies. I have no issue about being naked, but about being expected to allow anyone who wished to have unnecessary access to viewing my body.
That I felt hate for these people who violated my privacy and my sense of dignity does not change the fact that the violation of my sense of modesty is what created that intense hate."
More than 10 full years have passed and what has changed? ..Maurice.
Maurice,
In nudism, ALL participants are in the same state of undress. I am sure that if the physician came in to an exam with 3 medical students, and EVERYONE was undressed, it would be much less traumatic. That has been proven in the Stanford Prison Experiment and most recently in Red Cross and Congressional Hearings on prisoner treatment in Abu Ghraib and GITMO.
In sociology it is the us/them mentality.
Furthermore, it would demonstrate what providers say to the patients now, they look at all body parts the same way.
-- Banterings
If "undressed" patient means "totally nude", there is no rational need for the patient to be observed, throughout any procedure, in that state--including a dermatologic screening or surgery.
I would disagree with Banterings that a patient would be comfortable to see "the physician and 3 medical students entering the patient's room everyone undressed", nude. What would be the clinical value of a patient witnessing such behavior. In addition, this impending interaction would be potentially unsanitary. ..Maurice.
Being one of multiple naked/nude persons feels different than being the only one naked with one or more fully dressed people in the room but the doctor and other staff being naked wouldn't woek for me either. My vote is unless a baby is being born or some other REAL reason, everybody's pants stay on. JF
If there is a female in the room I prefer my pants stay on......Donald
I have a question to my male visitors here which I have never asked directly previously.
As you know, I have repeatedly described the teaching to first year medical students performed by the male standardized teaching patients as the students are examining the teacher's genitalia. One issue discussed is what the student, later the physician, should react and communicate to the patient if the genitalia exam causes an erection of the patient's penis. Students are told to reassure the patient that this occurrence is occasional and physiological and represents nothing other than this was an excellent sign that no penile anatomic or functional pathology was present and the exam can continue with the patient's permission.
The question I ask to Donald is whether the concern is that if a female "is in the room" whether Donald fears a physiological penile erection may occur. Or is it more simply exposure of his normal flaccid penis to be observed by any female present.
..Maurice.
I read Suzy's account from all those years ago. I was both shocked but pleased with her for what she said to the staff. You can't accuse her of not speaking up. But even Suzy got the opportunity to send the nursing student out of the room. Not a very good opportunity, but she was still able to make it happen. Oftener however these extra people just appear when it's too late to prevent anything or sometimes it's isn't too late but the patient is too intimidated.
What I didn't get about Suzy is how could she take it so hard but not be modest in her everyday life. I don't undress in front of anybody in my personal life. JF
Maurice,
You cannot compare nudism to a medical encounter. The Stanford Prison Experiment and most recently in Red Cross and Congressional Hearings on prisoner treatment in Abu Ghraib and GITMO are more appropriate and more relevant sociological/psychological treatise on the subject.
-- Banterings
Due to length, I must do this in 2 parts:
Maurice,
I am going to prove you wrong on the issue that you put the onus on the patient to speak up, I will demonstrate that the physician has a duty to inquire.
Let us use the example of an allergic reaction to penicillin:
Why does the physician (provider ask if there is an allergic reaction to penicillin? Because penicillin is commonly used in the medical encounter and an allergic reaction has side effects that are significant enough to create a condition of harm that will significantly impair the patient's (quality of) life.
In the same token, a provider as a professional practitioner of medicine, one should inquire with the patient whenever there is to be, or even a chance of intimate exposure as the patient's comfort level with the exposure. Choosing to forego an intimate exam is a valid option as is leaving underwear on.
So what are the possible side effects and are they really that severe?
It is obvious that PTSD would be common in ICU survivors, but gynecological/obstetric procedures (vaginal exams, pap tests, etc) routinely cause PTSD in women.
Preferences for providers' gender is an obvious and well documented. One side effect of failure to inquire and respect gender preference is the patient will avoid healthcare. Patient avoidance of healthcare due to options for colorectal cancer (CRC) screening that are unacceptable to the patient is well documented.
end part I
-- Banterings
Part II
Even when guidelines are followed, it may be abusive to the patient. Look at the treatment of intersexed children The United Nations calls the medical treatment of people worldwide born with intersex conditions, or variations of sex anatomy, face a wide range of ... torture or cruel, inhumane, or degrading treatment (CIDT).
The medical treatment of intersexed children in the United States amounts to "medically sanctioned violence and torture".
The United Nation's Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment found healthcare to be guilty of such routine treatment of patients.
All following current, US, medical guidelines...
Trauma informed care is the most current research on this issue and REQUIRES the provider to be the one to ask the patient.
Medical procedures have often been used as analogues for sexual abuse (Money, 1987; Goodman, 1990; Shopper, 1995; Peterson Bell, in press). Medical traumas share many of the critical elements of abuse (especially childhood abuse), such as fear, pain, punishment, and loss of control, and often result in similar psychological sequelae (Nir, 1985; Kutz, 1988; Shalev, 1993; Shopper, 1995).
So again, I demonstrate that exposure and intimate procedures in the medical setting can cause adverse side effects. It would be NEGLIGENT for a provider NOT to ask and put the onus on the patient to "speak up."
Please stop blaming the victim.
-- Banterings
The physician should always encourage the patient, from the first "sit down" with the patient and repeated during the entire patient-doctor relationship, to "speak up". It is essential to obtain a complete and necessary history..it is essential to fully evaluate the physical findings on examination (such as abdominal tenderness to palpation) and, of course, for the patient to express their concerns about their illness or the way the interaction with the physician is occurring.
We teach the students to have the patient "speak up" from the very first day of practice on the hospital wards. As I have already mentioned here previously, the students don't just first enter the patient's hospital room with "tell me why you are here". The student first words to the patient are a personal introduction and their role, how they intend to interact with the patient and then encourage the patient to "speak up", ask questions of the student and provide them the patient's permission to proceed. In taking the history, "speaking up" by the patient is essential and the students will ask questions based on what the patient has as yet not covered as history. Throughout the interview and physical the student should be reminding the patient to "speak up" if they want to terminate the student-patient activity. The patients are aware of this reminder and occasionally actually tell the student that the patient is tired and would like to end the interview and exam to which the students obey the request. Now, of course, in a physician-patient relationship, the physician may want to provide a rational argument to the command what the patient "speaks up" whereas first and second year medical students regularly will not present arguments to the patient's "speak up" request or command.
So Banterings, all physician's instructions should be assumed by the patient to be a request for an action that requires the patient to "speak up" any concerns or misunderstandings. And it would be and should be the physician to encourage "feedback" from the patient. ..Maurice.
Maurice
Regarding the discussion as it refers to nudism, nudist events, there is no power differential, therefore that subject has no application in any form as it relates to this material.
Secondly as male patients we have a real concern with some psycho female striking nurse striking our genitals with a spoon over a moment of the parasympathetic division of the autonomic nervous system.
Show me any literature of male nurses doing this to their female patients, I assure you there are none! Finally, you say that you see no clinical value in having the physician and 3 med students entering the patient’s room nude. Yes, I’ve said that in sarcasm but then I’ll ask you what is the clinical value of having spectators in the room when it’s obvious, there is no clinical value.
PT
Maurice
I think Banterings has made a very important point. “ So again, I demonstrate that exposure and intimate procedures in the medical setting can cause adverse side effects. “
Hospitals should post signs up for their male patients.......” Warning, an erection in this facility can cause you serious bodily harm”
I think he hit it right on the nail with that statement ( No pun intended).
PT
Maurice,
When you phrase it that way (above), then it does not sound like victim blaming.
It is not simply the patient "speaking up," it is the provider being cognizant of patient dignity and eliciting feed back.
The student nurse that you experienced, if she was cognizant of patient dignity, she would have discussed with you the reasons for checking INCLUDING NOT checking, then asking your permission.
-- Banterings
Good Evening:
Doctor Bernstein you asked Donald
"The question I ask to Donald is whether the concern is that if a female "is in the room" whether Donald fears a physiological penile erection may occur. Or is it more simply exposure of his normal flaccid penis to be observed by any female present."
In my case the possibility of erection has nothing to do with it.
I simply won't allow a woman I don't intimately know, see me in such a compromised position. I'll cancel the exam until I find a male who doesn't need people watching what he does.
regards,
NTT
Banterings, with regard to your last posting. Personally, whatever the etiology, my mental state was not sharp and I don't recall exactly what she told me or asked me though I do recall what she did overall was at a high velocity which is not what I would expect for a medical status evaluation by physical exam. But I said nothing. I can tell you that her exam was finished in less than 1 minute. But as I may have mentioned previously, I didn't react like a teacher observing the behavior of a medical student. ..Maurice.
P.S.-From my initial introduction to her by the female nurse on duty for me, she was a graduate in nursing though this experience was for meeting license requirement and "consideration for employment at the hospital." So I suspect, the graduate was simply in the act of completing a requirement. ..M.B.
"Furthermore, it would demonstrate what providers say to the patients now, they look at all body parts the same way."
-- Banterings
Good point. How selfish and arrogant of the providers not to share this ability [look at all body parts the same way] with sexual perverts. My understanding is that many sexual predators are looking for help with their addiction. Undoubtedly many of them could and would benefit from seeing the opposite sex as just all elbows. If the providers had sympathy for the sexual victims, they would surely devolve the secret.
BJTNT [male]
PT said: Finally, you say that you see no clinical value in having the physician and 3 med students entering the patient’s room nude. Yes, I’ve said that in sarcasm but then I’ll ask you what is the clinical value of having spectators in the room when it’s obvious, there is no clinical value.
This is a key part of what many physicians, nurses, and techs miss. Yes the patient may need to be exposed to the staff person doing the exam or procedure in order to receive the care they are seeking. The observers do not add any benefit to the patient, and such observers should thus only be there with the express consent of the patient, hopefully before they ever enter the room. If consent is not requested until after they enter, the power differential could be too overwhelming for most patients to answer honestly if their preference is really not to have observers. That there is benefit to the observers does not trump the rights of the patient to have their dignity respected.
You know, the time (minutes not seconds) that the professional allows the patient to make a personal decision regarding matters of dignity and modesty is a factor which has not yet been discussed here.
Take for example my experience in my hospitalization over a month ago to provide possible support to what I just wrote.
A lot has to do with the "velocity" of the words spoken in the request to the patient or does it?
As I was moved in my bed to the destination of my hospital room, as I previously written here, the first words I heard was from a nurse asking permission for taking a photograph of my "back" (actually in turned out from the photo back and buttocks and a bit of scrotum). I can tell you the words of the brief sentence were expressed "in a rush-like" manner. The same was true a couple days later when the attending nurse asked for my permission to have the "nursing school graduate" participate in my care. I can say in both cases the words came out zip, zip, zip (at least the way I recall). I think, in part, it was the brief request at high word velocity that may have had an affect on my response. (I must say, however, that with regard to the photograph, as I have previously written, I did understand readily the rationale.) With the request about the former student, the few words quickly presented to me may have affected my quick 'ok' without going into any detail as to what responsibilities the former student would have.
What I am trying to get at here in telling "my story" is that the velocity of the description to the patient about what may be happening next or what has already happened but awaiting a "speak up" response by the patient may affect how the patient responds. Does the professional speak "in a rush" and will that affect the response by the patient?
So now let's see what my visitors think about this possible "velocity" factor in a "thought out" personal response by the patient. Can the "speaking up" be affected? I think I gave examples in my experience which could be examples of my question. ..Maurice.
Dr. Bernstein, I hadn't thought about it before but a high velocity "request" such as you described is likely perceived by the patient more as a command or a notification than it is asking for consent, especially if the tone of voice is authoritative rather than inquiring. No doubt they are trained to do it that way so as to be able to document that consent was obtained without actually going through the trouble of truly obtaining informed consent.
Banterings said: "Furthermore, it would demonstrate what providers say to the patients now, they look at all body parts the same way."
This has been discussed many times. If it were even remotely true hospital and medical practice staff wouldn't shy away from getting medical treatment that involved their being exposed to their co-workers. If skin is just skin and body parts are just body parts and there is nothing sexual about healthcare, then being intimately exposed to their co-workers for medical purposes wouldn't be an issue for them. It is an issue however because they know that mantra is not true.
It has also been noted many times that no medical or nursing school would ever expect their students to allow themselves to be intimately examined by their fellow students nor do any medical or nursing schools expect their faculty to serve as standardized patients in this regard. Why? Because they know skin is not just skin and body parts are not just body parts.
When those who work in healthcare practice what they preach then we the patients can believe their "nothing sexual about healthcare" mantra.
Biker, your interpretation of what I was trying to express is correct: the rapidity of presenting the request reflects to the patient an intended "command" response rather than simple decision regarding "consent". And it is more difficult to request more details,interpret and respond if one is at the time symptomatic.
With regard to students examining each other, as I have previously written here, they do examine each other, usually men-men, women-women or women-men but more than rarely men examining the woman student. However, breast exam is practice on bare chested male students and women retain their bras. In any event, breast exams are later detailed and practiced on bare breasts of standardized women teaching "patients" as well as pelvic exams. Occasionally male instructors permit their chests and abdomen be student-examined. In my 30 years experience as instructor, I don't recall participating in this way but remain upright and ambulate from table to table to screen and teach.
I would summarize by saying for the majority of clinicians, the goal of establishing a diagnosis for effective treatment within the their mind trumps "something sexual" which might arise. ..Maurice.
Hello,
Can we categorize the "velocity" of health care as Mach 1 (i.e. By the time you're asked for a response, the procedure is already completed.) The notable, positive health care encounters are those in which the physician, nurse, etc. treats the patient as the most important consideration at that time. Too often the patient feels as if he/ she is just another procedure to be done in order to get to the next, and the next ad infinitum. Health care has not recognized the counter-productiveness of this merry-go-round. Placing the patient foremost at that time will save many later call button requests.
Reginald
While in the hospital, a female trainee transported me to Radiology. She asked if I could stand for the X-rays. When I replied "yes", the trainer rushed over with a strong tone telling her that it was time for her to be trained, both transferring a patient form gurney to bed [for the X-rays] to gurney plus training on taking x-rays. I looked at her to see if she would stand at attention and salute. The trainer never said one word to me.
It was clear I was to be the test dummy. The move from gurney-bed-gurney was unpleasant since it was a training exercise.
The 11 X-rays, taken for the training, involved re-positioning which was not comfortable. Why couldn't the re-positioning be w/o X-rays? Later I asked the MD how many X-rays he needed. Of course, only two. Roentgen accumulation is not a problem for the employees since they stand behind protection. I received 4 1/2 times [{11 - 2}/2] the required dosage, which is not a problem for an object.
Neither the trainee nor I said one word during the training. I knew my choice was to leave the hospital or endure the vengeance of the trainer if I had asked to stand for the X-rays or limit the X-rays.
Several days later, the B bed was to be given X-rays with a portable machine. All employees were told to leave the room. The tech, with a lead apron, stood by the door which was twice the distance from the machine that I was. Patients are just objects not affected by Roentgen ray accumulation.
This time I knew my nurse had orders to discharge me. I jumped out of bed and rushed out the door. It even attracted attention in the hallway. I told the nurse and the student nurse about Roentgen rays. The nurse's response was "I'll process your orders". This was 11-11:30 AM. Four days earlier I was discharged at 2-2:20 PM when both times [just a few doors away] the hospitalist told me between 9-9:30 AM that I would be discharged. Control, control, control. I know - just a coincidence.
BJTNT [male]
Dr. Bernstein, the student on student and student on teacher exams you describe do not include female breast exams or genitalia exams of men or women. Why not if there is nothing sexual about healthcare? It is just a clinical process after all. The same goes for hospital and medical practice staff not receiving intimate care where they work. Why not if there is nothing sexual about it? The answer is the student, teachers, and hospital/medical practice staff do see a sexual component to it. It is just convenient for them to say otherwise when it comes to modest patients.
Biker, with regard to your last posting. The reason for the presence of a female chaperone during a male physician's pelvic exam on a woman is there for emotional support for the patient and perhaps legal protection for the behavior of the physician. From a technical point of view, a routine pelvic exam itself does not require in most cases the assistance of another person or professional. So obviously in this procedure there is something "sexual" in its performance by a male physician. And there is a "sexual" feeling when the students are examining each other in class to explain the observed general gender division seen with students examining students of their own gender with occasional exceptions of female students examining male students and vice versa depending on the anatomic area. Female student's breasts are usually not fully bared in the classroom but the bras edges are seen to be usually pushed around a bit. Systematic palpation is usually demonstrated to all students on a male student who volunteers to be the subject.
When the inguinal region of the abdomen is to be examined on a female student or even a male student it is often performed through slightly "pushed down" clothing even though the remainder of the abdomen had been bared in both genders.
My conclusion here is that "sexual shyness" is present between medical students practicing some aspects of a physical examination on each other. What happens, later on in their interaction with other professionals in their life, I don't know except whatever I have written here about me personally (repeated Foley insertions by female nursing staff which was free of any improper behavior, non-disturbing for me preparation for surgery in the past "shaving" my groin by two nurses and most recently photography of my "back" and super fast "exam" (including Foley-penile tip) by a new nursing school graduate. ..Maurice.
Maurice,
As a first time patient for prostate problems, you are (unfortunately) going to have a view of healthcare that we all know to be the truth. Like many of us, you may ignore what happens, never bringing it up, pretend it was not so bad, and so on.
But, when you are alone with yourself, the feelings will creep up on you. You may find yourself in your bedroom midday, hiding from whom ever else might be around fighting back tears.
I hope that you never experience what we all have, but I have no faith in medicine any more. You have already experienced it with this student nurse who was more concerned about checking off skills and getting a job ($$$MONEY$$$) than your human dignity.
If this happens, PLEASE DO NOT HESITATE TO REACH OUT TO ANY OR ALL OF US HERE. This has become a place of healing.
As to your question of velocity: it has been discussed in other threads. It is called AMBUSHING.
Let me refer you and everyone else to one of the most definitive treatises on the subject: Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations by Joan P. Emerson.
-- Banterings
Maurice,
A male intimately examining a male and a female intimately examining a female also have a sexual component.
...but we are told as patients that there is nothing sexual about it, providers are professionals, we are crazy, blah, blah, blah...
-- Banterings
Good Evening:
Banterings is right about the prostate problem which is why men must do better and take a stand. And I too equate velocity with ambushing. Whenever a healthcare worker speeds up their speech that says they want to do something I more than likely wouldn't go along with. So when they are done speed talking, I ask them to repeat what they said at a slower pace. Then I say no way.:)
Healthcare acts like a baby yet they want society to believe they are all grown up & should be treated them like gods. They are of the belief they are above the law.
They KNOW that ANY interaction between a female provider & male patient WILL HAVE a sexual overtone attached to it so stop saying it doesn't & call a spade a spade. It's called being human. Neither gender can get away from it so stop trying.
If you really want to do something about it, when a man asks for a male nurse & you say there isn't one available, pull a male hospitalist in off the floor to handle the job. Stop saying there's no males available.
BJTNT you are correct in that all the public is to the healthcare system is a $ sign. Hospitals are the factories with the production lines in them. Get them in & out as quickly as possible. Keep them dollars coming!
Today there are very few independent doctors with their own practices left because they stupidly fell for corporate America's sale pitch for a better life hook, line, & sinker. They gave up their freedom and what did they get back in return for it, physician burnout and the patients got crappy care.
In closing tonight.
There needs to be a grass roots movement in this country to completely change the entire American healthcare system. From the mis-guided embedded culture to the way payments are made. Everything needs to change.
Society needs to force hard changes on the system because they have proved beyond any shadow of a doubt, they won't change their ways unless forced to do so.
We need to get back to PEOPLE FIRST. I know, it's a tall order.
Regards,
NTT
Maurice
It’s very hard for patients to “SPEAK UP” as you say, particularly when they are ambushed. Why do patients need to be ambushed in healthcare? I used to think ambushing is something people did when they robbed wagon trains in the wild wild west or when the cavalrymen came upon Indian teepees.
The majority of patients that are ambushed in healthcare are men. Why do we have to encounter “gangs” of people when seeking our healthcare? How many people does it take to change a lightbulb? Obviously, nurses are paid very well these days, especially school nurses.
A recent article on yahoo about a female school nurse having sex with one of the 13 year old students at the school. To keep him from reporting her she offered to pay him $2,000.00. School nurses see what the female teachers are doing these days so they want in on the action too I suppose.
PT
Good Morning Everyone:
PT, society still won't accept females as being predators like their male counterparts. That school nurse you spoke about, just must complete a 120-day program to the satisfaction of the judge & she doesn't have to serve the rest of her 7-yr. prison sentence. Still no equality.
Why do male patients need to be ambushed in healthcare?
I believe that female nurses are taught this method in nursing school then it gets reinforced by their peers on the job as a method for them to get the quick upper hand on young, old, and other male patients that have not had any previous experience within the system to get them to do her bidding. Those of us that have had previous experience know it's coming & can just stand our ground against it.
If our healthcare community were to grow up and start showing some maturity and begin respecting their male patients, this method would probably go by the wayside.
The system is and will continue to get confrontations from men because they refuse to change their archaic methods of treatment towards men. When enough men finally speak up or they make a mistake with an individual who hold power, things will have to change & they won't be able to stop it.
People don't trust today's healthcare employees. As long as that mistrust exists, change will inevitably happen.
Regards to all.
NTT
NTT,
The reason that there are very few independent physicians is because they refused t police their own ranks of bad actors. This not only includes predatory sexual behavior, but incompetence, doing unnecessary procedures, working while intoxicated, and so on...
Then came the internet and the answer "because I am a doctor" no longer had any scientific support.
Then there is the "this is how we always done things."
What have these tree situations lead to? Increased litigation against physicians. Society has kept their part of the social contract, but ALL SYSTEMS SEEK EQUILIBRIUM.
Whether supply and demand in economics, chemistry equilibrium (the state in which both reactants and products are present in concentrations which have no further tendency to change; ALL SYSTEMS SEEK EQUILIBRIUM.
Society has done the same. It did not intervene and begin judging physicians, instead they legally were mandated to have malpractice insurance.
Insurance is simply money in vs. money out. It spreads the risk so everyone only pays a little money in. When a profession with practices as corrupt as medicine (such as performing PEs on anesthetized women without consent today), it's practices not socially acceptable, then there will be law suits across the board.
Now instead of spreading the risk, every member becomes a risk and they are essentially left to pay the full cost of their malpractice claims.
So they sold out to big corporations with deep pockets that can afford malpractice insurance so they can still practice.
Their hubris prevented them from giving up their paternalistic power. Society has made them irrelevant. They are no more than retail employees, just better paid.
-- Banterings
Banterings,
I believe a lot of their victimizing ways could be reversed if we common people could vote about laws instead of just the lawmakers. Who's to say large numbers of complaints aren't just being ignored?
Why can't we have a television show called "There Ought to be a Law! ? " where the majority actually does have a say? An actual tracking system? Letters with confirmation numbers and receipts? It wouldn't be only because of the flaws in Medicine though. But how medical is payed for would be a huge concern right off.
Requiring set prices, dignity issues and recovery...
Investigation of other countries policies , how are they able to accomplish what we can't?
My vote is we find out who is being overpaid. Investigate whether or not people are dead because of it ( individual cases ) and penalize the offending parties. JF
Ambush-Definition by the free dictionary
1. A sudden attack made from a concealed position. 2. Those hiding in order to attack by surprise. 3. In healthcare, men whose intimate exams are suddenly invaded by female staff without prior consent.
There, I fixed it for The free dictionary.
PT
With respect of my recent hospitalization and in reference to PT's definition of "ambush", I want to enter the following to the conversation.
I was never asked what gender of nursing staff or other hospital staff attending. However, I did not await that question nor did I make a request regarding gender. As I have mentioned, all the nursing staff were female except during one night my nurse was a male nurse. He did not behave in any different manner with regard to communication than the female nurses, though he didn't need to attend to me personally except identify himself, hand me the night-time pills and work on the computer in my room. Through my stay the techs were all female except one of the venipunctures carried out by a male. The physicians were both male. And finally, as I mentioned the fresh Foley was inserted in the Emergency Room by a female nurse.
Again, no "desired gender" requests were made to me and no spontaneous requests by me were made to the staff regarding the gender of those staff entering the room.
I would conclude that PT's definition of "ambush" did not apply to the experience presented to me nor my reaction. I would probably use other words for my experience:
Try this one: "arbitrary assumptions" made by the staff. I like that better than "ambush". It sounds less personally traumatic and more realistic with regard to the staff's behavior with regard to what I was experiencing. Also, I didn't find a "bush" from which the staff might present to me-- well.. may I take this back: I noticed throughout my hospital stay that the door to my room was always open but hanging drapes covered 90% of the opening requiring some flipping of the drapes to enter my room, so entry was usually sudden and no knocking nor can I recall request to me for permission to enter since there reason for entry was professional and the staff immediately, on entry, disclosed their purpose. Is that "ambush"? ..Maurice.
Dr B
You're not a person who has strong feelings about exposure. Not everybody does. Some do however and PT's definition is a good definition. It should have been banned a long time ago. JF
Dr. B.
It's ambush. Where else and under what circumstances would you allow anyone, except for a few family members, to invade your private space w/o request? This addresses the heart of the manner in the culture of the medical community. There is no private space whenever you submit yourself for medical care. You have given them permission to own your body.
BJTNT [male]
In the past 5 1/2 months, I have spent 19 days in hospitals, five ERs, four stays, three different medical centers.
Being an old man, I believe no female happened to see my outlier genitals. This avoided a peep show [unlike three years ago] because who doesn't have an interest in seeing an unique "elbow"?
In the first two days, I received none of my medication. Undoubtedly, they would tell me that the meds were in my IV. Live and learn. I didn't know eye drops could be given via IV. After two days w/o any meds, only once were the twice-a-day eye drops given more than once a day. The once-a-day drops were never given. Then pills in a hazardous way - some days, some pills. Of course always a prescription for a new pill. It does make you wonder about the importance of meds.
The ziploc bag holding my eye drops contained two bottles [a sixty day supply] which the hospital will not give you upon discharge. Is anyone interested in containing costs?
BJTNT [male]
So am I simply an anomaly in terms of concern about my personal physical modesty when I am being formally treated as a patient? Should concern about being physically "exposed" trump the potential medical/clinical benefits which can arise from such exposure?
Perhaps what makes me different than virtually all currently writing here now and in the past Volumes is that I have had no "sexual traumatic experience" in my earlier years and currently as a physician I am aware of the potential clinical value of physical examination, diagnosis and appropriate treatment. I am biased in this way because I professionally live it and have been teaching it for all these years.
I can also assure you that I found no evidence on my recent hospital admission nor of the prior clinical office visits that I have been treated as a VIP because of my profession. Of interest is that during the entire 2 and 1/2 day hospital stay, no one ever used the word "doctor" as part of my name.
What I am getting at is that I am sure that my experience is not a statistical anomaly. (Here I go back to statistics.) Has anyone here or in the past Volumes actually presented references to any statistical studies on this issue? I just don't remember. Am I an anomaly? ..Maurice.
Dr B,
I remember on an earlier volume a female patient talked about her male doctor undressing her and doing a well woman exam on her. She said she thought it kind of sexy.
There's a large number of patients who aren't especially embarrassed or who are euphoric to get that kind of intimate care. They are not who are concerns are about on this blog.
You don't have to answer this question but can you honestly say you're never secretly thrilled to see a female fully exposed to you? Or that you never have been secretly thrilled? Did the chaperone being there take that feeling away?
I hope I don't sound paranoid because this is what I actually think.
I think the opposite sex care was a deliberate thing. Disguised as care but designed by people with fetishes for people with fetishes. That DOESN'T mean that every medical person has fetishes though. Probably the number of staff who doesn't is larger than staff who does.
The male doctors ( or female doctors ) who examine patients while female staff nonchalantly stroll in and out, that's on purpose to. That physician looks SO dignified at their patients expense. JF
JF, never in my medical career has a patient been examined or treated fully naked. This "fully naked" is not in the best interest of the patient or in the best interest of making a correct diagnosis. (Again, fully naked state rather than systematic segmental exposure is not a fully accepted dermatologic procedure. What I have practiced over the years and what I teach my students is to expose the portion of the patient's body which needs the inspection, palpation, percussion and auscultation. Performing these components of the physical exam covered with clothing is at times worthless or provides misleading information. However, exposure of parts of the patient's body which is not at the time being examined may produce chilling, abnormal increased muscular tone to palpation elsewhere with shivering and, of course, as described here modesty concerns or concern by the patient regarding the "real interest" of the physician as fully described on this blog thread. ..Maurice.
You may be interested in reading Moof's responses to my blog thread titled "Invasion of Patient Privacy, Physical and Historical: Are Doctors Unaware?" Do you think the general public has the same attitude toward physicians as she does which she writes:
"Dr. Bernstein, I think that many of us are intimidated by the position, if not always by the individual ... and it's a rare physician who tries to dispel that. Actually, the very profession itself makes communication difficult relationally - it's like a fine balance between detachment and intimacy, and that can be very awkward on both sides: physician and patient."
Do you think that it is the "detachment" vs "intimacy" that may be part of the doctor-patient relationship that contributes to the concerns described on our "dignity" blog thread. How should both the patient and the physician create and maintain a balance between the two parts. Or do you think that this "balance" issue is not really pertinent to what you all are experiencing? ..Maurice.
Maurice
In all due fairness to those on this blog, those were your experiences. Yes, you are a statistical anomaly in the big picture but look at it this way, consider yourself lucky. There are a number of factors that are at play, remember the VIP card and consider your age to be a factor.
Sorry Maurice, don’t take that the wrong way but, it does play into the equation. Furthermore, you said “ all the staff were female except one night shift nurse.” Did you make that statement only to strengthen your assertion that despite the “ statistics” you only experienced arbitrary assumptions.
That’s the first clue to the big picture, why are there not an equitable gender staffing on nursing floors. HINT: We’ve heard all the excuses and the fact is, there are no excuses. Several comments ago I mentioned the female school nurse who attempted to bribe her male student to keep shut about the sexual relationship she had with him. Truth is there are hundreds of arrests just like this one regarding female school nurses. Female teachers having sex with their male students this year is up 680%.
It’s not just nursing that men have been kept out of but teaching as well and now look what happens. During your experiences as a patient you say that you were treated professionally and frankly I’m glad for you. But, what about those who have not, you’ve seen the articles, the discussions in the news etc.
You can’t say that it does not happen, you can’t say it hasn’t happened to us, just that it hasn’t happened to you!
PT
PT, you have defined my intellectual dilemma which I have had since this blog thread was first published: where am I and where are you within the statistical display? Where are the studies and where are the results of carefully crafted studies? Are "you guys" or
am "I" in the majority (or conversely minority)? Where is the data? The full and valid statistics have nothing to do with the published stories of "bad actors" and their unprofessional crimes--it has to do with solid statistical analysis. So where is that data..where is the final conclusion? ..Maurice.
Asking me about guns and seatbelts doesn't violate my privacy. Doing a vaginal swab when I could go in the bathroom and swab myself does. JF
🐵🙈🙉
How can there be data, how can there be statistical data when the secret weapon of risk management, the state medical boards and the state nursing boards work very hard to conceal it. Look at the three monkeys 🐒, the mainstay of hospital politics that have been in play for 50 years for there you will see why there is no data.
PT
And yet, PT, note there is research evidence demonstrating that there is attactiveness of women with rectovaginal endometriosis (a pathologic condition where the inner lining of the uterus spreads outside the uterus to other tissue and organs and causes up to serious symptoms but also according the the research sexual attractiveness. Here is the abstract of the published formal research:
https://www.ncbi.nlm.nih.gov/pubmed/22985951
Now, where is the research regarding the statistics of attention to male patient physical modesty? ..Maurice.
Maurice
That study was from Italy and what, why the motivation to do such a study is beyond me. Whenever there is research money to be spent you have to find something, anything to get a paper published. Don’t perform any study nor present any statistical data on privacy violations on male patients because, it will automatically file under “ male patient modesty issues”. Dont put a bad name on the nursing industry, don’t make waves on our gender neutral mantra that we created. Nursing has a fear of Homophopia, it’s ok that there are female lesbians but keep spreading the word that all male nurses are gay. Now, there Maurice, I fixed it for you.
PT
Maurice,
You state:
"Try this one: "arbitrary assumptions" made by the staff. I like that better than "ambush". It sounds less personally traumatic and more realistic with regard to the staff's behavior with regard to what I was experiencing. "
This is "...you haven't got anything that I haven't seen before..." Just because YOU are not traumatized by it, does not mean that those of us on here should not be traumatized by it. In fact, telling your story can be traumatic for some here. In psychology, this is called a "TRIGGER".
Some may also feel that you giving a pass to blatant bad behavior is also a diminishment of trauma that we experienced. You noted 3 examples of unacceptable behavior that should not be tolerated:
- Gaining your consent when you may not have been fully coherent.
- The student nurse doing the solo exam.
- Not knocking and waiting to be allowed to enter your room.
I understand this may not be traumatic to you, but PROFESSIONALLY and ETHICALLY this behavior is UNACCEPTABLE!!! By you giving a pass, you are part of the problem and NOT part of the solution.
Do you NOT teach your students about Trauma informed care?
I suggest that you educate yourself and this should be standard for the curriculum at your medical school. (All of medicine should be educated and practice it.)
Tying this into "triggers", you would see that those who have suffered traumatic events and/or those with PTSD may NOT be able to tolerate certain situations that remind them of the trauma that the rest of us give no thought to.
This is how survivors cope:
You also further ignore the feelings of the patient (and the concept of "...you haven't got anything that I haven't seen before...") by saying "detachment" vs "intimacy". Again, as the patient and a surviver I don't care how the provider feels.
-- Banterings
Maurice
As to "naked", there was once a time (surprised that you don't remember) when for the annual physical exam the patient would just get naked and remain that way. This continued in pediatrics (even for teenagers) into the 1990's. Do you not remember Dr. Atul Gawande's piece titled "NAKED"?
Medicine is very careful with its terms so that it can play semantics. Obviously the patient is NOT clothed, which is the opposite of naked. Medicine uses terms like "unclothed and draped."
There may be advantages to hospital gowns: They are functional, allow doctors to gain easy access to the patient to conduct a physical examination. They are also cheap and easy to clean.
Researchers in Finland have argued that wearing a hospital gown is often unnecessary and can even be traumatic for some patients.
A recent study found that patients are often asked to wear hospital gowns even when there is no medical reason for them to do so.
Research so far suggest that the hospital gown is undignified and adds to a sense of disempowerment and vulnerability.
This is made worse by the professional, authoritarian, white coat worn by doctors and nurses' uniforms, which can further increase the power imbalance.
Again, just because the provider says the patient is "not naked," it does NOT mean the patient doesn't feel naked OR that the patient is CLOTHED!
-- Banterings
Maurice
More on The free dictionary of the definition of ambush.(am bush)
I’m listing three examples of how ambush is used in healthcare, these are actual events that have occurred. My disclaimer to healthcare workers who peek in on this site. Many in the past have accused me of writing about medical situations that are fiction, note that these are events that have occurred prior to the inception of the Internet. I will list the where and how you, yourself, others can prove these events have actually occurred.
At a major teaching hospital in Indianapolis, Indiana between 1980 and 1985 , an appendectomy was being performed on a young male patient, age 7. The surgeon made several statement to the anesthiologist that the patient keeps moving, the patient keeps moving.
At one point the surgeon looked around the large surgical drape that goes above the patient’s head and is often affixed to two IV poles. The surgeon saw the anesthiologist performing oral sex on the young male patient with the endo trachial tube in the patient’s mouth. The anesthiologist was arrested.
A male gynecologist was examining a female patient on stirrups that recently had gynecologic surgery and was being seen for a follow up. There was a long role of gauze in the patient’s vagina. The gynecologist grabbed one end of the gauze and started to pull it and while holding on to the gauze, turned to the door and said “ have a nice day” and with the gauze in his hand continued to walk out the door and as the gauze unrolled out of the female patient’s vagina. He was reported to the state medical board.
A young female nurse working in pre-op at a prominent Indianapolis hospital would bully all her young male patients that they needed a Benadryl injection in the buttock prior to their surgery. She would then have them turn prone and pull their gown over their head, give the gluteal injection while their coworkers would peek around the curtain at the patient.
These three events were published in the Indianapolis newspapers between 1980 and 1987. Any library can request microfiche of all newspapers and with a weeks worth of looking these articles can be found along with other articles of how healthcare workers use the technique of ambush on their patients.
PT
A. Banterings
Many hospitals have pants as well in addition to the gown, but guess who they give the pants to these days and it’s not the male patients!
PT
Maurice et al,
The question has been posed here how to make a change. I think that I have the solution; let's apply medicine's ethics to its providers.
In light of the teaching of pelvic exams under anesthesia without consent, THEN the next time a medical student or healthcare provider is unconscious or drunk, feel free to have sex with them (no consent needed) & invite your friends (of all genders) to do the same.
-- Banterings
PT,
I wore long pants and a long gown in the hospital.
Donald
Good Afternoon:
Dr. Bernstein, you keep looking for studies. Our American healthcare system doesn't do studies about what would benefit their patients like new gowns & male caregivers. IF they were to do ANY studies, they are studies that were done in secret and will remain secret forever.
Reason being is that the medical community has spent decades keeping ANYONE with the influence and/or power to force them to change, to find out that they aren't doing right by the American people. They don't want ANY outside interference in the way they do business.
The gown studies that Banterings wrote about were done in other countries. American doctors want that feeling of power over their patient so they will not give up the gown easily.
And PT's correct most American hospitals won't just give a male patient hospital pants. He's got to know to insist on them or better yet, bring his own clothes if they won't interfere with why he's there
They know that the walls around them are cracking a little more with each passing day as more & more stories about how patients are being abused are getting thru the cracks and out into the public's eyes. One day a big enough story will seep thru the cracks & humpty dumpty will come crashing down.
The two things I really don't like about today's healthcare system are;
The pigheaded stubbornness of the system. Men aren't trying to take over. They just want the same considerations they give to women. There's absolutely no good reason if a male wants a male caregiver for a catheter insertion that a male hospitalist can't step up & do it if a male nurse is unavailable. Male healthcare has been ignored by the American medical community for over half a century now.
The other thing is the fact that lawyers are too scared to take the healthcare system on in court.
That's it for now.
Regards,
NTT
Donald
That’s wonderful, I’m so glad. After 4 decades of working in healthcare it wasn’t till the 90’s that I saw pants. Pants are never offered, you have to ask for them. I’ve never seen a long gown, what is that?
PS. You must have bribed the nurse,cna or just cried a lot.
PT
Dr. B.
I agree. Studies should be accomplished so we can obtain the real statistics, not just the self reported ones by the medical institutions. When will the medical community allow outside oversight, not just the current tame agencies?
What would be the number of deaths due to medical errors/mistakes [they report 250,000] including 100,000 due to bad sanitation? I'll bet the real numbers would be several times higher and I'm not a gambler. However, I never past up a mortal lock.
BJTNT [male]
They give it to whoever asks for it. When I had my surgery,once I was ready to walk around pushing my IV pole a CNA rushed over to me because unbeknownst to me my #$$ was uncovered. After that I saw a male patient with the hospital gown pants on and requested a pair. JF
My observation has been that studies completely ignore staff gender in scenarios where gender is likely the single largest factor. For example I recall a study about patient tolerance/embarrassment during urodynamic studies. They differentiated patients by gender, age, whether they had had the procedure previously, and whether the patient had received literature on the procedure beforehand but ignored the gender of the staff as a variable affecting patient embarrassment. How could they miss the single most important variable affecting embarrassment?
Speaking about "embarrassing" episodes in a physical exam or procedure between the physician and patient, try this link for s series of sad or "amusing" even if not valid examples of "15 Patients’ Most Embarrassing Moments in the Doctor’s Office."
Any similar experiences by the males and even females reading this blog thread?
..Maurice.
NTT is correct that the profession attempts to keep all its information secretive (just like the Free Masons).
The reason that the profession has lost the public trust is because the answer "I am a doctor" is no longer acceptable and has always not been correct.
Medical libraries kept the sacred knowledge away from the public. Unless one was a practitioner or medical student, no access was granted. We had to trust physicians. The internet has changed that.We now have all the scientific research at our fingertips, more than any physician can learn in a lifetime.
Patients also have access to communities of patients dealing with the same issues.
-- Banterings'
Good Afternoon:
I agree with Biker on the studies. They NEVER ask in those things if the gender of the providers is an issue for the patient.
A urodynamics study I read about today stated; "Urodynamic testing was performed by either a nurse or a medical assistant trained in urodynamics, with the attending physician in the room. The nurse or medical assistant typically placed the urodynamics catheters and get the patient ready for the study and the attending typically comes into the urodynamic room upon the commencement of bladder filling."
The question NOT asked in the study but should have been was; "How much of the patients discomfort was due to the gender of the providers?"
Same issue with a urology study done in Israel.
"Do Urology Male Patients Prefer Same-Gender Urologist?"
Same issue all they ask is do you prefer a male to a female urologist. No questions about the gender of the supporting cast.
I believe that the American medical community purposely NEVER asks about ancillary gender because IF too many men answered a publicly done study about gender preference in intimate medical scenarios they'd have to deal with the issue rather than keep brushing it under the rug. There would be a trail for someone to follow. That's a BIG NO NO in the American medical community.
Canada has a better grasp of the situation than the US ever will. They know there's no such thing as "gender neutral". On the website of St. Michael's hospital they acknowledge as much that ultrasounds can be a gender sensitive exam. Then they go on to explain your options right on their website.
https://www.stmichaelshospital.com/programs/imaging/ultrasound/exams.php
You'll NEVER see this on an American hospital website until humpty dumpty comes crashing down.
America is SO FAR BEHIND the rest of the world when it comes to the human side of healthcare, I don't know if we can or will ever get out of the dark ages.
That's it for now.
Regards,
NTT
NTT
During urodynamics testing the physician ( urologist) is never in the room and dosen’t need to be.
PT
Deliberately
Please be sure all postings are identified with a name or pseudonym.
In the context of all which has been written on this blog thread, BJTNT has been recently following his pseudonym with his gender.
That brings up a worthy issue regarding the interpretation by others, especially those reading the postings here for the first times, as to the gender of the writer. Do you think that gender identification (and would that also include, well.. I am sure you all saw the Facebook List (Summarized by ABC News) from Agender to Two-Spirit
One can argue that what is written here is tempered, shaped by the individual writer's gender, gender definition and gender experience. If so, should we all just guess? Or what is written or how it is expressed is more factual or thought to be factual of what is really going on within the medical system and each writer defining their gender is unnecessary.
I think this is an important issue to discuss and one which hasn't been brought up previously (as far as I can recall).
..Maurice (Male)
Good evening:
PT the urodynamics study with the attending physician in the room was done at the University of MI.
I agree normally the attending never shows.
Regards,
NTT
Per PT
"During urodynamics testing the physician ( urologist) is never in the room and dosen’t need to be."
That was certainly the case in my urodynamic test. The MD wasn't present and if I did not make my preferences known I most assuredly would have been attended to by an LPN and a medical assistant, both female.
58flyer(male)
They could still be assaulted outside the facility. Also who's to say that the so called false accusations by female patients against male doctors might actually be true? When those kind of accusations occur both accused and accuser should be investigated. JF
Dr. Bernstein, concerning your "15 Patients" list, I would bet my bottom dollar that those mothers sending their Middle School and High School sons to female pediatricians for intimate exams would never ever send their Middle School and High School daughters to a male pediatrician. Mothers contribute to the socialization of their sons that they should not have any expectation of same-gender privacy or dignity in healthcare settings.
Good Morning:
If the American medical community can't or won't support a man's right to his dignity & privacy, then they should stop supporting a woman's right also & let her take the luck of the draw just like guys are being forced to.
There has to be a way to get this issue out of cyberspace & into the open where it can be freely discussed by any & all interested parties.
Regards,
NTT
My question is why should those kids be getting intimate examinations anyway. Biker, male gynecologists are much less common that before. PLENTY of girls were examined by male gynecologists or male doctors in the past. JF
Maurice,
Most of those genders are duplicates.
Philadelphia is San Francisco on the East Coast" because of the city's history of Quaker tolerance. The Quaker tolerance has allowed for the respect of the human dignity of those who have been marginalized. The first great historical occurrence of this is the underground rail road running through the Greater Philadelphia area. Later, it became a safe haven for the LGBTQ community.
Having many friends and colleagues on the LGBTQ spectrum, one learns about the variances in human sexuality and respect for fellow human beings that may be different.
What has been traditionally called gender or sex, is NOT a single thing, but rather it has 5 very distinct components.
- Gender/identity: This who you see looking back at you in the mirror. How YOU define your gender.
- Presentation: How you present or express your gender to the world. (Do you wear a dress or pants?)
- Sex/phenotype: What you were born with between your legs (so to speak).
- Attraction: This attribute has 2 subsets
- Romantic Attraction: This who you are mentally attracted to (personality).
- Sexual Attraction: This who you are sexually (physically) attracted to.
The answers to these 5 questions can be; male, female, both, or neither. These answers may not be set in stone, they may fluctuate.
Someone VERY, VERY close (and dear) to me is non-binary, gender fluid, and prefers to present as female. So what does this mean? For her:
Gender/identity: She sees herself as both male and female, but MORE female.
Presentation: She dresses androgynous (having the physical characteristics of both sexes) with more feminine attributes for work and some family functions (an unfortunate necessity), but prefers female attire. She wears eye makeup all the time, hair is long and highlighted, wears large female earrings, painted nails, etc. She has a feminized body.
Sex/phenotype: She was born male.
Attraction: This attribute has 2 subsets
Romantic Attraction: Her wife is cis female. (Due to wife's health condition, her wife is unable to have sex any more.
Sexual Attraction: She has sex with both men and women.
Non-binary means that she is not either male or female. Sometimes she is one of them, most times she is a combination (leaning heavily female usually), sometimes she is neither, sometimes she appears to be something else. Gender fluid means that she can very easily change how she presents or sees herself. The insurance industry and legal industry that both her and I work in are very alpha male dominated. Her personality is totally that of an alpha.
One reason that we are such good friends is that she shares my disdain and avoidance of the profession of medicine. Out of curiosity, I asked her what she preferred for intimate care. (Like me), her first response is "no one" and that intimate care is NEVER necessary, so she would refuse. Pressing the subject, she said on the very unlikely chance that she would seek intimate care, she prefers male.
No surprise that she presents to her PCP as male and there is no mention of her gender issues in her medical record. As she puts it, "It is none of their God damn business..."
I agree with that. Since we avoid preventative care, what the hell does my gender have to do with a sore throat?
So, how SHOULD healthcare handle provider gender for gender nonconforming patients?
The same way that it SHOULD handle it with cisgender patients: ASK THEM. Even if a patient does not have a gender preference in providers, OR if the patient's gender preference is respected, the patient may not be comfortable with the individual provider. In the same respect, a patient WITH a gender preference may allow a provider not of the preferred gender to care for them.
-- Banterings (alpha-male)
JF, what's past is past. Yes women had no choice but to see male doctors long ago. For the most part women can now choose the gender of the doctors.
Middle School and High School boys routinely get intimate exams if they want to play sports; checking for hernias is standard protocol. Girls that want to play sports don't get intimate exams. High School age boys routinely get testicular cancer exams when they get annual physicals. And with women rapidly taking over the ranks of pediatricians, boys can increasingly expect all of these exams to be done by female doctors while their female chaperones watch. As female NP's increase their presence in primary care, it could also be them that are doing these sports & school exams.
Good Evening:
If this story doesn't prove beyond ANY shadow of a doubt that ethics is out within our medical community none will. Civilian oversight must happen soon.
This sounds like an old episode right out of Law & Order.:)
https://www.nytimes.com/2019/08/21/health/sperm-donors-fraud-doctors.html
Regards,
NTT (m)
Banterings wrote: "Since we avoid preventative care, what the hell does my gender have to do with a sore throat?" How about oral gonorrhea? particularly in men who have sex with men. ..Maurice.
It’s sad, isn’t it. That all the bad, the ugly, the stupid knee jerk reactions and all the other misgivings that happen in humanity affect the care that many innocent male patients recieve. Our healthcare system it seems was invented somehow just for women, but that it was an afterthought for men. The gowns, the women’s centers, mammo, labor and delivery as well as a labor force that is predominately women.
That all the negative that some men do in turn negatively affect the care that most men recieve.We are now seeing an increase in the bad, the ugly misgivings that women do in healthcare. The question is, when is that going to come back and negatively affect the care that most women recieve.
For the gay community, their healthcare and their right to be treated professionally should never be paramount nor exceed the rights I, a heterosexual (straight male) should recieve. I in many regards believe that all the unprofessional behaviors that male physicians have exhibited in the past has and going forward will negatively impact the care of many future male patients. I can say the same for many female nurses and physicians in that regard.
PT
I don't care what questions they ask me, my just taking the attitude that it somehow might matter to them even if I don't understand why they are asking. That said, if they don't tell me why they want certain information I may not answer fully or truthfully. This is especially so since the advent of EMR's that freely make my info available to people who don't have a need to know. Its not that I have dark secrets but rather that unless it is pertinent to the medical services they are providing it is none of their business.
What is important to me is not what questions they ask but rather that my providers and their staff treat me with dignity and respect my privacy. While for me that means male staff for intimate matters, I accept that is not always possible. It is always within their control however to not have extra sets of eyes without my prior consent and to not expose me more than is necessary (as opposed to convenient for them) or for longer than is necessary (as opposed to convenient for them). It is within their control to always ask for my OK before exposing me or otherwise doing something to me.
It's not wise for me to have run my mouth as much as I have. Were the kind of retaliations I have talked about to actually happen, I could be investigated.
I wouldn't fear a REAL investigation because I would be exonerated but our judicial system is appropriately as ethical as The Wonderful World of Medicine.
I looked back at some of the earlier volumes and read about a young boy getting hit by a car but was uninjured because the car was barely moving. He told the attending adults that he was fine. And he was until he was taken to the hospital to be checked. Once there a nurse forcibly depants him and Dr Penis flicker, flicked his penis a few times. The boy was fine when he entered the hospital but left " with a life long scar !"
The fact that the doctor was protected by law doesn't matter to me because we don't get to vote about laws. That doctor was a legalized child molester and so was the nurse and they both should have had their hands surgically removed. JF (F)
Marice,
Are women not prone to oral gonorrhea?
Again, they do NOT need to know about my gender. Regardless of gender, they can ask:
"Due to your specific symptoms, there is a possibility that you may have oropharyngeal gonorrhea, or oral gonorrhea, which is MOSTLY from having oral sex with a man who is infected with it but can also from having oral sex with an infected woman or kissing [1] an infected person of either gender. Is there any possibility that you have engaged in any of these activities 3 months prior to the symptoms of your sore throat?"
[1] Chow EPF, Cornelisse VJ, Williamson DA, et al Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men Sexually Transmitted Infections Published Online First: 09 May 2019. doi: 10.1136/sextrans-2018-053896
Within the oral cavity, the pharynx is most commonly affected. Pharyngeal infection is reported to occur in 3% to 7% of heterosexual men, 10% to 20% of heterosexual women, and 10% to 25% of homosexual men. It usually is seen as an asymptomatic infection with diffuse, nonspecific inflammation or as a mild sore throat. The likelihood of transmission of pharyngeal gonorrhea to the genitalia seems much less than that of genital–genital transmission. Of significance, however, is the fact that N. gonorrhoeae has been cultured in expectorated saliva from two thirds of patients with oropharyngeal gonorrhea. (Source)
If the physician pushes the subject, THEN JUST LIE> I encourage people to do this especially when providers refuse to respect the patient's right NOT to DISCLOSE and right NOT to DISCUSS>
Just as physicians have ethically justified to THEMSELVES to lie to patients (AND they do lie to patients), SO patients have ethically justified lying to providers.
Both sides know that each other lies.
It does not build trust in the physician to tell the truth (by patients) when "Much of the research on
patient dishonesty has concluded that patients lie because of psychological disorders or financial
gain. "
-- Banterings
Good Evening:
If your a guy & the doctor knows you don't have much experience within the healthcare system & he wants an intimate related test, he will lie to him as to the ins & outs of the test so he takes it. Happens ALL the time because they know if he knows ALL about the test he may not do it if females are a part of it.
So yes doctors do lie to patients.
Regards,
NTT
NTT, they aren't technically lying to the inexperienced male patient but rather they are not obtaining informed consent. Same end result though. In effect they have set the patient up for an ambush that serves their purposes to the detriment of the patient.
Having had my own deer caught in the headlights moments I now know it is unlikely anyone I interact with is concerned with obtaining informed consent when scheduling me for a test or procedure and that its on me to ask questions and do my own research as to what it entails.
Good Afternoon:
True Biker they are setting him up to be ambushed.
Been there done that so to prevent it, I don't allow the office to schedule any appt. until I am satisfied what it is they want, & everybody who will or could be involved. Without that info I don't do any tests anymore.
It's the only way to keep from being ambushed.
I wish our medical community would grow up because this is not the way it should be.
Regards,
NTT
As a physician, I am perfectly comfortable with the act of "informed consent" under all circumstances (clinical decisions, clinical examination, testing or radiologic procedures, surgery which apply to the patient but also actions, behaviors or rules which can affect family members.)
"Informed" should be "understandable" by both the patient or family. The degree of "informed" presented should always be guided by clinical importance but also signs of understanding by those receiving the information.
Except for life-threatening emergencies, time should be made available for all patients to be informed.but also "listened to".
If all this communication is followed irrespective of patient gender, the immediate and long term benefits for the patient, the family and even for the healthcare provider should be substantial.
If everything I have written is "wishful thinking" then it is time for an evolution in how medicine is practiced. And it will take the patients themselves and aware medical profession teachers and ethicists to initiate the change in practice. ..Maurice.
Good Morning:
A man, recognizing he has a medical issue has decided to seek medical help. He goes to see his provider. His provider knows most males won't speak up as far as their comfort level with opposite gender care. Its just a fact of life.
Where I see the ball is being dropped is on the provider side. Providers don't see males as having dignity issues. That has to change. Providers need to go to bat for their male patients against the hospitals.
They know guys won't speak up so it's up to the provider to make sure their patient knows everything about any exam, test, or procedure the provider feels are necessary for their diagnosis.
After the patient is told ALL the ins & outs of what they want done the provider should ask point blank are you okay with being intimately exposed and possibly handled by opposite gender staff? If you're not, that okay, we will find a way to do the exam, test, or procedure in a manner comfortable for you. But you have to tell me if you're okay with it.
What's happening is the provider wants something done so they blindly send them off to the lions den unprepared for what's ahead of them. If the issue the patient is there for is intimate in nature, the patient may or may not go back because they got shell shocked by the way they were treated for the test.
On intimate issues, the provider needs to become a confidant to the patient & work with hospital staff to take care of the patient's needs so they can do whatever tests the provider wants.
Our medical community knows men have issues with intimate care.
It's time the community pulled their head out of the hole in the ground & worked together with men instead of forcing them to put up shut up & do it or walk away.
The community has ways of dealing with this issue they just won't do it. Male radiologists can be cross trained on ultrasound. Male hospitalists, can step in for issues like catheterizations.
There are ways. I'd personally like to know why healthcare refuses to treat their male patients with dignity & respect.
Regards,
NTT
ATTENTION: NO FURTHER COMMENTS WILL BE PUBLISHED BEGINNING TODAY AUGUST 24 2019 ON VOLUME 103. FURTHER COMMENTS NOW CAN BE WRITTEN TO AND PUBLISHED ON VOLUME 104. ..Maurice.
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