Preserving Patient Dignity (Formerly: Patient Modesty):Volume 104
What emotional reaction to the behavior of the medical profession in the examination and treatment of male patients is the basis for what is being discussed here? Is it fear? Is it not fear itself of exposure but the discrimination when considering the behavior of the profession to female patients.
Have we detailed here the opinion of the psychodynamics of what is really going on in the mind of the male patients who are attempting to survive their illness but also survive the alleged emotional mistreatment by the medical profession on male patients? Is the real upset, evidence of gender inequality in medical care with regard to bodily privacy? Let's get down to the "nitty gritty" if it hasn't been clearly defined in all the Volumes up to this new Volume 104. ..Maurice.
Image: From British Museum via Google Images. For details of the image this classic image drawing read the information at https://www.britishmuseum.org/research/collection_online/collection_object_details.aspx?assetId=192152001&objectId=711876&partId=1
BEGINNING SEPTEMBER 14 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON VOLUME 104. YOU CAN SUBMIT YOUR COMMENTS NOW
TO VOLUME 105.
posted by Maurice Bernstein, M.D. @ 8:56:00 AM
174 comments
174 Comments:
NTT said
“ Male radiologists can be cross trained into ultrasound and male Hospitalists can step in to do catherizations”.
Male radiologists nor female radiologists for that matter are not trained to actually perform an ultrasound, they only read them.
A radiologist is a physician. Now there are male ultrasonographers but in the field of sonography, women out number men by
a factor of 9:1.
Another point I’ll make is that a hospitalist is a physician. You are never going to find a hospitalist that can/will insert a Foley catheter and to be quite honest there are many Hospitalists although they are physicians have never in their training/career inserted a Foley catheter.
Many Hospitalists are typically internal medicine physicians and or pulmonologists and are not always at the hospital on a 24 hour basis. The best approach is for the nurse to find someone that can perform a the catheter placement who you would be comfortable with.
NTT, I appreciate your comments but I wanted to interject and let everyone know what the role of practitioners are in hospitals as well as what the real world scenarios are. I’ve said this over and over and that is that I believe a scrotal Ultrasound could be performed with the patient covered. A vaginal, transvaginal ultrasound is performed with the patient covered, thus why not men for their scrotal exams?
The answer is feminism. Feminism is the answer for most of the concerns that are presented on this blog. Feminism has created a two dimensional healthcare system, one for women, one for men. Feminism sets the rules as to how each gender is treated, not the physicians.
When you perform an ultrasound, the transducer(probe) is touched to the anatomy, from there on your eyes on the screen. You do several things with the probe. You angle or press on the probe to see the various structures. There is no reason to actually see the body part. For that matter the patient can guide the transducer ( probe) to the site (under a sheet). Note the transducer (probe) is prewetted with a gel.
The licensing agency for all ultrasonographers ( sonographers) is through the www.ARDMS.org and for a moment take a look at the gender of those in that licensing agency.
PT
There is nothing more valuable than a blank stare during conversations of debate. Ask any female nurse why they don’t hire more males into nursing, their reply will be “ well not many apply”. Yet secretly, they don’t want them applying. They make up stories that all male nurses are gay and additionally the nursing industry shuns them.
Ask a female nurse why there are only female mammographers. Ask a female nurse why only female nurses work in L&D. Then ask them why if everyone is a professional why they don’t hire men in these roles? If females are soo professional doing intimate care on male patients then why are there instances of the Denver 5 or the operating room staff of Twana Sparks.
My disclaimers: Note that I will no longer use Dr. Before Twana Sparks name because I think she is unworthy of the title.
If male nurses can’t be trusted in working on pediatric nursing floors ask them why are female nurses being arrested at Grade Schools having sex with young boys and offering $2,000.00 as bribes. They can’t be trusted around children either.
It’s been reported that Ob/gyn residencies are for the first time seeing over half of the class as females and I believe these numbers will swell closer to 100%. Not that I care but it would be priceless to see blank stares of practitioners who somehow think that as their patient population continues to shrink that somehow healthcare is gender neutral.
PT
Good Afternoon:
There's no reason why radiologists can't be cross-trained if they want to. Maybe the male hospitalists need to go back to school for training also.
There has to be an answer to this other than;
put up shut up & do as your told or don't seek medical care.
Those two scenarios are unacceptable.
Healthcare needs to encourage more men to enter the nursing & technologist fields by using incentives.
We're not animals we're human beings and deserve to be treated as such.
I don't see help coming from Washington as I've been beating that dead horse for months now. They are bought & paid for by the industry.
Lawyers look at the healthcare system as a losing financial proposition so they won't take them to court.
Right now I see a bleak future for men, their sons, and their grandsons if they need intimate medical care. Expect no dignity, no, respect, & absolutely no privacy.
We're going backwards instead of forwards. So sad.
Regards,
NTT
So..the basic issue is the medical system discrimination of the professional nurses and technicians and male patients to favor the female nurse or female tech and favor the comfort of the female patient. As far as physicians themselves, there are a "few bad apples" but most doctors are simply limited in obtaining bi-gender staff or having to attend to patients in hospitals or clinics with the bias noted above.
So what are the practical approaches to a solution of equality? $$$$$$$ ? Higher salaries for all nursing and techs (and necessary cuts in salaries of the business men of medical care)? These higher salaries should be a stimulus for more and more men to enter the nursing and tech business. Professional care gender selection by the patient should be a "number one" requirement in the operation of a medical/surgical facility regardless of size. And from the ethical point of view, patient autonomy at all points of medical care should be the ongoing principle in order to attempt to preserve patient dignity.
The business of attending to the medical care of people should never be directed simply to profits as in "stocks and bonds market" but directed to maintenance of physical, mental and emotional health of each and every patient. ..Maurice.
The primary goal of hospitals and clinics is to create wealth, providing healthcare is second. For years hospitals have been telling nursing schools to pump out more nurses. The idea behind hospitals doing this is to create the false illusion that there is a nursing shortage when in fact hospitals enjoy there to be a glutton of potential employees to keep salaries low and to ensure womanpower availability.
Hospitals maintain a very close relationship with nearby nursing programs and often dictate politics within the nursing schools as well as privately telling them about expanding their L&D suites. You never ever see this in medical schools as far as gender goes but perhaps in the resident selection choices about wether to choose neurology vs ob/gyn I’m sure male residents have thought long and hard over this.
With the rise and advancement of PACS and RIS( radiology information systems) radiologists are expected to pump out a large number of interpretations over short amounts of time, being able in neuroradiology, MRI, trauma, none of those people have the time nor the training to go over to ultrasound and perform a scrotal ultrasound on a male patient, just not going to happen!
Hospitalists are now more than ever required to be the neurologist, nephrologist, pulmonologist, consult with the neurosurgeon, pathologist and orthopedist etc. Their job roles continue to expand and and would mock anyone expecting them to place a catheter, they just have too many important matters to attend to.
Physicians couldn’t really care less about the gender staffing at the hospital besides, they have no say and are in no legal position to dictate the staffing, hiring etc, however, at their office it’s an entirely different picture.
PT
So, PT, NTT and the others reading, let's go back to answering the basic question I asked in the introduction of this Volume 104
What is the basis for what is being discussed here primarily by the male gender? Is it FEAR OF BEING EXPOSED (and perhaps illegally sexually attacked) by FEMALE employees within the medical system OR is it personal examples of SEXUAL DISCRIMINATION in that female patients are "protected" {not completely) in many ways against exposure or sexual "injury" and male patients are NOT?
Returning to the introductory graphic to this Volume, is the primary feeling one of "fear" of "falling" into the "trap" of female medical professional misbehavior... OR "anger" regarding the inequality of privacy and ability to respond as compared to female patients? Or do you see a little of both in the facial expression of the painting of a male attempting to "hold on" to that "crack" in the wall (the "medical system").
My impression from what is written here is both fear and anger. The fear has developed over the years from past experiences perhaps from childhood and the anger is based on the statistic reality of what has been written here and known about the current medical system. ..Maurice.
Maurice
Imagine how black society was treated in the 50’s and 60’s, expected to ride at the back of the bus. Blacks and whites paid the same fare did they not? Now translate that to how male patients today are treated in healthcare. Not only are we not given the same privacy privileges but when unprofessional behaviors occur there is no accountability. There are no stupid knee-jerk reactions, no changes in staffing, nothing, just swept under the rug. I don’t think fear plays a role to any degree as does the prejudice and discrimination.
Healthcare is a hefty price tag to maintain for anyone these days in spiraling healthcare costs which continue to go unchecked. Look at the big billboards as you drive down the freeway. “ we care about your health” , advertisements for healthcare companies. Did you forget to include this in your analysis, Maurice. Dont you think people want value for their healthcare dollar. Families are expected to be treated professionally, shouldn’t the men of these families be expecting that too?
PT
PT, based on your expressions, that is why a complete overturn of the medical system is necessary and something like "Medicare for All" and a complete overhaul by the federal government regarding the way patient care is currently practiced should be part of the Medicare including the acknowledgment of the ethical identification of the patient autonomy in all personal matters of medical care.
Lets take medical care out of the hands of business. Any arguments against this proposition? ..Maurice.
Dr. Bernstein, certainly there is a continuum amongst males ranging from fear of or anger at being exposed on up to no concern whatsoever. The roots of how individuals come to be wherever they are on that continuum vary even for those who are at the same spot on that continuum. For some the basis may be past trauma, for others body image or inherent modesty, and for some just knowing the underlying discrimination and double standard at play. For some there is nothing in their history or persona that causes there to be any discomfort with opposite gender intimate exposure in healthcare settings.
No matter where men may fall on the continuum or what their reasons may be for where they fall, there remains a fundamental disconnect between healthcare and society as a whole. Today in general society (not decades ago) with a couple notable exceptions (men's college & professional sports locker rooms and men within the criminal justice system) males and females enjoy comparable opposite gender bodily privacy. Bathrooms, locker rooms, changing rooms, kid's camp facilities, dormitories and such are segregated male vs female. While in those settings both sexes are reasonably assured opposite gender cleaning people, maintenance staff, teachers, coaches or others are not going to invade those spaces when people may not be fully dressed.
For women when they enter the healthcare system, though they may be subject to some degree of opposite gender intimate exposure, especially in ER & OR scenarios, much effort is given over to protecting their privacy and dignity. Given we are approaching gender parity amongst physician ranks, many women can substantially achieve female-only caregivers if that is their objective. Thus for women their healthcare experience is reasonably consistent with their experience in general society. There isn't a huge disconnect.
For men on the other hand the healthcare system follows none of the exposure to opposite gender rules that are commonly applied in general society, yet the system expects men to accept it as normal. Men are expected to accept the "we're all professionals here", "there is nothing sexual about healthcare" mantra despite ample evidence that those mantras are not true.
The "we're all professionals" mantra is truly bizarre when the requirement for achieving professional status in healthcare is simply donning scrubs. That men are expected to accept 16 year old CNA's or PCT's (Personal Care Tech) such as exist in some States, 18 years old in others, as professionals and be comfortable being bathed or showered by them given their professional status speaks to how bizarre that mantra is. That men are expected to believe that the donning of scrubs makes female staff asexual defies credulity.
For men the disconnect between societal norms concerning bodily privacy and healthcare norms is profound. This is the fundamental issue.
Good Afternoon:
P1.
This should be healthcare's mission stmt.;
In our eyes, ALL people are EQUAL. NO gender will EVER be treated differently or given priority over another. Dignity, Privacy, & Respectful treatment from ALL our staff to ALL our patients at all times while under our care.
That should be what the healthcare system is all about. Unfortunately, right now, they are nowhere near that plateau. It will take them decades at the pace there are going to get anywhere near that hefty goal.
Dr. Bernstein I agree that every medical institution should have an "impartial" individual with an MD NOT an MBA after their name at the top running the show. An MD (who has shown they have excellent people skills), should also be appointed to the government positions of Health & Human Services & Administrator of the Centers for Medicare & Medicaid.
Not someone from healthcare or big pharma.
You are correct sir in that the only real way this problem will get fixed is a complete overhaul of the system but this time with the input from ordinary people like us. Not just bureaucrats & healthcare executives because we all know that the bureaucrats will just let the healthcare executives "do their thing" & we will be right back in the same mess we are in today.
PT's analogy of how people of color were treated back in the 50's & 60's compared to the way healthcare treats male patients today is spot on. Today's system has two tiers. On the top tier you have women & girls. They get all the special treatment. Their dignity is respected & privacy protected without question. Then there's the second tier where men have to put up, shut up, and do as were told or don't seek medical care.
Both male & female patients today fear for their safety whenever they have to deal with today's medical community. The medical community today, no longer has the "bright shine" that had everyone putting doctors & nurses on pedestals. Too many "dark" stories of what healthcare employees are doing to patients has tainted their image.
Women fear of being gawked at, fondled or raped by male healthcare workers while men who have had previous experience within the system get extremely nervous & anxious about the possibility of having to deal with an alpha female healthcare worker with gawking, touchy/feelie, lewd comments, & voyeuristic tendencies.
Those gentlemen that have no experience within the system & expect that their healthcare system will do everything to respect their dignity & protect their privacy are going to come out of their encounter shell shocked.
So how do we fix this.
First thing that has to happen is the veil of secrecy the healthcare system has been operating under for decades, is replaced with complete open transparency. Without it, a rebuild will be no better than the original.
Next, if PT's right & hospitals maintain a close relationship with nursing schools, its time the hospitals talk to the schools & have them start pushing for more male enrollment. If financial incentives are needed then you use them. Same goes for The American Registry for Diagnostic Medical Sonography or (ARDMS). Push for more male enrollment. Use incentives where necessary. We need more men in the system asap.
Now, how do we change the hospitals & medical clinics.
Let's start by taking away one of the female nurse's pet peeves. Since guys started entering the field, women have complained the guys are being paid more. Time to remove that crutch. Equal pay for equal work. Only exceptions I see could be seniority & experience.
Good Afternoon:
P2.
Next, the culture. The culture in today's hospitals doesn't promote corroboration amongst colleagues which in turn would promote better patient care. What we have today is toxic towards male patients and employees and it HAS TO GO. You've got nurses bullying each other on a daily basis & that in turn makes for an unsafe environment for all patients. Change the culture & make the workplace safe for everyone.
They've been told since they went to school for their training, men have no modesty therefore just smile, go in, introduce yourself, explain why you're there and get on with the job at hand. If you need help, just grab another nurse.
That attitude no longer exists. He's a human being first & foremost. He's to be treated with the utmost respect as any female patient & his privacy will be protected the same way we protect female patients.
Respect & dignity violations of any patient will be met with strong penalties. Multiple violations & you risk your employment at the institution.
A rebuilt system MUST be based on healthcare workers having the necessary special qualities of emotional stability, compassion, empathy, and strong morals as actions like mocking & bullying patients & colleagues have NO PLACE in healthcare.
Getting people with the right character is not easy these days, so to protect the patients, there must be in place an avenue that patients can use when abuse takes place. Strong penalties must be in place and enforced on the abuser(s) whenever necessary to give the system accountability & creditability.
Working together our country can build a world-class healthcare system. A system built on the foundation of these five words. Do No Harm and CPR.
Always remember; Let no harm come to any patient in your care.
All patients regardless of sex are given;
Choice to each client without always questioning why.
Privacy, given to the highest-level to every patient no matter the circumstance.
Respect. Give every client the respect they deserve and you will get the same back & more.
Do No Harm and CPR go hand in hand. You can't have one without the other and successfully build a healthcare system everyone will be proud of.
So now the question is, will the medical community put away their stubbornness, pride & everything else & work with the people?
Regards,
NTT
Biker
Amen!
BJTNT
NTT
Amen!
Maurice.
Despite all the great postings on the subject so far written to this Volume.. I still want to read your description of the graphic for this Volume. If you were that male in the opening graphic, looking at his face, body and posture and scene, what is your view of its relation to what is being discussed here. Do you see yourself as that male in the graphic I selected? ..Maurice.
Well said,NTT!!!.....Donald
Here is an example of how patient autonomy through personal surgical decision making and not following the advise of physicians led to a terrible conclusion not only to the subject of the decision (the newborn delivered child) but to the physicians who advised the appropriate approach which was rejected by the patient and yet the patient may end up with 200 million dollar malpractice winning.
Patient autonomy in decision-making can, in this example, be possibly directly harmful also to the medical professionals. ..Maurice.
Dr. Bernstein, I don't see myself in that graphic because I'm not afraid. I have learned to speak up and to be better informed. Yes I was ambushed in the past and I thought I had no choice but to just accept however it was I was treated, but that's in the past. I'm also a realist and know I won't always be able to get same gender intimate care but I can at least demand that they not be casual with my exposure.
Biker, I appreciate your demand that the physician et al "not be casual with my exposure." However, have you ever had a spontaneous penile erection when your genitalia was exposed or clinically manipulated? If so, what was the reaction of the physician, nurse or other professional present?
As I have written here many times in the past that our students learn to respond to such an erection with the following: "This erection sometimes occurs during an exam and it is a good sign since it shows that your nervous system and blood supply to your penis is normal."
I think this statement to the patient shows the patient that the penile reaction was recognized and accepted as a important normal sign by the examiner and immediately and directly presented this information to the patient--nothing "casual". Better to stop and explain than let the patient "suffer" from his penile reaction occurring "in public".
There is so much more appropriate patient-acceptable behavior which our students are taught, so it is "hurtful" to teachers like us to read about T.Sparks et al. (Notice I didn't identify as Dr.).
..Maurice.
Biker and NTT,
Excellent posts!
58flyer
Maurice asks
"Biker, I appreciate your demand that the physician et al "not be casual with my exposure." However, have you ever had a spontaneous penile erection when your genitalia was exposed or clinically manipulated? If so, what was the reaction of the physician, nurse or other professional present?"
Maurice I am not sure you are aware of my past abusive experience but it relates to just this. I experienced a spontaneous penile erection when bathed by a nurse while an adolescent. The reaction by the nurse; a blunt force impact to the scrotum. No warning.
58flyer
Dr. Bernstein, no I have never had an erection in a medical setting. Had it ever occurred a professional response such as you teach your students would have been wonderful, but I'd of been beyond mortified nonetheless and probably never gone back to that practice or facility.
I'll reverse the question and perhaps PT or others who have been behind the scenes can answer. After giving the patient the suggested professional statement, what does the staff say once the patient is out of earshot?
Another question. When it happens does a record of it go into the EMR so that going forward everyone that patient encounters in healthcare settings has that info before them?
Penile erection during exam of the male genitalia is a normal psycho-physiologic reaction which during a properly performed genital exam usually will not occur (in all the exams I have performed over the many years, I have not witnessed such a reaction). If erection does occur, it is simply physiological unless there is evidence of patient motivation for intention.
It is my opinion that recording such a non-intentional, non-pathologic rare reaction in the patient's medical record, without prior clinical concern about neurologic or vascular pathology and the patient's full understanding of the rationale for inclusion and permission is unnecessary and unethical. If the patient states that erection or even ejaculation is a repeated response to genital inspection or palpation, then this history may merit inclusion and documentation in the medical record with prior explanation and patient approval. But, as I said, I have had no such experience within patient examinations. ..Maurice.
Maurice,
As to "..."wishful thinking" then it is time for an evolution in how medicine is practiced...
There is an evolution in medicine; physicians are now employees of big healthcare corporation ( a subsidiary of Walmart)...
PT,
The AMA creates the physician shortage with their monopoly.
Much of this is a byproduct of feminism and the thinking that all men are rapists.
-- Banterings
58flyer, I would say that the nurse's response to your penile erection was unprofessional (it is NOT her responsibility to attempt to terminate an erection by distraction or some "reflex" caused by intentional testicular pain.) This action on her part demonstrates her insecurity. She should have continued on without concern or asked you if you would rather clean your genitalia on your own. Attacking the patient sounds criminal! ..Maurice.
Maurice
Assaulting patients with a spoon is criminal, yet it was taught in nursing schools. I knew a male patient that had been struck with a metal spoon. There is actually a website devoted to this pathetic behavior as one female nurse in New Jersey proudly proclaimed that “ dont get an erection or It will be dealt with. I hope she is deceased now, that her demise was from rectal cancer, then mets to her brain!
PT
And then, of course, is the answers from professionals at Quora
JF, if you would be so kind to inform our visitors, what has been your experience, if any, in your patient attending occupation and what were you taught as a reaction to erection on bathing or otherwise? ..Maurice.
Dr B
I've never heard one single word about what to do about patient erections from management. It's been extremely rare that erections have occurred in the nursing homes. When they have it's been younger patients and our response was half embarrassed laughter.
It was well understood that we weren't to hit our patients/residents for any reason. ( although I know that it has happened with combative patients.also behind closed doors )
JF
Maurice et al,
The problem is NOT gender. If all men were given nothing but male providers and females given nothing but female providers, this thread would continue about how providers continue to abuse and mistreat.
The problem is that the medical education kills empathy and conscience and creates sociopaths. I have demonstrated this ad nauseum. You can NOT say this can NOT happen.
It happened in the Nazi concentration camps, the United Nations has declared many modern practices are inhumane and med students learn TODAY (still) PEs on anesthetized women without consent.
The profession of medicine is morally bankrupt. It needs to be burned to the ground.
-- Banterings
Just following up on my last comment, here is an example of the profession of medicine being morally bankrupt:
The position paper The Male Genital Examination: A Position Paper of the Society for Adolescent Health and Medicine
Note the paper pushes "A complete examination of the male genitals, including inspection of skin and hair and palpation of inguinal nodes, scrotal contents, and penis, and inspection of perianal area (as indicated), should be performed annually as part of a comprehensive physical examination.
The paper says ABSOLUTELY NOTHING about consent, patient choice, patient dignity, right to refuse, or the OPTION of OMITTING.
Yet it concludes:
Despite the lack of evidence... the male genital examination should be included as part of a routine physical examination... The male genital examination should be included as an evaluation competency for health professionals in training.
-- Banterings
Banterings, I'm going to disagree a bit on the adolescent male genital exam matter. The article speaks to a recommendation that the exams occur, and why. Who does the exam, how it gets done, and how it is consented is a separate matter. Most recommendations for medical examinations and testing only speak to the need for those exams and tests.
Speaking to the who does it, how is it done, how is it consented matter, this is much of the problem males face in our female-centric healthcare system. The literature that would create informed consent about the exam or test is almost non-existent.
JF, I'm not surprised that there hasn't been formal training on what to do concerning erections. It's just embarrassed men after all. It does beg the question as to how much effort goes into ensuring staff respect patient privacy and dignity. Some staff of course just have it within them to do the right thing, but others need to be taught and then held to account.
Lest anyone forget, nursing & rehab facilities do have 16 & 17 year olds doing some of this work, either as CNA/LNA's or as CNA/LNA students doing their clinicals. How well are they prepared to handle such matters in a mature professional manner?
Banterings, I agree with Biker's interpretation of the "position paper".
Consent was not the issue, it was whether examinations need to be performed.
And, of course, if some physical exam technique or any other medical technique is warranted under the clinical conditions, education of the patient and awaiting patient's acceptance with any personal directives.
Another issue not as yet discussed here is how should professionals respond to examination requests by the patient which are not clinically warranted for that patient. Is there permission for the professional to reject the request.
Pertinent to the article, suppose you were a sixteen year old male's female physician, first visit, and he insisted that you, the physician, examine his testicles for tumor even without presenting any history of abnormalities on self-examination and without any genital symptoms or family history of cancer. The appointment was for a "sore throat". By the way, his parents are present in the waiting room. I am just curious how my visitors here would interpret the request and what would be your final response to the patient's demand? ..Maurice.
Genital exams should be by patient request or at least with their consent. The 16 year olds parents shouldn't be in the room watching either. If the patient is ok with the same sex parent being in the room that's one thing but it should never be assumed.
I have difficulty with the chaperone thing anyway. If a patient requests one or agrees to one, then it's good/ok for them to be there. That has absolutely never been the case for me though. I AM ok for her being in the room so long as she isn't looking on from the foot of the table.
In a female intimate exam it's possible to give a patient a certain amount of privacy with a chaperone/ assistant in the room.
That's probably not true for a male patient though. And in his case the attendant will be opposite gender.
It's been said that those people are present to prevent misunderstandings and it's true.
First misunderstandings they disabuse the patient of is that their provider has any empathy for how their patients feel. The second notion dispelled is that voyeurism is considered abusive in the medical world. Thirdly if patients are unhappy with how they've been treated that doctor has his/her witness to gang up against them.
If patient humiliation is to much? They don't have to come back again. Im sorry Dr B. This is exactly how I feel about imposed chaperones and/or assistants and staff coming and going from the room.
Also much of the intimate exam shouldn't be happening to begin with and one reason for them is so the patient can be charged more. JF
We have been taught to not tell other people ( staff or otherwise ) if we catch a patient/ resident masturbating. JF
Dr. Bernstein, if I were that 16 year old's physician I'd firmly tell him such an exam is not warranted and won't be performed. How to best document such things and perhaps fire him as a patient I'd leave to those who know best how such things are handled.
Good Morning:
I agree with Biker. No symptoms, nothing in the record about any issues in that area, therefore, no exam.
Regards,
NTT
An important question to ask our visitors here with regard to preserving patient autonomy is whether physicians should always follow the patient's direct request for examination of a specific part of the body including the "sexually sensitive" areas which would not have been routinely examined WITHOUT the patient providing specific clinical symptoms or the patient's own worrisome findings. Should physicians have the right, after verbal pertinent questioning, to reject a specific examination request by the patient presumably because of time limitations and absence of supportive history?
What I am asking is: through the patient's ethically inherent decision autonomy how manipulative should a patient be and allowed to direct the examination by the physician? "I don't want this..but I want and insist on that." Is such power inherent in the preservation of patient dignity? ..Maurice.
Good day Dr Bernstein,
As far as I'm concerned, it should always be up to the patient to decide what will and what wiil not be examined. Putting aside the idea of preventive medicine and wellness/health check-up visits, the présomption is that the patient is seeking care for a reason (a presentation of some sort).
When I go see my provider, I will generally go along with whatever plan he or she may have (as far as what is to be examined). That is, right up until the GU system and rectal examination. This I will flat out refuse (it's been my default position for many years now) and I have no intention to change it. My opinion on this is quite simple: I (the patient) will tell you (the provider) when it's time to examine my genitals, not the other way around.
Although to be fair, since I mentioned to my doctor (a woman) my uneasiness and discomforts at being asked to undress a couple of years ago for examination, things have been surprisingly smooth, and the process expedited (at the cost of thoroughness, since what she does now is perfunctory at best)
Regarding your hypothetical situation with the young male patient, I would suggest that any health concerns (as expressed by the patients) should be addressed. If not physically by actually performing an examination, at least verbally to assess whether an examination would be required.
As for interpreting the picture heading this current volume, it seems a little too obvious. A man is faced with a difficult choice. Does he preserve his life (by holding on to the cliff side), or his modesty? I am always suspicious of seemingly obvious conclusions.
Your mileage will, of course, vary.
Dany
Dr. Bernstein, the patient should always have the right to say no to any exam or test. For example at the end of my annual physical last year, my PCP asked if I would like a DRE. I said no and that was the end of it.
If a patient presents a valid reason for a specific body part to be examined, and that examination falls within that physician's normal scope of practice, then the physician should examine it. If instead it is just some creepy guy looking for his jollies, the physician is well within their right to say no. I'm OK with the physician making that judgment. It is no different than physicians sending pill seekers away. The patient is free to seek out some other provider if they would like.
I once heard a female nurse say “ I could say something nasty “ to another female nurse regarding a young male patient in her care. These kinds of comments signify two things.
1) That the feminized nursing industry has accomplished their goal of ensuring that most all their encounters as a patient will be professional yet they will not be culpable for comments or behaviors they themselves make about their male patients.
2) They will never be held accountable, why? Their managers and directors are guilty of the same behavior and are the architects of the linage of nurses who have constructed this feminization of healthcare today.
Maurice, I noticed my last post about Quora was not made. Don’t worry about it. Everyone knows the truth that any attestments made on those sites are political correctness and only solidify the lies about nursing today.
PT
Biker,
The problem of not discussing with the patient shared decision making/informed consent, options (including omitting), who does it, etc. is that the guideline is INCOMPLETE. Furthermore physicians are not capable of independent, critical thinking. Everything is memorization, repetition, and guidelines without deviation. This allows providers to coerce patients into such exams, for this reason ALL guidelines need to include shared decision making and option of omitting.
Maurice,
As to your example, the patient is requesting that the physician preform the exam. Is the physician not free to say that she rather a male physician or more experienced physician examine him is she does not feel comfortable or competent in such a Dx?
What if a patient is asking for a PSA test at age of 50? Does the physician blindly order or is there shared decision making?
JF,
In most states children under the age of 18 (some as young as 10) can consent to STI and HIV testing WITHOUT parental consent. Based on the concept of informed consent, informed refusal exists. Although a genital exam in this regard may be looking for cancer, every provider is taught to look for STIs along with other conditions "while there."
This usually has more implications for the provider failing to gain consent/refusal from a minor. They don't realize that despite being a minor that they have the right to consent/refuse based on the legal rights given to minors to consent (refusal assumed) under state law. See: Minors’ Access to STI Services
Under the doctrine of informed consent, the right of informed is assumed. It is a dichotomy where if one exists then the other must exist (just like good and evil).
In this situation, if the provider believes that there may be an STI involved, then the 16 year old can consent to the exam without parents.
-- Banterings
Sorry, PT, I wiped that posting as Spam since there was no writer identification and I didn't recognize it as a criticism of Quora. I get too many Spam comments needing deletion. By the way, what is wrong with "political correctness". In many, many ways I have looked upon our current President as needing "correctness" politically and humanisticly. Shouldn't ideals of the nursing profession criteria be publicized? ..Maurice.
Maurice
I couldn’t care less what the presidency needs. I can tell you what I need and what I’d like to get considering what I pay into that annual $4 Trillion dollars healthcare fund. The comments made by Quora are nothing more than political correctness made to make the nursing industry look good. Do you think they or anyone will truthfully address anything on the Internet? Do you think that any nurse being employed anywhere is going to post their picture, their credentials with comments saying to the effect of what they’ve actually seen or heard regarding their patients. Not going to happen!
PT
Considering the death toll at a Florida nursing home one man has considered renting a room at any Holiday Inn. One day at your typical nursing home costs $188.00, whereas one day at your Holiday Inn costs $59.00. At Holiday Inn you get free maid service, a gym, swimming pool and breakfast. Another advantage of being at Holiday Inn is that if you get an erection there will be no cna’s or nurses to laugh and tell everyone.
PT
PT, I get your point but out of fairness there are many other motels with other names that would be available for prolonged stay but also assistance along with privacy. It was interesting that the death toll at the nursing home involved in the Florida hurricane was adjacent to a hospital where there was no loss of electric power. Of course, being a transferred patient there would not necessarily provide the personal privacy that you attribute to your motel example..though, on second thought, I wonder if any motel if one stays long enough is totally demonstrating 100 percent privacy. If its not the attendants, its the next door neighbor. ..Maurice.
Maurice
All hospitals have backup emergency power generators. Next time you are in a patient’s room at a hospital take notice of black power outlets and red power outlets. The red outlets provide power 24/7 from a generator located in the bacements. Another thing you might want to notice about motel staff ( they always knock). Hmmm, I think the hotel, motel industry could teach a thing or two about hospitality to the healthcare industry.
PT
PT Don't forget at Holiday Inn the daily fee also includes all utilities. Not a bad deal compared to most below par assisted living.
Other than being afforded the dignity of continuing to live, my comments here are a digression from the usual discussion but pursuant to the FL assisted living facility deaths discussion.
The poor training/decision-making at that facility in FL is not unique. My stroke victim wheelchair-bound assisted living facility resident uncle died earlier this summer in SC. Despite the deemed professional status the staff garnered by donning scrubs, in the midst of a heat advisory they moved my uncle outside into the sun(he liked going outside) but then forgot to bring him back in. They found him non-responsive and covered with flies. Deploying their professional training, rather than call 911 they called the duty nurse who lived 45 minutes away and cleaned him up while they waited for her to arrive and make the decision to call 911. He died a few days later in the hospital never having regained consciousness.
If assisted living facility staff are not trained well enough to even know when to call 911 and the duty nurse on call does not know enough to tell the staff to immediately call 911 when she got their call, the odds of assisted living facility staff having been trained to address erections or simple normal exposure using professional protocols is rather slim. But they're all professionals we're told.
Did anyone wonder if the basis of interest those reading and writing in all these volumes of the topic whether dignity or specifically modesty is because the reader is becoming old. If you could be looking at the medical system as a teen-ager right now would you have a different opinion as to what is going on? Do you hold the very same views of what is good and what is bad as you did when you were years and years younger? Is the differences in "expectations" between being a youth and being much older? Do you think that now you are much more aware and sensitive to how you and others are being treated than when you were a youth? If this possibility is a valid one then maybe what you observe and experience in the medical system is not related to some systematic change occurring in recent decades but it is simply that you are looking at and experiencing medical care with older eyes and older brains and now criteria set by a much older patient? Just a thought to consider. ..Maurice.
Hello Dr. Bernstein,
One could argue that the reason we "older" posters are critical of medical care is the result of "undignified care" when we were younger. The reason we may be vocal now is because, as youngsters, we had little voice in our "care"; and, we didn't know what to expect from medicine. Additionally, in prior eons, one could never question the medical profession. As older adults we can now place in perspective the poor care that we had received and, we can now voice our dissatisfaction. Furthermore, as adults, we can now question those procedures which were previously foisted upon us as necessary protocol.
Reginald
Dr. Bernstein, I agree with Reginald. Growing up blue collar in the 60's we were taught by example to not question authority be it police, school, church, or healthcare. Authority figures were to be deferred to. Sticking to just healthcare I knew better than to complain to my parents about any perceived indignities incurred. That the expectation was to "man up" even as a child did not need to be said. We just knew the rules.
Each of the 6 boys in the family came into this world larger than the one before. The last one (the 7th child) resulted in an emergency cesarean because at 10.5 pounds he was just too large for my mother to give birth to naturally. Upon completion of the delivery the doctor (the general practitioner that had delivered all of us) on his own authority tied her tubes because he didn't want to risk her having another. My parents just accepted it because the doctor said so. That was the world of deference to medical authority I grew up in.
As much as we may complain I do think male dignity is better respected now than occurred in my younger years. The kinds of school physicals I had no longer occur for example. Better is not good enough however. Long ago there was not even any pretense of respecting the privacy and dignity of males. Things have improved to where we are now 2nd class patients rather than 3rd or 4th class down in steerage.
Growing up expecting my dignity and privacy to be considered just as important as that of females was not even on the radar. Somewhere along the way I grew weary of being deemed a lesser class of patient and my expectations changed faster than the medical world has changed. They may be polite today, but polite is not good enough.
Maurice,
Current trends among younger patients (especially female) show a preference for gender concurrent care. (I have cited multiple sources supporting this previously.) Older patients (especially women) tend not to care as much as this is the system they were brought up in (all male physicians).
Older men are beginning to express a preference as the luxury of all male physicians that they once enjoyed is disappearing.
We discussed this with changing the thread name that human dignity is innate and that medicine does not give enough to respect our dignity as patients. I have repeatedly demonstrated this with scientific research that backs the anecdotal assertions made by your posters here.
You seem to refuse to accept the reality that is our modern healthcare system and the moral bankruptcy that it suffers. One only need to point to the fact that intimate exams on anesthetized with out explicit consent by medical students still occur in 2019 to show the moral deficit of the practice of modern medicine.
"One lie is enough to question all truths."
Medicine can not claim the moral high ground on ANNY issue or be BELIEVED in how compassionate its members are OR that they treat patients with dignity when this is happening in the earliest stages of entry into the profession. This does not even take into account all the other reprobate conduct that exists in the profession as acceptable guidelines TODAY.
The solution to the problem is finding why professionals such as yourself refuse to acknowledge the moral turpitude that is business as usual. You have even ignored abusive, unprofessional behavior in your own care (the lack of true informed consent, not knocking before entering, the student nurse's solo exam...).
You may be in denial as a psychological defense mechanism.
...try disassociation, it allows you to accept the fact that you were abused and helps you avoid the abuse again. I speak from experience.
The information superhighway has changed the perception. Patients find that physicians are not always truthful or knowledgeable, and when abused, we are not alone or crazy because this has happen to others who feel as we do and we are validated.
This has also lead to an awaken enlightenment in society's morality. We are no longer looking the other way simply because the offenders are prestigious members of the community. The Catholic Church is a prime example.
Technology is allowing us to prove our assertions as opposed to it being a "he said, she said situation." Look at the police and cell phone videos.
Finally, starting with the chiropractors' antitrust law suit against the AMA, Doc Google, Watson, PAs, NPs, etc. have shown that physicians are not our only hope. They are replaceable.
Their hubris, failure to give up absolute power (which corrupted them absolutely), and dispense with paternalism has relegated them to nothing more than retail employees at big corporate healthcare store.
Since the profession of medicine has desensitized ME to the human dignity of providers, when they cry about depression, burnout, and suicide idealization, MY response is that they should try diet and exercise.
-- Banterings
A. Banterings
Outstanding commentary, just outstanding!
PT
Biker and Banterings, You hit the nail right on the head and well stated! Being 73, I am a product of the same time frame work, but after being brutally assaulted by female staff when I was 20 and hospitalized, I will not put up with crap from medical staff and doctors. Personally I find contemporary staff and doctors dumber and ruder than ever. Before following any suggestions made by my current GP, I discuss matters with close friends who have PhD's and even 2 PHDs and /or former university deans, and well published. Sure have caught some major errors happening and even miss read CT scans.
So..it is the past experiences that, in general, has set the state of mind regarding more recent interactions with the medical profession. And, am I correct, that unlike the ongoing distress as well described in the past by JR affecting her and her patient husband or even Rick, others here are sizing up the issue in a less subjective manner? The reason I am trying to make the distinction is that arguments for change are better made in an objective rather than ab actively subjective frame of mind or am I mistaken on this point. Another way of saying what I am trying to express is that "whining" at the time is less effective in making an essential and potentially valuable point. So.. I would modify my long time advice here.. "Speak up to the physician or system with the facts and requests needed to be presented but DON'T WHINE." Anyone want to argue with my advice on methodology? ..Maurice.
Maurice
I can’t speak for others but I will say that it’s not just past experiences, it’s every experience. What the hell! This tells you that there are serious ethical issues throughout the medical industry that go beyond the typical healthcare culture. I’ll go on to say that patient privacy is an expectation, ever hear that phrase?
Do patients have to be on guard at every turn? Why should we have to Speak up? Since when do you have to be on guard when you are the one paying? Are you on guard when you go to Starbucks? Or what about a burger place? Patient privacy is an expectation and it is the job of every healthcare worker to ensure that for their patients.
At this point in my life I’ve learned enough from the healthcare industry to know that I trust the folks at Starbucks, the burger places and the housekeeping staff at hospitals more so than nurses and physicians sadly to say.
PT
Hello again Dr. Bernstein,
I'm not sure that "whining" is the proper word. I'd suggest that the sentiments presented here suggest anger, frustration and resentment. Some posters are angry that healthcare places patient dignity last on the agenda, irrespective of hospital-stated "rights". Others are frustrated that they must "fight" for something as obvious as dignified care - as defined by the patient. Finally, we resent being told that our dignity concerns are outlandish - "we've seen it all, genitals are like elbows, we're professionals, etc."
Personally, I'm astounded that physicians are so uncreative. Most doctors have spent at least 8-10 yrs in training (education and/or OJT). They're supposed to be the brightest and the best. Nevertheless, ask a doctor to place a catheter or to have a male nurse place one and, the response is total bewilderment. Instead of a creative response, they resort to protocol, lack of personnel, blah, blah, blah. There definitely seems to be a disconnect between mastering procedures and creative responsiveness, especially responses involving affective considerations. Can you offer a reason for this seeming disconnect; or, have I presented a false dichotomy?
Reginald
Better believe it is on going. I am trying to decide wetherto sue a university hospital here in Utah in Federal court for violations of my Federal legal rights by their ignorant, abusive and bullying staff--at age 73!!
This is regarding physician burnout and my THEORY about it. I think that slavery is alive and well in America. Not all of us are poorly paid. Some are well paid but NO slave is well adjusted.
Doctors who work long hours for years on end are slaves. They MIGHT be ATM cards for their spouse's and family ( and nothing more ).
This here isn't doctors but I have noticed from my coworkers that the ones who work excessive hours have no patience with the patients or other staff. Their own needs aren't being met.
Also when there isn't enough accountability job performance suffers. Where I work the wages are low but there's little accountability on my shift. We CAN call 911 without asking for permission. We don't even have a nurse on our shift. ( 3ed )
We have some hard workers and also some really lazy workers. The lazy workers- - 1st shift comes in and find patients saturated in urine.
Im a slow worker but I work hard.
From what I've heard on this blog , female staff does have a lot of accountability for patient modesty violations. Neither do doctors ( male or female.)
Otherwise I don't remember what point I was trying to make. It escaped me. If I remember I'll repost. JF
Well said by Reginald: "Finally, we resent being told that our dignity concerns are outlandish - "we've seen it all, genitals are like elbows, we're professionals, etc.""
A big part of the problem is definitional. As PT and others have noted, every hospital includes in their guiding principles respecting patient dignity, privacy etc. The problem at a practical level is that their operating definition looks at dignity and privacy solely from the perspective of the staff. If the staff are comfortable with the patient's exposure and they are polite while exposing the patient they deem themselves to have respected the patient's privacy and dignity. Their operating definition ignores the variables of whether there were more people present than needed to be present, whether the patient was exposed longer than was necessary (staff convenience being the priority), or whether more of the patient was exposed than was necessary (staff convenience being the priority). Being polite is not synonymous with being respectful.
Their guiding principles ignore staff gender altogether which can be taken to infer gender neutrality in the delivery of services while at a practical level male and female patients are differentiated. Their operating definition of gender neutrality is that only female sonographers will be allowed to do vaginal ultrasounds but it is OK to have female sonographers do testicular ultrasounds. From the male patient's perspective that is not gender neutrality, but again respecting patient dignity and privacy is only defined from the staff's perspective.
A good friend of mine was recently hospitalized due to infection following surgery. He was sick, not crippled, and was capable of urinating in a bottle but for what I can only assume was staff convenience they catheterized him. A couple days later an LNA comes to shower him and seeing his hesitation she gives him the stereotypical "you don't have anything I haven't seen" response. No doubt all the staff involved in his care would insist that they respected his dignity and privacy. They were comfortable providing his care after all.
Good Morning:
Dr. Bernstein I'd say it both past & present (as it's still happening today), experiences that drives us for change.
My nephew is a high school senior on the varsity football team. They recently had their team physicals usually done by a male doc. He was in his underwear with a female NP. Time came for the hernia check & she told him to drop his drawers. He respectfully declined & asked for a male. She told him sorry it's me or no football. He stood his ground, got dressed & left.
So as you can see its still happening now to the younger generation.
Regards to all.
NTT
NTT, good for your nephew. Few teenage boys are that confident in themselves to stand their ground. Hopefully the coach backs him up on this. A complaint to the school board would likely result in a change back to have a male provider do the physicals.
NTT
Imagine if this nurse quacktitioner went for a mammogram and a male mammo tech there told her it’s me or no mammo.
PT
American Sentinel University nursing school sets the criteria which must be followed by nurses to, as our blog title indicates, reach the goal of the preservation of patient dignity.
I have a suggestion. All those writing to our blog thread here, why not all of you, everyone of you, write your experiences and advice directly to the school. You can even mention this blog thread as a resource for more details of the topic. Present your experiences and your advice to the nursing system. Expect a response by the school for your e-mail. I think if you all follow my suggestion something of value will come out of this wonderful back and forth we are experiencing here. Do it! This suggestion may be a better starter for preservation than multiple comments simply written here. ..Maurice.
p.s.- Make your writing helpful toward improving the nursing profession and avoid displaying gross anger. Instead, display the facts and present clearly your view regarding how the observed and experienced unprofessional behavior, in your view, can be eliminated.
Something I noticed on the American Sentinel University website, if you scroll down to the bottom where the 4 photos are, there is a link to an article called Cultural Competencies: Matters of Modesty. It addresses male and female modesty.
58flyer
Biker says: "A good friend of mine was recently hospitalized due to infection following surgery. He was sick, not crippled, and was capable of urinating in a bottle but for what I can only assume was staff convenience they catheterized him."
This reminds me of a situation that a friend of mine encountered about a year ago. He had back surgery in a day stay clinic. In recovery, his female nurse informed him that he only had 30 minutes to produce urine or he would have to be catheterized. It was late in the day and no doubt that nurse wanted to go home on time. When he couldn't produced urine, she bullied him into taking the catheter. He was very distressed by that, especially when I told him I did not pee after my last hip surgery for 13 hours post op. My male nurse wasn't too concerned but brought in the bladder scanner so I assume it was beginning to be a concern. I was able to pee after standing up and hearing the water running in the bathroom sink.
I advised him to see who signed the cath order since in my state a nurse cannot perform a cath without a signed physicians order. He asked for his medical records and found that not only was there no cath order, there was no record of the catheterization. He took it straight to his attorney. We will see how that comes out.
58flyer
Good Morning Ladies & Gentlemen:
Hope everyone is having a great holiday weekend.
Dr. Bernstein. Under that American Sentinel University besides the Article on Dignity they also have another one that was written in 2017 called;
"Cultural Competency: Matters of Modesty"
https://www.americansentinel.edu/blog/2017/03/21/cultural-competency-matters-of-modesty/
The last paragraph states;
"While the majority of nurses are female, many mistakenly believe that male patients really don’t care about modesty, but that often is not true. Many hospitals don’t have nearly enough male nurses or technicians on staff, but you should try your best to honor requests for same-gender providers for baths, catheterizations, or other intimate procedures. Always try to be sensitive to modesty concerns—even when it creates an extra step for you or takes more time."
What that says is we know there's a problem but the majority of today's female nurses just don't give a damn.
Because of the #meetoo movement. many innocent men are being punished because of the acts of a few deadbeat men.
And what better way to punish men than to become a nurse.
The system needs to do psychological profiling on medical & nursing students while in school so these people are unleashed on a unsuspecting public.
A quick change of gears, my nephew told me he wasn't the only one not going along with the "drop your drawers" NP. He would tell his mother & asked me to talk to her.
The team coach has lost 4 players. I spoke with him & now he understand why the guys walked.
He and I are going to go together late next week & speak to the board of edu.
Goal is a complete change in policy or take the story public & they can feel the wrath of the 1,000's.
That it for now. Have a geat rest of the holiday weekend everyone.
Regards,
NTT
Maurice
Look at the picture placed on that nursing program. A female nurse and what looks to be a grandmother, Oh how so marketable. Isn’t that so sweet. That school is in Aurora Colorado, probably where some of the Denver 5 did their nursing program at. Well, I may write some thoughts but they may not be too nice. I’d start out by saying please don’t wear your stupid scrubs to coffee shops and above all stay out of the grocery stores in them.
PT
Don't bet on it PT. Lots of ladies like the male attention
JF
NTT, thanks for the additional reference to the the American Sentinel University commentary and instructions regarding specifically the matter of patient modesty--admitting the concerns of both male and female patients. Now our blog readers and writers should write to reinforce and extend the advice from this presentation. ..Maurice.
Hello,
The following was sent to American Sentinel Univ. It was sent to the e-mail address: info@AmericanSentinel.edu. I'm sure they'd appreciate other positive comments.
"TO: American Sentinel University:
Hello,
I have read your article in The Sentinel Watch, Patient Advocacy: Preserving Human Dignity. It was exquisite. Would you please endeavor to have it published in a national medical journal. Your University is obviously at the forefront of a modesty/ dignity movement which will ultimately affect the entire medical system.
As you noted in your article, Modesty/ Dignity for some individuals involves both body and psyche (soul). It's a modality that reaches to the core of our being. It is an integral part of who we are. When our modesty/ dignity is violated, it's not just a physical affront. Our entire selfhood is traumatized. Our values, self-worth and emotions are shattered. Although, possibly, unaltered physically, our soul is pierced. That identity we call ourselves is somehow not the same. Moreover, the scars are not visible. They sometimes lie dormant until something triggers a flashback of the event. And we relive the agony again and again and again. Physical wounds heal; but, psychic/ emotional ones are masked with layers of self-doubt, feelings of inadequacy or outbursts of displaced rage. Our innocence has been wrenched from us, never to return. We feel less than we were before the incident, through absolutely no fault of our own.
We fault health care for modesty/ dignity violations because, medicine tends to bifurcate the physical and the mental/ emotional (with the exception of obvious mental health conditions). Many training institutions neglect modesty/ dignity concerns. They feel that the physical outweighs everything, even when life and death do not hang in the balance. The sentiment is that the patient will overcome the emotional travesty once the physical is healed. Only recently has health care recognized that the patient heals more quickly, if his/ her emotional concerns (including modesty/ dignity) are also addressed. Neglecting, or even denying, this aspect of the person is one of the most serious deficits of modern medicine. Admittedly, treating the whole person (especially, in an emergency situation) is a tremendous undertaking. One cannot fault health care for not always succeeding at this task. Medical personnel, nevertheless, can (and should) be faulted for denying the existence of modesty/ dignity concerns by adopting a "leave your modesty/ dignity at the door" attitude. For some individuals, this is tantamount to saying, "leave a very important part of your being at the door". The travesty of trampled modesty/ dignity is not overcome by denying its existence. Most patients, including silent male ones, are asking to be seen as multi-faceted individuals with dignity/ modesty concerns and, not just a body to be fixed.
Again, I thank you for your respect for patients’ modesty/ dignity concerns. American Sentinel University should be proud of its leadership role in this endeavor. Do make your article available to others who are not so forward-thinking. Finally, I encourage your institution to make a concerted outreach to men, encouraging them to consider a career in nursing.
I salute your school."
Reginald
Good Afternoon Everyone:
In reference to American Sentinel University.
Dr. Elaine Foster
Dean, Nursing and Healthcare Programs
Email: elaine.foster@americansentinel.edu
Phone: 303-557-0754
She's the dean of the nursing program. I've also asked who wrote the two articles. But letting the dean of the program what's going on in the "real" world might help her tailor programs.
Regards,
NTT
Thanks to Reginald and NTT for beginning to get involved in American Sentinal's attempt to set standards in nursing which hopefully will be beneficial regarding dignity and modesty for both genders. ..Maurice.
Maurice
American sentinel University is a facility that offers all their programs online. They are not a facility that teaches new nurses but rather from an rn to a bsn, a 2 year registered nurse to a 4 year rn. For these people their mentality, culture, mindset is already set and cast. For many they are on the 10 year or 15 year program most likely starting out as a cna, taking classes for a 2 year rn. Basic algebra typically taught in 6th or 7th grade is a class they would have to take as a pre-req at their “ college”.
It’s pointless to have some commentary and instructions on their website, who among their student population is going to read it, I mean really. It’s not like they are going to re-invent the wheel. These community colleges that do specialize in new nurse programs ( this is not one of them) accept the dumbest of the dumb. I’m not sure how you can call your facility a university when all the courses are presented online. Obviously, if you are a 2 year rn you never attended a real university, rather a community nursing college.
Many hospitals and nurse licensing in the future will require a bsn for employment, enter American sentinel university. Get your bsn online while you are working currently as a 2 year rn that took you 10 years to get. Yeah, oh and by the way it’s politically correct that we put politically correct junk on our website to merely give the illusion that we don’t want anyone to think that our female nurses leer at other people’s junk.
PT
In the United States of America, when today we were celebrating Labor Day (you did too, didn't you) WHO exactly are we celebrating? Do all the professional participants within the medical system of the United States represent the ones we are also including in this labor celebration? If not, why not? Don't those of us professionals in the medical system, like me or even in PT's roles deserve celebration? Or do the visitors to this blog thread look upon those medical professionals as something other than laborers? We experience hours of hard mental and even physical work at times..and allegedly leading to "burnout" (including suicide) of some due to the mental if not any physical exhaustion (the latter might apply to the nurse workers). So..can you better define and explain who have we been celebrating today..Labor Day? ..Maurice.
Oops..I left out JF and also AB in NW as medical system workers.
..Maurice
NTT,
A hernia check is NOT required for participation. If he had a hernia, that would not prevent him from playing. Hernia exams should only be done when the history indicates a possible problem. The NCAA 2008-09 Sports Manual doesn’t even mention the word hernia. There is no other need for genital exams to play sports. Even "Pop Warner" (mini) football does not require a hernia check for many years.
There are plenty of links on this thread that support this assertion along with alternative means to test for the presence of a hernia. My blog has more info on this.
I would have his family send a letter and reference it to the Me Too Movement and what happened with Dr. Larry Nassar, and how hernia exams are unnecessary.
-- Banterings
Dr. Bernstein, Labor Day had devolved into being more a 3 day weekend celebrating the end of summer than it is an actual holiday celebrating workers but to the extent it celebrates the American worker it would seem it covers everyone that works for a living, doctors included.
In my working career I worked 50 - 60 hours a week for decades in a sometimes high stress setting, but I was paid very well for my efforts. I retired early when I decided I just didn't want to do it anymore, but I had no complaints because it was a package deal. Big responsibilities for which I was paid commensurately.
When my job required I take certain actions due to behavior, competence, or simply economic conditions I never lost sight of the actual people my decisions were impacting. They were not the behavior or the competence or the economic necessity but rather they were real people with real families and lives but for whom those other factors got in the way. My goal was always to respect their dignity and allow them to leave with their head high as a person and looking forward rather than in arrears.
Doctors and other healthcare professionals similarly carry large responsibilities for which they too are paid well. I didn't feel sorry for myself during my career and so I don't feel sorry for professional level healthcare staff whose reality is similar.
The problem we discuss is that too many see the patient as the gallbladder, the heart condition, the cancer and so forth and forget that we are real people who just happen to have a medical condition. To our benefit they treat the condition but to our detriment they sometimes strip away our humanity. They do this in part by being casual with our exposure and by projecting their comfort with our exposure to mean we must be comfortable being exposed. They've seen it all can only be construed to mean we the patient are OK being seen if we are relegated to simply being the condition and not the person who has a condition.
Said another way modern healthcare has too many technicians who address the condition and too few healers that care for the person.
Biker, you are correct in how you evaluate physician orientation when they are actively in the process of "taking a major responsibility of care" of the patient's illness. It is much about the amount of time available for attention to that single patient whether it is about history taking or physical examination and also procedures when other patients are waiting to be attended. So, yes..it is oriented to the job, the responsibility of establishing the cause of the disease, treating the disease and returning the patient to better health. As the years and medical economics have moved on and changed, spending time with the patient to develop detailed understanding of the patient as a patient and not only a disease has become more difficult. I have sensed that toward the end of my day to day (and nightly) medical practice which ended with my formal (but not complete) retirement 19 years ago next month. Without the time available for more detailed communication about the patient's and family "feelings" about the illness, therapeutic physician empathy is harder to develop and to express in words or even in recognized behavior.
Let's get back to the "older days" when physicians and nurses had more time to truely "attend" to every patient as an individual sick human with the patient's limitations and not just "someone" with symptoms to be diagnosed or finally arrive at a diagnosed disease to be treated.
In conclusion we need more doctors, nurses and medical techs--all who have more time to treat patients humanistically as well as diagnostically. ..Maurice.
Dr. Bernstein, pushing doctors and others to see more patients per day certainly constrains them in getting to know the patient, but it is more than that. I will note that most of the issues we discuss here are more with the staff than with the doctors though perhaps they too are being increasingly time-constrained.
Regardless, many of the indignities discussed are not a factor of time but rather attitude and culture. Adding a 3 second delay in opening the door after knocking so as to allow the patient to say OK (or not OK as I tried to do in a derm visit) isn't going to impact productivity, nor would pulling a curtain or shutting the door. When being roomed by the Medical Asst it wouldn't impact their productivity for them to say Dr. B has a female medical student shadowing him today, is it OK if she comes in with him for your exam? When making the appt. for a testicular ultrasound, it is not going to impact the clerk's productivity to ask if I have a preference for a male or female sonographer. In a derm full skin exam the scribe can be positioned so as to not be seeing the patient but still be able to record what the doctor is saying. And so forth. There are many very easy things that can be done that can make a difference for patient dignity without impacting productivity.
Biker, Biker..true..true. I have a feeling that staff finds there isn't enough time (nor the staff's formally educated response instructions) to prolong the action carried out.
With regard to scribe presence, I may have noted this here previously, but my son-in-law's dermatology exam involved a video image transmitted live to a (as I recall, female scribe resource) apparently across the country for documentation preservation. It wasn't "full skin" based on my understanding but it was a routine part of the exam and it isn't clear to what detail this imaging to afar was fully explained to the patient. ..Maurice.
Maurice et al,
The American Medical Association--a doctors' cartel that has controlled the medical labor market in the U.S. keeping demand and salaries high artificially.
Thanks to doctors, there aren't enough doctors.
-- Banterings
I read post about patients wearing only a gown with no underwear for cataract surgery. When I had cataract surgery all I had to take off was my glasses.
I have taken on American Sentinel University because while they use the term dignity, they describe it as an "an individual’s sense of self-worth and self-respect" as opposed to it being our intrinsic value. They also get away from the term dignity to modesty. This ALL has the implication of the patient being too modest and thinking too highly of themselves and their self worth.
Thank you NTT for Dr. Elaine Foster's email, as I addressed the email to her.
What I sent Dr. Elaine Foster is almost verbatim on my blog, the post "Why it is Patient DIGNITY and NOT patient modesty."
I have to assume that their intentions are pure, but what does the medical community have to go by when trying to protect and implement a curriculum of Patient Dignity?
Their basis is what healthcare believes about patient modesty, and we see the fallacy in that thinking.
American Sentinel University is doing good, but NOT GOOD ENOUGH!
-- Banterings
Dr. Bernstein, on your son-in-law's derm exam, that sounds like that Google Glass thing where the scribe sees whatever the doctor sees. It is basically glasses the doctor wears. I would never consent to that. Given the casualness with which the medical world treats male exposure I am not going to trust that the doctor turns it off when he gets to the intimate parts or that the scribe deletes those parts or that they have ironclad controls that will prevent its eventually finding its way to some internet porn site. Assuming the transmission is going to India which is the most likely scenario, the control aspects are going to be even less trustworthy.
Yet again they are cutting expenses in a way that the doctors make more money and the patient's privacy is even further eroded. In my elected position at Town Hall I get calls from India all the time and I am far from impressed over the quality of the people these big banks contract with trying to cut costs processing mortgages and other land transactions.
mitripopulos,
This is exactly how we create change. Once the first lawsuit is successful, then all of the malpractice/liaility lawyers will jump on the gravy train.
-- Banterings
Banterings, are you saying it is going to take lawsuits as the primary if not the only method to successfully obtain and sustain the preservation of patient dignity when exposed to the behavior of the medical system? Wouldn't the risk of additional loss of personal funds for legal assistance beyond paying for the medical bills themselves be a factor for the patient to reject suits? ..Maurice,
Maurice,
Legal is my realm. The legal of medical is what I do for a living.
Historically, medical changes either when there is legislation (such as in 2000, the law giving patients a legal right to their medical records) or when it costs money (the excuses of defensive medicine). Attorneys will take a case on contingency, meaning they only get paid if they win or settle.
There are basically 2 types of contingency cases; those that the attorney believes they will win by judgement and the payout will be equally as big. Think the lawsuits against drug/medical device manufacturers, big tobacco, asbestos, etc. The other type is the nuisance lawsuit, these are done by "mill" law firms. These firms (attorneys) have thousands of these lawsuits occurring simultaneously.
In the Greater Los Angeles area, it is not uncommon that a single liability attorney (personal injury, auto accident, medical malpractice, work comp, product liability, etc.) will have up to 15,000 concurrent cases at any given time. (I can attest to this from personal experience.)
These attorneys tend to be the "ambulance chasers" that advertise "get the money you deserve."
One needs to ask themselves how can an attorney handle 15,000 CURRENT clients? These firms are looking for settlements to make these go away. It is all about VOLUME!
When the profession refused to police themselves, patients sued for malpractice for ANY (even minor) infractions. Malpractice premiums went up so high, physicians had to sell their practices and become employees of large healthcare corporations. This is changing the system to patient centered care and customer service.
-- Banterings
Donald, as I reported to this thread in Volume 87, for neither of 2 cataract surgeries was I required to remove my pants or shoes. ..Maurice.
Banterings, what you just wrote should be encouraging to virtually all those reading this blog thread in that the system is changing "to patient centered care and customer service." Isn't that what virtually every patient desires? Isn't that the goal of those writing to this thread's title? So what is the current problem? The "change" is not going fast enough or the medical system is gaining power in "fighting back"? ..Maurice.
Banterings,I am in favor of modesty for both men and women.Can you find an attorney that will take your case?
Maurice,
The problem is that there are still physicians in private practice and there are still healthcare systems (hospitals, facilities, etc.) that are owned by teaching institutions.
The teaching institutions are our biggest threats because that is where things like intimate exams on anesthetized patients without consent occur. If we can break the teaching institutions' back bone and have a corporate takeover, then we will be on our way to solving the problem.
-- Banterings
Banterings, name some corporation names that would do a "good job" to move the medical system "on its way" to the full support of patient dignity. How about Walmart? Look what they are doing related to guns and bullets.. to help attain a goal of preserving the dignity of remaining alive and not killed or injured by a shooter. ..Maurice.
Maurice,
I am not saying that a big corp will do a better job, but at least they will have an easily accessible customer service department rather than one's only recourse being an impotent professional licensing board.
Customer complaints will only lead to being assigned to the less desirable shifts and positions (holidays), poor performance reviews, and annual raises will suffer. Termination will make one less valuable when applying for a position at another facility. Even if patient treatment does not improve, at least we can get our pound of flesh.
Furthermore, the harsh working conditions of retail America will help keep providers "softened up" so they will be more likely to concede to the wishes of the patient rather than argue that "as a doctor they know best"...
-- Banterings
Maurice
Walmart is doing nothing but posturing to the political big picture agenda. More deaths are attributed to teens texting and driving each year more so than all of those who die from gun violence. Maybe Walmart should ban selling cell phones to teens. Let’s get to the root cause of why patients are not afforded respectful care in our healthcare system. An erosion of ethics, accountability and I believe perhaps much fault lies with nursing programs failure to introduce fair and equitable guidelines that address the respectful care of male patients.
Nursing is a very feministic industry, one-sided approach that one size fits all. Nursing theory as taught in nursing school is devoid of concepts addressing advocating for both genders, that somehow the male patient is an afterthought. At the core it appears that the driving force just depends on the culture of each facility. Of course they love to create these stupid phrases such as “ best practice”. What is the best practice in patient care? Wouldn’t you say advocating for the patient as the best practice?
PT
PT,
As a long time reader, infrequent contributor that you have so crudely labeled a "fetishist", seeing as you're so strongly against the continuation of this valuable blog I invite you to stop contributing. Do you really believe that the large number of medical abuse victims that want to read this blog to learn but are either too embarrassed to talk about their trauma or just don't like forcing their opinions on others should be considered some kind of sexual deviants? I hope Dr. B keeps this blog going. Maybe if non-contributors feel that they can share their opinions without being so harshly judged by PT they will do so. Stan
Stan,
I am a big fan of [most] of what PT has to say. Both his internal knowledge and his hands-on education of healthcare (as more than just an administrator) is spot on. It offers the readers here a glimpse of the "hidden culture" of healthcare both among the technicians (those hands-on people like physicians, nurses, NPs, PAs, etc.) and administrators (hands-off people).
I have many friends and colleagues who live alternative (fetish) life styles. Interestingly enough despite their proclivities, some have no problem with healthcare and there are others that avoid it all together.
There is also an ethics among people in alternative life styles (surprisingly more than among healthcare providers). They would not come to a forum that is serious as this to live their fetishes. Those who would do that are paramount to the guy only wearing a raincoat and flashing people in the park in the middle of the day (that is more the ethics of healthcare providers).
That being said Stan, most of us who post here have been abused by the profession of medicine; PT included. We all respond very differently. PT's recent stance has been perplexing to me in light of his historical views on this blog.
I try to practice the principles of trauma informed care when dealing with people on forums such as this, something that we should all try t do. (After all, we the patients are better than the profession of medicine in our humanity.)
Still, I have recently noticed a decline for mu compassion and humanity for providers. One of my recent Tweets was:
"Since the profession of medicine has desensitized ME to the human dignity of providers, when they cry about #depression, #burnout, and #suicide idealization, MY response is that they should try diet and exercise."
I have also recently adopted the position that when a provider commits suicide, it is due to some deep seated guilt that they carry with them for abuses they have committed against patients and this is a form of justice as my initial reaction.
I do not like this is how I feel. I see this person as a monster, but he is there protecting that inner child that was abused in a hospital so many years ago.
Deep down there is still humanity and compassion. This is what the profession of medicine has made me. I know that these feelings have emerged recently due to some stresses that I am dealing with in my healthcare, a recent reemergence of a pride in paternalism in healthcare, and recent news stories of abuse by providers.
Let me illustrate with a scenario that I am sure that EVERYONE on this thread has recently wrestled with. As Maurice has become a prostate patient, I think that eventually he is going to suffer the abuses that we all know exist and have seen first hand, and we will have triumphed in his enlightenment. Yet, having suffered the traumas we have, NONE of US would wish that upon anyone, even at the cost of potentially enlightening a provider of what really happens.
-- Banterings
Stan
I would say that crude might be a nice word if I were describing someone who uses their healthcare providers as a means to fulfill their fetish. Appreciate that fetish defines many abuses of the healthcare system and often just working in healthcare alone for some is a fetish. If you haven’t remotely grasped these concepts by now I suggest you do some considerable reading online in psychology as it relates to the healthcare patient. Additionally, I recommend exploring Munchausen and by proxy, as well as nurses who enjoy deliberately over medicating patients to put them in a code so as to experience the rush they get when appear as a hero to save them.
I have much stronger words I’d use besides crude to describe those who simply enjoy reading this material for the sake of erotic fetishism. I know for a fact there are many lurkers out there and I suppose there is only soo much “sick” material that’s available online for those who enjoy that kind of thing. I wouldn’t go so far as to say this blog subject is invaluable and yes I have said many times it should be discontinued and I still believe so. This subject blog was and is not meant for therapeutic purposes despite Maurice’s upinions are.
It’s a down hill slippery slope for any physician, therapist to assume that some blog material is going to somehow provide therapy for its readers. The echelon of those unfortunately who want change on this blog are small and those are the ones who post on a regular basis. I nor anyone else has time to play a violin nor sing any “ I’m soo sorry for you songs”. The impetus as I see is to find, suggest a solution for the disparity, discrimination, sexual harassment and assault as well as a loss of respectful care, privacy and dignity of patients, male in particular.
PT
Stan et al, after reviewing the 104 Volumes of this thread topic, I am sure that most readers will find that each writing contributor has different ways of expressing their views--some views of which are severely "dirtying" the medical profession and some expressing their views in a "softer" way.
Unfortunately, we have not been having folks working in the medical profession or patients to come forward and support and fully praise the medical system or their experiences and perhaps present their ideas of why their experiences are different from the majority writing here. But, I expect every evaluation and expression by each writing visitor and even those who do not write will be a bit different in emphasis and other forms of expression.
What I don't want written here, which I have repeatedly noted, is that arguments written here are NOT based on the facts or logic of the specific expression itself and but primarily describing the personal character features of the one who had written that expression. That is ad hominem should not be a feature of the rebuttal. We all have different ways of expressing ourselves but what counts is the facts or logic leading to the final conclusion. I agree that sometimes I do "scratch my head" to follow PT'a logic but, nevertheless, that is MY problem for which I could ask for a further explanation.
Anyway, what I just wrote applies to everyone including ME. Everyone, keep writing and, if necessary, argue or support what others have written here. ..Maurice.
I’ve always said that this subject blog will never have the trickle down effect that will change our healthcare industry. I have instead felt that economic equilibrium change ( more males entering the nursing work force) eventually will be favorable. As much as I hate political correctness it may just be the magic pill we have been looking for.
Furthermore, another idea that could possible catapult our goal is to get some news headlines to say that this subject blog is about 15 years or so running which when you think about it is a long time for a blog subject such as this. Who knows, we could even help catapult Maurice into some prime time television talk show “ ask the Bioethicist”.
There are roughly about 25,000 hospital nursing directors in this country who have for decades held on to their one sided fits all modicum healthcare delivery system while collecting hugh salaries. All their faces should be paraded on national TV for all to see. Then there are the countless female wanna be college nursing instructors who have made many penis jokes to their all exclusive female nursing students for a cheap classroom laugh that has no educational clinical value.
I firmly believe the dog training camp has a better grasp on instilling the concept of discipline, self worth and value to humans than any of these nursing programs. Nursing has become soo full of themselves that now they have a new title for nurses, the nurse Doctor.
—————————————————————Please excuse me while I make a quick trip to the bathroom—————————————
————————————————————————————————————————————————————————————-
Sorry, I had to wipe my Ass
Sometimes I get to laughing soo had I have it coming out at both ends
PT
It is the Organization who is responsible for a lot of the pain both for the patient but also for the healthcare provider. PT how about the ER female nurse who may not have any time at all to "go to the bathroom".
Here is the story and here is the conclusion:
Health care is currently facing unprecedented challenges. It is impossible to work day in and day out on the front line and remain ignorant to what is crumbling all around us. There is an absolute need to refine our approach and continue to address the problems our industry is facing. I respect and welcome novel and innovative system design into the emergency department. However, I ask you, the current changes are being made at what cost — and to whom? Are we fixing a problem or just creating a new crisis? A crisis that will be faced without the strength and spirit of undervalued experienced employees who have not or cannot be replaced.
I implore our department and its leaders to rise up — to do better and be better. We have an obligation to care for our community and for each other. We are falling short.
Sincerely,
A concerned ER nurse
..Maurice.
Maurice,
You will NOT get any healthcare providers here. As you want arguments based on facts and logic, what are they going to provide? Anecdotal evidence of how compassionate healthcare is, how patients don't mind a procession of medical students groping their private part, and not only are we suffering from some psychopathology, but we are outliers too.
In light of the scientific proof which has been presented here, even you (Maurice) can no longer deny the FACTS that we have ASSERTED about the treatment of patients.
Let me present you with a PubMed paper that upholds the first assertion that I made and that you claimed was anecdotal: medical care (exams) that follow guidelines can be traumatic and create PTSD.
Proof that the profession of medicine is unaware of this lies within the fact that someone HAD to research this topic (and providers still don't believe it.
This is a glaring example of how individuals who are supposedly soooooooo intelligent (compared to us mere mortals), lack BASIC common sense and do not recognize the obvious due to their hubris.
-- Banterings
Maurice
I read the story posted on KevinMD and as you would expect I responded. It’s a big lie, fabricated. Admit it, nurses hate their jobs with a passion. Let’s look through the facts for a moment.
1) At level 1 trauma centers the Er does not cover trauma with their nurses. The nurses respond to trauma from the trauma ICU.
2) Around the clock there is a house supervisor whose job is to do nothing but maintain staffing levels. They have agency nurses to call, they have their own pool agency to call for nurses to work.
3) it’s a fallacy to say they don’t have time to go to the restroom. Why do they spend soo much time on their cell phones at the nursing station.
4) How about the big billboards you see. Your Er wait will never be more than 30 minutes.
Don’t forget, I’ve worked in emergency rooms for over 40 years. That article has many falsehoods. Another issue is that emergency rooms have Er secretaries as well as ER techs that do the bulk of the care. Lab comes to the Er and draws their own blood. Would you like me to keep going.
PT
Starting the Abstract of the article you put up are the words "Frequently, episodes of care such as preventive clinic visits, acute care, medical procedures, and hospitalization can be emotionally threatening and psychologically traumatizing for pediatric patients."
I would say that this statement can and does apply to all patients beyond the age of children but up to our ages and all occupations including ill physicians and nurses (since in the case of the medical professionals, there is the memory of the medical experience of their patients in the past to recall and more detailed knowledge of pathology and attempted treatments despite their own current management by others seemingly following "medical guidelines". Don't think that your doctors or nurses are immune when they themselves are the patient. ..Maurice.
Maurice
One more comment about the “concerned” nurse. Why did she hang in there for 20 years? There are countless opportunities where he/she could work. She could transfer to another unit, she could go to prison, school or home health nursing. She just hates her job like all other nurses. No one made them pursue that career, now why are so many of them complaining?
PT
Maurice
Physicians and nurses are immune, they use that VIP card.
PT
And for the final posting by me for this day, may I introduce you to Maurice, a French rooster, as reported by the New York Times today, who the French judge "found that the rooster, being a rooster, had a right to crow in his rural habitat".
I would, as the judge, defend PT and say he has the right to "crow" in this
bioethics habitat as well as all the other writers here. ..Maurice (not the rooser in the news).
Dr. Bernstein said: "Don't think that your doctors or nurses are immune when they themselves are the patient."
I'm just hypothesizing but I would guess that they largely fall into one of two groups. One would be those who are like Dr. Bernstein that see it all in purely clinical terms and are not bothered by their exposure.
The other would be those who won't get treatment where they work and who perhaps are still concerned with their exposure where they do go. If they themselves were like Dr. Bernstein and saw it all in purely clinical terms they wouldn't be shy about getting treatment where they work or anywhere else. Their exposure to co-workers would not be a big deal given they're all professionals and there is nothing sexual about healthcare, or so they tell us patients.
I would add that the same can be said for medical and nursing students. If they believed there is nothing sexual about it, they wouldn't mind their own exposure for educational purposes.
Bottom line is if my exposure is purely clinical to healthcare staff, then they should see their own exposure as purely clinical to their peers and any other healthcare worker.
Biker
That is an excellent way you phrased it. I worked at a large hospital in the mid 70’s and sought care at that facility as well. It way one of my first introductions to Hipaa violations before Hipaa existed. By the end of the day everyone knew I had sought care there despite very very few saw me as a patient. I’ve never seen any nurse seek care where they worked at the numerous hospitals I’ve worked at and to a very large degree they have verbalized why they wouldn’t. Your commentary was correct, what’s the big deal if everyone is a professional?
PT
Biker,
There are 4 types of providers:
Those like Maurice who see intimate exposure as purely clinical and don't mind exposure in a clinical setting, even at their own facility where they are treated by their coworkers.
There are those who see intimate exposure as purely clinical but do NOT want to be exposed to their coworkers (HYPOCRITICAL). This was the argument that I made about med students and peer physical exams.
Then there are those who will not allow exposure in a clinical except to 1 or 2 trusted providers who have earned our trust over many years of respecting our autonomy and boundaries.
Then there those who (like many on here) refuse exposure even if purely clinical.
PT can validate all of this: that for many years physicians (and other providers) self treated and would think nothing of writing a Rx (if samples unavailable from pharm reps) or signing a physical (participation) form for staff and family. As providers became employees (subject to their employers' policies) and laws about treating family and friends became more stringent, they fell back on an old tradition of physician reciprocal agreements.
These physician reciprocal agreements existed even when physicians could self treat and self prescribe. When they needed another physician's signature for things like their annual physical, they would have a friend who was also a physician and they would just sign each other's paperwork.
Even today, there are physicians known to other physicians that they basically just sign off any forms that need signing by a physician. These practices do a very rudimentary exam if at all: mostly they ask the physician being examined of any problems. They may order a chem-14 and CBC to make it look legitimate.
-- Banterings
Is this where contributors of this blog thread should go to make their concerns about the medical system known and acted upon:
Boston Children's Hospital Institute for Professional and Ethical Practice (Harvard Medical School)?
Start out by going to this link about an upcoming program
"Deep Dive into Error Disclosure
Disclosure & Apology after Medical Errors & Adverse Events"
Read what the internet workshop is about but importantly at the bottom of the page read the names, titles and sites of the two professionals who are leading the program.
I would suggest that those professionals Stephen D. Brown, MD and Pamela Varrin, PhD might be valuable individuals for our visitors to communicate with to further the goal of preservation of dignity. ..Maurice.
A. Banterings
I am validating that what you say is the truth and if I may take it a step further. In those days essentially all physician’ s offices had many Demerol samples, thus the physician usually never had to write a script as reps from Big Pharma left many samples. Secondly, physicians and hospital administration would bring their family members for free tests that were non-emergency bumping patients that were scheduled weeks in advance. I know of many drug companies that would wine and dine physicians, taking them on cruises and expensive gifts left which of course influences the script writing for Big Pharma pharmaceuticals.
I’m not placing exclusive blame on physicians for this as you can see Big Pharma is finally taking on big hits for all the inappropriate business dealings. It’s the same system that we speak of on this blog as to how patients are taken advantage.
My disclaimer: To all medical personnel who are somewhat young and have never heard of Demerol. You may find this compound in many old PDR( physicians desk reference) as well as a google search.
PT
PT, Is that what makers of fluorqunolone antibiotics do ?
Donald
For Cipro, levaquin as an example are expensive without some insurance plan you may find. You can buy these same drugs at any pharmacy in mexico for as little as 100 (500mg) for $10. Without a insurance plan her in the US expect to pay $800 for the same script.
PT
Caution: Beyond $$$$: TOXICITY. ..Maurice.
That physicians and others who work in healthcare might give advantages to their friends and family does not shock me nor does it overly trouble me. It isn't right but every profession does the same. Lawyers, police, educators, auto mechanics, plumbers and so forth all do it too. Knowing or being related to the right people has its perks. It's always been that way and it exists in every facet of society.
What bothers me more than anything with the healthcare industry is the hypocrisy. They put forth the lofty patient dignity statements in their literature but then make staff and staffing convenience a higher priority. They affirm their non-discrimination policies and then organize themselves for the comfort of female patients to the detriment of male patients. Worst of all they say medicine is gender neutral and that there is nothing sexual about healthcare despite their own actions being the polar opposite. As I have stated before, if gender neutral and nothing is sexual, why only female mammographers? Why do they go to other facilities and practices for their own healthcare? Why don't medical & nursing students practice on each other? Why? Because they know medicine is not gender neutral and they know patient exposure is not always purely clinical. The fact they who are fully dressed don't mind seeing exposed patients is irrelevant.
https://patient.info/forums/discuss/fluoroquinolone-toxicity-syndrome-427305
To further illustrate what Biker has said
Why are the core values of every hospital located in the Twilight Zone? Why do they make physicians take an oath? Why do physicians and nurses maintain a license with medical and nursing boards? Finally, everyone it seems in healthcare say that, “ well when you are a patient you are not to have any modesty”. Do they mean privacy or dignity? If that is the case why don’t they just pull all the doors, curtains, privacy dividers etc out of the hospitals? Make the walls out of glass and burn all the gowns, patients will lay in bed nude and going for tests nude.
As far as Hipaa is concerned just post a big sign outside of the local Walmart every week with the names of every patient who were there as it wouldn’t be any different than it was 30 years ago. Physicians offices would throw patient data and paperwork in the local dumpsters each week, Fact. Many years ago when I had knee surgery I was walking through the mall and a scrub nurse who I recognized involved in my surgery said to her husband, he was a patient recently that I was in on.
Let’s just make patients wear a billboard for a whole week on the front and back of the billboard say “ I was a patient at such and such a hospital for X number of days, bumper stickers are optional. When nurses and other staff call you hun and sweetie tell them they can adopt you, take you home and feed you. We will see how long they call you sweetie after a week of paying for your food.
I should be able to call the dept of homeland security and report a biohazard in effect when I see nurses wearing their scrubs into coffee shops and grocery stores. What has happened to all the nurses scrub uniforms that feature Betty Boop on them as well as “ I’m a sexy nurse”. Do they not make those anymore? Have hospitals and physicians offices frowned upon that type of scrub attire?
Finally, if a young female nurse came into your room at the hospital wearing scrubs with “ I’m a sexy nurse” all over them causing you to have an erection upon which she immediately struck your penis with a spoon. Would you be able to recover damages from the scrub manufacturer for injuries?
PT
Oh..on the other side maybe the physiology explaining what is happening is coming from the male patient.
How about this "American Men Fantasize About 'Sexy Nurses' Because They Want To Be Mothered"
The sexualization of medical care providers is indicative of an American male desire for comfort and care.
So..there is always another side to explain a view of male patients about female nurses which has been going on for ages.
Does this "old" to "modern" history play a role in the attitudes toward specifically the nursing profession which is being described on this blog thread? ..Maurice.
Dr. Bernstein, "mothering" and "sexy" anything can only possibly go together in a perverted mind, and yes there are perverted men out there same as there are perverted women.
On the ongoing theme of sexy nurse in society, might the source be the general male experience of being exposed more than was necessary and then attributing that unnecessary exposure to female nurses purposely sexualizing their male patients?
Maurice
No one forced female nurses to wear scrubs that say “ I’m a sexy nurse”. No one forced female nurses to engage in boundary violations as evidenced as a major problem with state nursing boards. The last person I would trust in this world is a female marriage counselor especially writing a column that seems to blame men for every infraction.
The other person I’d have a lack of trust for is some dude that likes to comment about porn and costumes and tying it in to the medical industry. I’m a patient that wants privacy and respectful care and I’m paying for that. I couldn’t care less about some stupid articles written by these people. Let’s visit them in 40 years from now and after they have a chance to be a patient and ask them what their opinions are then.
PT
Biker et al: have we discussed here fully what is expected to be the behavior of a nurse of either gender but particularly a female nurse toward a male patient? What are the sick male patients looking for?
I don't recall that in some past Volume we have printed out a list of specific acceptable "non-sexualizing"
behaviors toward an office, clinic or hospitalized patient which would be pertinent to all the duties for which female nurses are assigned or for which they are morally and legally responsible. What are the common duties and how should they be carried out if the patient is a male? This list will assume that no male nurse is available to complete the necessary task. ..Maurice.
p.s.- let this listing be one developed by all those contributing to this blog thread.. so add, reject and discuss. "WE WANT AND INSIST, AS A MALE PATIENT IN NEED, FOR THE FEMALE NURSING STAFF MEMBER TO CARRY OUT THE NEED IN THE FOLLOWING SPECIFIC MANNER" ..Maurice.
Dr B
I think much of the question/request has been answered already multiple times. For instance the scrotal exam being done with the patient being covered.
Also at the root of this problem is silencing patient voices. There should have been a much larger number of male nurses and CNA's/ technicians already hired.
The only exceptions SHOULD be hurricanes , mass shooting , out of control fires..... Disasters injuring large numbers of people.
Here is the start of a list Dr. Bernstein using the assumption that a male staff member is not available:
- knock and wait for an answer before opening the door
- ask for an OK before bringing any observer, chaperone, scribe or assistant into the room
- close the curtain
- close the door
- gather your supplies and get them ready before you expose the patient
- say what needs to be done next and ask for an OK before exposing the patient
- only expose what needs to be exposed.
- only expose the patient for as long as he needs to be exposed
On the matter of only exposing what needs to be exposed I don't mean that being the the end result. I mean from the beginning. For example if I am on the table for a cystoscopy, yes my penis needs to be exposed, but don't lift the gown halfway up my chest so that I am exposed from there to my feet, and then throw a sheet over my legs. I mean cover my legs first right up to my genital area before lifting the gown from underneath it and only lifting the gown to immediately above the penis. In a nutshell only expose me so that you have access to my penis.
On the only being exposed for as long as I need to be exposed, using the same example, as soon as the penis is prepped cover me over and as soon as the doctor removes the camera, cover me up again.
Exposing me more than was necessary or for longer than was necessary or to people who I did not give permission to be there means either you don't care about my dignity or you are enjoying the view. Neither is acceptable.
Allowing that perhaps enjoying the view is not a factor for a given nurse, the goal still needs to be minimizing the patient's exposure, not maximizing your efficiency or convenience.
Biker,
Just as in Maurice's case with the curtain, knocking, informed consent, student nurse, AND even with the issues surrounding gun control (like background checks):
These things are in place, they are NOT being practiced! Why do we need to have a list of things we would like being a list of WHAT SHOULD BE PRACTICED REGULARLY?
Part of the problem is tat those in healthcare have been indoctrinated. Maurice, who was the subject of the abuse has excused this unprofessional and abusive behavior. When providers can't see it for what it is when it happens to them (naked, vulnerable, labelled patient, afraid, disoriented, etc.), what makes you think that a provider who is fully clothed is going to call it out when it is occurring to a patient in front of them (when it is more fun to watch)?
-- Banterings
Well..in contrast..the Mayo Clinic published in the American Medical Association Journal of Ethics June 2019 "Mayo Clinic's 5-Step Policy for Responding to Bias Incidents". I can't provide our visitors here to a link to the full article (go to your medical resource library) but here is the published Abstract:
"Patient bias towards clinicians and employees in health care is common, but policy to address bias and to support staff is relatively limited. Creating a framework to address bias incidents is critical for cultivating environments that are safe for employees and patients. Mayo Clinic has created both policy to support staff and a reporting mechanism for accountability. Education, resources, and training are available and being disseminated to teach employees ways to respond to bias incidents.
And here is how the patient was and is now educated as to Mayo policy:
Our online “patient responsibility” policy preamble previously read, “we respect each patient’s cultural, psychosocial, spiritual and personal values, beliefs and preferences.” This preamble has since been revised to state, “We won’t grant requests for care team members based on race, religion, ethnicity, gender, sexual orientation, gender identity, language, disability status, age or any other personal attribute. If you’d like more information on our policies, contact the Office of Patient Experience.”
And, in conclusion,
A patient’s preferences can be mistaken for a patient’s needs. In a fiduciary profession, grounded in altruism, making changes that prevent granting patients their preferences can be challenging. Organizations and individuals must communicate the rationale for new policies that patients may find difficult. At Mayo Clinic, the Patient and Visitor Conduct Policy allows us to address both microaggressions and egregious behavior in a manner that supports the rights and responsibilities of patients, staff and the organization.
It does appear that the "system" is aware of patient discontent and in different ways may be "fighting back". What do you think? ..Maurice.
Maurice,
Nursing has its roots in catholic nuns that took care of people before the profession of medicine existed. They cared for people in the name of God. The care was dignified and compassionate. Even when Clarissa (Clara) Barton practiced nursing during the civil war, it was a mentality of "taking care of our boys." Women recognized the role of men in society. Men were respected because we were the providers for our family and we fought the wars.
Men practiced chivalry. Just as men would hold the door for a woman, men would do things that no one wants to do. Men did this as a sign of respect of our mothers and wives. Feminism was the demise of mutual respect of the sexes. Feminism wanted men to stop our gestures of respect as they were demeaning. Talk about a slap in the face.
The way men were treated in healthcare was fueled further by the feministic idea that "all men are rapists" and the historic feud between male doctors and female nurses. Now that women have broken into careers that were traditionally male, with IVF, and affirmative action for women, there is now the idea that men are useless. Just as in the stories of the Amazonian women, men are treated as second class citizens, pets, slaves, or a blight on their female society.
Ask any wife married for more than 2 years what a man is like when they get sick. They want their mother (like when they were 6 years old) to take care of them. The last thing that they want to hear is "man up." If nurses were more like "mommy" than harpies, men would have no problem with intimate care.
-- Banterings
" A patients preferences can be confused with a patients needs?"
If they are referring to modesty than the whole little sermon was down the drain.
To clear up confusion on the healthcare workers part, just assume that all patients are modest, be they male or female.
And even if the caregiver is the same gender, still only expose what needs to be exposed and only to who needs to see it.
Let there be self swabbing in private body parts. Dr B, I realize that you're not excessively modest but many people are.
Akso, I don't know if this applies to you or not, but onetime PT talked about a doctor intimately examining a young boy while his mother watched. He then said "what if a man watched while his daughter was given an intimate exam?" You then said it has sometimes happened. My concern was did either even happen in your office or was it just complaints you have heard on this blog?
You've talked about never being aware of patient embarrassment. First lets talk about the boy. If he angrily told his mom I hate you. If he suddenly announced I'm gonna go live with Dad or if tears seemed just below the surface , don't automatically assume they were fighting already for other reasons. Very possibly he was humiliated.
If you did an intimate exam on a girl while her mother and/or dad looked on and the girl sobbed, don't assume the crying was because of symptoms. Also, please tell me that neither of those things never happened in your office.
Mayo facilities are a joke
Just ask the 5th year resident who took a cell phone pic of his patients penis and sent it to his colleagues.
These facilities no longer accept Medicare.
Mayo facilities frequently lie to their patients regarding what insurance they accept.
The care at at Mayo facilities is no better than anywhere else.
Now, I’m letting you all in on a little secret. Good medical care is like finding gold, it’s where you find it!
If you want to see what people think of Mayo facilities just go into yelp, the truth is all there.
Finally, I couldn’t care less what Mayo’s policies are. I have 2 very bad experiences there as a patient and I never expect to return.
PT
A. Banterings
Amen! Isn’t that the truth!
PT
Hello Dr. Bernstein,
Thank you for you info re Mayo Clinic. Your use of the term "fighting back" seems instructive. I have constantly asked, "Why must one 'fight' to receive dignified care?" Shouldn't medical personnel strive to work WITH the patient to achieve this care? In most instances individuals do not encounter health care via catastrophe - even emergency care is more or less "routine". How difficult is it to obtain a male to place a male catheter (or other intimate care) in 99% of hospital encounters? Will Mayo now REJECT the REQUEST of Moslem women to receive care from a FEMALE physician? Will a similar request from Moslem MALES for MALE physicians also be REJECTED? Additionally, will these requests be treated differently? Finally, how does Mayo's 5-Step Policy fit with our society's concerns for liberal inclusivity? Do I detect some contradictions (dare I say "bias") here?
Reginald
Oops! I forgot that the AMA's Journal of Ethics is open to the public (no subscription needed) and this issue titled "Limits to Patient Preferences" is freely available at
https://journalofethics.ama-assn.org/issue/limits-patient-preferences
There are a whole bunch of complete articles available, including the one from Mayo Clinic to which I previously referred-- and they are all pertinent to what we have been discussing on this blog thread.
Let's discuss these articles and point out what views expressed are misleading and which provide some basis for support of the expressions presented by our visitors here.
..Maurice.
Maurice et al,
This policy is in direct violation of the Americans with Disabilities Act. All one need to say, to my condition (one listed in DSM such as PTSD), "I am requesting a reasonable accommodation of..."
The Supreme Court ruled in the case of male nurses in L&D, as a BFJQ, gender of the care giver is one the most important choices that a patient can make.
I suppose that they will be hiring male L&D nurses and male mammographers at the Mayo Clinic now.
This is just paternalism rearing its ugly head again. It will be cut off.
-- Banterings
Funny, the AMA's Journal of Ethics is open to the public but the Mayo Clinic's Patient and Visitor Conduct Policy is a secret...
-- Banterings
In the articles about patient preferences they don't really get into male patient gender preferences. Race is the dominant example used in the articles but when it does mention gender it is almost always female patient preferences. Male patients having a preference for male staff for intimate care is not a focus of any of the articles.
The reality is that no matter what Mayo's or any other institution's policies may be, they already staff themselves for the comfort of female patients. None of those facilities are going to entertain hiring a male mammographer or otherwise staffing themselves in a way that raises the ire of female patient's when it comes to their intimate care. They will just use their policies to shut down male patient gender-based requests.
Banterings wrote:
"Biker,Just as in Maurice's case with the curtain, knocking, informed consent, student nurse, AND even with the issues surrounding gun control (like background checks):
These things are in place, they are NOT being practiced! Why do we need to have a list of things we would like being a list of WHAT SHOULD BE PRACTICED REGULARLY?"
That's the point. Nothing I included in my list is profound or operational onerous in any way. The entire list is simply interacting with the patient in a courteous and respectful manner. It isn't too much to ask. Yet again I will say being polite is not synonymous with being respectful. Being respectful requires the accompanying actions such as I described in addition to being polite.
Good Morning Everyone:
Banterings, you & AB in the NW are the legal eagles here.
Healthcare facilities are using the BFOQ privacy exception all the time against male nurses & techs to keep them out of L&D & mammography. Their claim is that labor and delivery nurses & mammography techs perform intimate functions and if a male nurse or tech is performing these duties, the patient's constitutional right to privacy is violated.
My question is why shouldn't a male patient turn around and sue a facility for not using the same BFOQ hiring exception & hire male nurses/cna's/techs to do intimate functions on male patients whereby lessening the chances that the facility would in any way, violate the male patient's constitutional right to his privacy?
That exception is being used against men all the time. If possible, it's about time it got shoved back down the throats of the institutions for a change.
Regards,
NTT
NTT
Mammography is the one facility whereby they don’t need to use BFOQ law. A mammographer must first be trained and hold a license as a medical radiographer. Then be given on-the-job training in mammography at a hospital or clinic. They never let men train in this area thus if you can’t train for the job you can’t apply for the job. Thus it never rises to the BFOQ application.
I’ve never seen a male nurse, cna or even a unit clerk in an L&D suite in any of the over 20 hospitals I’ve worked at. The director of L&D suites interviews staff but appreciate that many female nurses transfer into these units from other departments and therefore have hiring priority from outside applicants. It’s very easy for an L&D Director to get the staff she wants by excluding men and it will never rise to the BFOQ application.
We have talked before about BFOQ law and the qualification but know that the Human Resources departments of hospitals are staffed by women as well. I’ve never seen a male in any human resource department of any hospital I’ve everworked at. They just hire who they want and if anyone asked up and challenged BFOQ they would laugh you out the door. It would never rise to the occasion.
They can say, it was an internal transfer, it was an existing employee with more qualification, it was an existing employee who has longer years of service at the hospital. They are never ever going to come out and use that BFOQ card,why? They don’t want that ugly card to come out of the drawer to be challenged!
PT
NTT
BFOQ is a card employers can use to restrict one gender from employment and yes I agree with you 100%, we should be able to hold medical facilities accountable to flip that card. I can’t think of any employer in the US that uses BFOQ law against women. Appreciate that when that card is played there is often a court challenge that can go to the Supreme Court but again as I have mentioned they work very hard not to use that card.
Again I will use Mammography as an example. It is the only occupation in the US that is employs women 100%. They have accomplished this by preventing men from acquiring the training, thus they are disqualified to be trained because they are men. You see,
men are never turned awY from mammo Jobs. You can’t do a job and be hired if you can’t get the training.
BFOQ was a law qualification used in employment and in my opinion it must also (should) be used as a free standing application to respect both genders. But,in healthcare it legal to discriminate against men, it’s legal to be unprofessional towards male patients. If you are a female nurse and you gawk at your male patients even after your patient has died the worst that will happen is you get 3 weeks of paid vacation.
A female nursing license is indestructible, despite killing your patients by violating the 12 safe rights to safe medication you keep the license. If you are a female nurse, have sex with your male prison inmate patient, kill your husband and burn the house down to hide evidence your license is still intact. If you are a female nurse and assist your male lover in killing his old girlfriend your license will remain intact. Why? So you the female nurse can practice nursing to abuse more male patients the next day and the next.
PT
Sometimes the news or advertising media biases patients in making their autonomous medical decisions.
Actually, I wrote an article on this topic which was published in the AMA Journal of Ethics in 2007: https://journalofethics.ama-assn.org/article/hospital-reputation-and-individual-patient-decisions/2007-03
Notice that my orientation of the article was that physicians' decisions regarding their patients should be based on listening to the patient and attempt to arrive at a conclusion which would be acceptable to the patient's decision and still be of therapeutic benefit to the patient. Let me know what you think of my article and conclusions since really, for my continued limited medical practice and teaching-- it hasn't changed. ..Maurice.
I must do this in 2 parts:
NTT,
When the courts look at gender as a BFOQ, the courts have rejected customer preference as a basis of hiring one gender for a position. This was seen with female only flight attendants as in Diaz v. Pan American Airways or Wilson v. Southwest Airlines. This was also rejected in the reverse of Asian clients not wanting to deal with a woman in business as in Fernandez v. Wynn Oil.
The courts have upheld gender as a BFOQ in healthcare settings an a matter of customer preference affecting customer/client/patient privacy. In Fesel v. Masonic Home where the families would remove clients if a male aide was hired, the courts found:
While these attitudes may be characterized as "customer preference," this is, nevertheless, not the kind of case governed by the regulatory provision that customer preference alone cannot justify a job qualification based upon sex. Here personal privacy interests are implicated which are protected by law and which have to be recognized by the employer in running its business.
In Backus v. Baptist Medical Center, the plaintiff was denied a transfer to the OB-GYN ward on the basis of gender. The court ruled that due to nature of the ward, an employee’s competence was secondary to the obvious “bodily intrusions” that would result from allowing male nurses. The court opined:
Due to the intimate touching required in labor and delivery, services of all male nurses are inappropriate. Male nurses are not inadequate due to some trait equated with their sex; rather, it is their very sex itself which makes all male nurses unacceptable.
The court stated that it does not matter that a nurse is a health care professional because he would be an unselected intruder on the patient’s right to privacy. It differentiated between a delivery room situation and instances where a female may by choice select a male doctor
In EEOC v. Mercy Health Center, 24 a very similar situation was at issue. A male nurse sought employment in the labor and delivery area of the hospital. The court observed:
The privacy right has been recognized in a variety of situations, including disrobing, sleeping, or performing bodily functions in the presence of the opposite sex...
...Courts have recognized that [customer preference may]. . . give rise to a [bona fi de occupational qualification] for one sex where the preference is based upon a desire for sexual privacy (emphasis in original).
The court ruled that due to the sensitive and intimate nature of the duties, the presence of a male nurse could create medically undesired tension.
End Part I
-- Banterings
Part II
In Local 567, American Federation of State, etc. v. Michigan, the state mental health institutions maintained a practice of same-sex personal care for its patients.
The plaintiffs claimed that even though there might be privacy rights implicated by the type of care given to patients, the intrusion would occur regardless of gender. The court disagreed, stating that this was an unrealistic view of human mores and contrary to law. It stated that most people would find it a greater invasion of privacy to have naked body viewed and have personal care performed by a member of opposite sex.
In Jennings v. New York State Office of Mental Health, a mental hospital had adopted a policy that stated that each ward would have to have both a male and female Security Hospital Treatment Assistant (SHTA) during each shift. As a result of this policy a female employee was transferred to another ward. She objected to this policy and claimed that gender did not qualify as a BFOQ. The court adopted the following standard:
1) the OMH has a factual basis for believing that it is necessary to staff at least one SHTA of the same gender on each ward in order to protect the privacy interests of the patients; 2) that the patients’ privacy interest is entitled to protection under the law; and 3) that no reasonable alternatives exist to protect those interests other than the gender based hiring policy.
The court concluded that certain duties of a SHTA (e.g., bathing patients and assisting them in the bathroom) affected the privacy of the patient and that a person of the opposite gender would be unable to adequately perform some of these duties and successfully respect those rights. Then it ruled that privacy was entitled to protection.
Finally, it concluded that having one member of each sex was the minimum necessary to ensure privacy rights. The court stated that it made no difference that there were male doctors on female wards and female nurses on male wards because they were trained professionals.
Based on court rulings, the Mayo Clinic's policy is in direct violation with a patient's right to privacy as held up in Title VII cases of BFOQ.
Reference: Gender as Bona Fide Occupational Qualification
-- Banterings
Good Evening:
In Backus v. Baptist Medical Center, the defendant claimed that labor and delivery nurses performed intimate functions and if a male nurse were to perform these duties, the patient's constitutional right to privacy would be violated.
Then as you said Bantering's, the court then rule against the nurse saying "because he would be an unselected intruder on the patient’s right to privacy".
So, I'm a male patient in the urology ward. They want a female nurse to insert a urinary catheter. No males are available. By the ruling in Backus v. Baptist Medical Center, she would be an unselected intruder on my right to privacy.
Therefore, I should be able to sue since my constitutional right to privacy was violated with her presence.
Same goes for any guy receiving any type of intimate care that doesn't want a female present. They are violating his constitutional right to his privacy according to Backus v. Baptist Medical Center.
Another way we might be able to spread some influence is if we are to be subjected to this unwanted way of treatment, the feds should mandate three things.
1. Patient is allowed to have their own advocate with them from start to finish regardless of provider chaperones if any are present and regardless of procedure being done.
2. Anything uncalled for from the provider if reported and they are guilty, a mandatory stiff penalty is given for violating the patient. No more I'm sorry. Anyone caught giving anyone a pass on penalties is fired on the spot no questions asked.
3. Force use of the BFOQ card in urology and ultrasound to better protect men's privacy.
We've got to break that glass dome somehow.
Regards,
NTT
Please note that there is a Mayo Clinic and a Mayo Hospital. These are two separate facilities that as A. Banterings had mentioned have that same policy in effect at both facilities. The female staff couldn’t care less about the policy as it does not affect them, ask me how I know.
Their mammo suite offers all female staff as well as a female radiologist in the event a biopsy is required, however, their health insurance allows them to go anywhere. Appreciate that generally female nurses account for 93-95% of all nursing staff, not so at Mayo. Their numbers approach very closely 98-99%, ask me how I know.
When the 5th year surgery resident took a cell phone pic of his patient’s penis the very first thing Mayo did was want to know who amongst their ranks reported it to the local news. Not who recieved the cell phone pic, not the concern of the patient or the general public, but who leaked it to the news, ask me how I know.
PT
In the Jennings vs NY Office of Mental Health case that Banterings posted it should be noted that the court differentiated between what seems like CNA level staff vs physicians & nurses. Patients had an expectation of privacy at the CNA level but not at the physician/nurse levels. Odd.
I also find it very odd that mammograms and L&D are deemed private enough that no males are allowed but all-female urology staffing is deemed OK. Using what logic can this be justified?
Quoting NTT,
"We've got to break that glass dome somehow."
3 things:
Legislation, Legislation, Legislation.
That's what it's going to take.
58flyer
This comment has been removed by the author.
Good Morning Gang:
Flyer you are correct & it won't be easy as the healthcare lobby has bought off most if not all of this current congress.
I've been sending letter after letter & have received no response. Went to a town hall mtg & told the senator don't expect my vote if you don't fix male healthcare.
Regards,
NTT
Flyer, NTT, & Biker,
Here is how you change things.
First, I am creating a "legal guide" of issues such as facilities not acquiescing to patient preference of providers violates the rulings affirmed in Backus v. Baptist Medical Center.
Find he largest ambulance chasing firm around the Mayo Clinic (or other facility), send a letter to "Sr. Partner, Medical Malpractice," containing the "legal guide" and let the hounds loose.
Biker,
In In Backus v. Baptist Medical Center, the court stated that it does not matter that a NURSE IS A HEALTHCARE PROFESSIONAL because he would be an unselected intruder on the patient’s right to privacy. It differentiated between a delivery room situation and instances where a female may by CHOICE SELECT a male doctor.
The court recognizes that patients have a preference in choosing their providers' gender.
-- Banterings
Banterings, could you summarize the issue as expressed on this blog thread, provide the current legal and your understanding of ethical supports in a format of a couple hundred words which I could put up on the international bioethics listserv to which I subscribe and write and identify the author as you wish? I would then present pertinent excerpts of the responses by the ethicists (unnamed) here for review.
I think that with your legal knowledge and research, what you write would be better expressed than what I could write. ..Maurice.
As if patients' dignity and human rights are not being violated enough already. Read this KMD article that advocates medical profession needs more shadowing opportunities.
You can read my comments if KMD decides to post them. There are others that point to the abuses that shadowing causes along wit an interesting POV about age of majority and entering into legal agreements.
-- Banterings
A. Banterings
Did you notice he said “ it can get dang crowded in there” just like at the Univ. Of Pitts. Where half the hospital crowded in to watch and take cell phone pics of a patient having penis surgery.
PT
Good Afternoon:
Kudos Banterings on your KMD comments.
Regards,
NTT
And, I too, contributed to KMD now and if it is accepted you may see:
A "shadow" is a visual image of an object which is only understood as to its significance by discovery of the nature of the object. That discovery in "shadowing in medical practice" requires the patient to communicate with the source of the shadow and express to all confidence in the source's history and role and it should be the patient who sets the limits. Without patient-accepted participation, there should be no attempts to shadow any patient. . Anyway, that's my view. ..Maurice.
Maurice,
Forgive my rant here, this is not a personal attack against you, but these are valid questions.
"Without patient-accepted participation, there should be no attempts to shadow any patient. . Anyway, that's my view. "
Does this ACTUALLY OCCUR?
Your answer is that you do not know because you have never experienced it personally, never had "shadows", AND you only teach 1st and 2nd medical students.
See the comments and links in those comments in the KMD article: It happens regularly.
Your profession is morally corrupt!
You may not be morally corrupt personally, you may not teach your students to be morally corrupt, but corruption permeates the profession!
Time to pull your head out of the sand. Going back to the beginning of this thread, everything that you have dismissed as anecdotal and outliers has been proven to be the status quo. Yet, when you are subjected to it, you do not see it as abusive, you give it a pass.
Does it not bother you that at the very least you were the victim of unprofessional behavior that tread upon your human dignity and at the worse you were a victim of abuse?
Does it not bother you that don't recognize what happened to you?
How severe does the abuse have to be before you realize that the profession of medicine is broken?
This leads me to question if you would even recognize if any of your patients ever expressed discomfort, embarrassment, or refusal being that you do not recognize the abuses committed upon you.
-- Banterings
Maurice,
Here is another example of the profession of medicine being morally bankrupt: Does Your Medical Center Have a Contract With ICE? These Do.
An editorial published in July in the Washington Post also takes issue with the ethics of working for ICE and others involved with detaining migrants.
"Acting in the patient's best interest is the most fundamental tenet of medical ethics, professional duty and moral practice, so a job that requires the physician put the philosophy of the facility first — an immigration detention center run by a for-profit private company under harsh and inhumane orders from the government — runs counter to everything we doctors are told is our highest duty," wrote Ranit Mishori, MD, MHS, from MedStar Georgetown University Hospital in Washington, DC, and Physicians for Human Rights.
-- Banterings
I may be an anomaly internal medicine physicians but what I write is my true experience. I have been active in the practice of internal medicine between the late 1960s until 2000 when I formally retired from daily practice but continued to be licensed and since 2003 to the present, I have regularly been attending to patients in a "free clinic" twice a month. My patients have been males and females and no children. I have never (and I mean never) have experienced or sensed or received patient feedback or obvious discomfort as part of my physical examination both in office or in hospital environment. I have never seen misbehavior described on this blog on the part of others working with me toward my male or female patients. Of course, this represents the period primarily in the latter half of the 20th century. But despite my much more limited professional participation since 2000 and though I still perform male genitalia and rectal exams on localized symptomatic male patients but pelvic exams are performed by others, I have heard no feedback.
With regard to shadowing, none in the past and currently this is in the early stages of development in the clinic I now attend. However, the "shadow" are first year resident physicians, who may be taking the patients history and physical under my supervision and only after my patient agrees to have that individual in the exam room.
With regard to my own medical and hospital personal experience, I have had no significant "mal-experiences" as an adult or emotional turmoil regarding professional behavior during 3 hospital admissions and many office visits perhaps because I had nothing emotionally upsetting in childhood medical care. I am confident that I had no signs of VIP treatment. Currently, no males to reinsert Foley catheters were offered to me and I was professionally treated by the females.
So what I am getting at is that while I am not fully convinced the majority of patients in our country are as unhappy with the professional gender behavior issues amply described here by our writers, still after 14 years of input to this blog thread, I truly understand there is a ongoing professional issue that is affecting patients and needs to be resolved and I am looking for approaches to attain that goal.
But as far as personal experiences, both in my professional and private life, I am simply providing a source of broadcast for others and providing my own suggestions for attempted resolution of what I recognize are their valid personal experiences and even nationally documented professional misbehavior or worse.
That's my response to Banterings.
..Maurice.
Maurice,
Sorry to "beat a dead horse," but this is par of the problem, not following guidelines or professional standards.
That being said, guidelines and professional standards are a STARTING POINT for the discussion with patients of what is proposed. Deviations away from guidelines and standards are PERFECTLY ACCEPTABLE if at the patient's request or through shared decision making.
For instance, a chaperone should be offered and the presence of such discussed while the patient is fully clothed before the procedure. Many patients, especially men do NOT want an unnecessary voyeur present for intimate procedures. Thus, not using a chaperone at the patient's request is perfectly acceptable.
Read: Colonoscopy Surveillance Recommendations: Still Suboptimal in Practice.
Again, physicians should start with the recommended 10 year interval. Some patients may want shorter intervals due to their personal preferences, some may want longer. These personal preferences need to be respected as a subset of the patient's human rights and patient autonomy.
Two studies reported at the 2019 Digestive Disease Week found that surveillance intervals often are too short, possibly putting patients at risk for harm from unnecessary interventions...
The overall rate of adherence to guidelines was 59%...
"Our findings are consistent with literature demonstrating lack of adherence to current guidelines set forth by gastroenterology societies. This disaccord can expose patients to either unnecessary harm or the risk of developing interval malignancy," Dr. Abu-Heija said...
However, overuse of medical procedures remains a significant contributor to the high cost of health care, Dr. Abu-Heija noted. "The false premise of 'might help, can’t hurt' should rather be rephrased as 'can hurt, might not help,'" he said.
Samir Gupta, MD, MS, an associate professor of medicine at UC San Diego Health, said lack of adherence to surveillance guidelines is common, and the reasons vary... A longer-than-expected interval could be the result of lack of knowledge by the doctor. Most worrisome, though, is that the physician just wants to make money, and you make more when you bring people back more frequently. That’s a real thing.
Let me repeat the last line:
Most worrisome, though, is that the physician just wants to make money, and you make more when you bring people back more frequently. That’s a real thing.
-- Banterings
Maurice
Your response to A.Banterings, those were your experiences and are not reflective of the billions, yes I said billions of healthcare visits as experienced by others in this country each year. You have read therefore I am certain you are aware of such discussions and behaviors that were associated with Dr Twana Sparks and the operating room staff, the incident at the Univ. of Pitts hospital, the Denver 5, the female nurse in a New York hospital with her cell phone pic involving her male patient as well as the numerous articles on ProPublica.org.
I should mention that although you may not have experienced such unprofessional behaviors, at least that’s what you say, you cannot deny that they occur. You say you are not convinced that the majority of patients are unhappy with the discussion of gender behavior as discussed by our readers. Is that now the new definition of outliers, if it dosen’t reach the level of majority then it’s just an outlier. Another point I want to bring up is that many female patients now have options, there is a reason that many female patients seek options.
For many years female patients have expressed concern regarding sexual assault from their physician providers, I know, my mother was one of them. Female patients now have more options than ever before, but you see the equation has not changed for male patients, it’s only getting worse. We see a pattern that not only exists in healthcare among the female healthcare worker but the female teacher as well. It’s been apparent in the prison system for years, that incarcerated males suffer a higher rate of rape by female guards and the problem extends to male juvenile victims as well.
Btw, this information has been available for years on the justice department website. I might have the assumption that when you started this modesty blog that the subject was just some benign manesfestation that some patients have with seeking healthcare and that any concerns were at that time held by a very few.
Maurice, I’ve worked in healthcare since the early 70’s, where have you been?
PT
Maurice,
I do not doubt that you have never received feedback or noticed discomfort in your patients, but my biggest issue is that you have white washed unprofessional behavior:
- Your questionable and hard to recall informed consent.
- Not knocking/drawing curtains
- Everything about the student nurse.
I am sure there others that I missed.
Even if none of this was traumatic to you, still why have you not "spoken up" to the hospital about the care that you received?
As a physician, your concerns should carry more weight.
-- Banterings
A.Banterings
I’ll let you in on a new twist as to what some endoscopists are doing. Suppose Dr Maurice gives me an order for a routine colonoscopy along with a list of where I can go on my insurance plan. I select an endoscopist on my list and I call them up to make an appointment. Guess what, they want me to make an office visit first! Never mind that it’s routine and that I already have a referral for the test.
Why wait 10 years, they can get more income faster. You see they are not going to glean any more info than what their medical assistant will get when they call you with a few questions. My advice to anyone experiencing this, bypass them and find someone else.
PT
Good Evening Gang:
Thank you Banterings for all the great legal info. I'm incorporating a bunch of it into a letter to congress , the White House & some reporters I know. Gonna try & shake the tree again.
P1.
Ladies & Gentlemen. In a recent article in the New Haven Register Dr. Jared Bieniek, medical director of Hartford Healthcare’s Tallwood Men’s Health Center stated in no uncertain terms, “When it comes to health care, men are an underserved population.”
They're underserved because the American healthcare system was feminized back in the mid 1960's leaving men with one choice. Leave your dignity, respect, & privacy at the door or don't seek medical attention.
Many men not wanting to be further embarrassed & humiliated by a healthcare system having little compassion, nor any ethics, morals, or empathy towards patients have walked away from needed healthcare.
The blood of those men's deaths, is squarely on the hands of the healthcare community for forcing them to have to make a choice that should never have had to made in the first place.
In America today you have men that out of their own choice, prefer opposite gender care in medical situations.
It is their choice & it should be honored by all.
We also have many men that out of their own choice, prefer same gender care in medical situations where intimate gender specific exposure takes place. It is their choice & it should also be honored by all.
Problem is their choice of same gender care, is being ignored by our healthcare community. The system is ignoring men's constitutional right to their privacy all in the name of profits.
We know in theory, in the eyes of the law, EVERYONE is equal.
In Backus v. Baptist Medical Center, a male nurse asked for a transfer to the L&D area. Hospital denied his request & the court agreed saying that L&D nurses perform intimate functions & if a male nurse is performing these duties, the female patient's constitutional right to her privacy is violated. The court went on further to say, the fact that the plaintiff is a male health care professional does not eliminate the fact that he is an unselected individual who is intruding on the obstetrical patient's right to privacy.
Another court ruling states there are jobs for which one sex is inherently and biologically more qualified than those of the opposite sex. The biological difference between men & women which in turn produce psychological differences are the facts that justify limiting personal contact under intimate circumstances to those of the same sex.
In York v. Story, the court stated:
"We cannot conceive of a more basic subject of privacy than the naked body. The desire to shield one's unclothed figure from view of strangers, and particularly strangers of the opposite sex, is impelled by elementary self-respect and personal dignity."
In "Griswold v. Connecticut, the court recognized certain individual rights not specifically enumerated within the Bill of Rights.
Having one's body inspected by members of the opposite sex may invade that individual's most fundamental privacy right, the right of privacy of one's own body."
We know courts are protecting women.
What about men?
A man needs say a scrotal ultrasound, or a set of urodynamics studies, a cystoscopy, or a urinary catheter placed.
All the above aforementioned procedures are of a very intimate medical nature.
Without even blinking an eye first thing medical facilities will do is schedule men to have these test run by female healthcare workers because in their minds, men have no dignity.
Now, having female hospital personnel performing any these types of procedures on male patients who don't want them involved in their intimate care would, without question automatically violate that male patient's constitutional right to his privacy by court definition.
Yet today's medical community does this very thing each and every day with impunity.
P2.
WHERE IS HIS PROTECTION? WHERE IS THE FEDERAL GOVERNMENT? WHY AREN'T THEY PROTECTING HIS RIGHTS TOO?
Feminization of our healthcare system by healthcare executives themselves, has cost men their constitutional right to privacy and it's about time congress acknowledged they let it happen & move immediate to protect men's privacy rights.
When healthcare fired all the male orderlies back in the 1960's they took away a male patient's constitutional right to his privacy. We therefore call upon the United States Congress to remedy this unconstitutional situation with judicial expediency. Men have suffered far too long already.
It's time to mandate hiring quotas & force the system to use some of those profits they made off the backs of their male patients they've been abusing for over a half a century now to hire more male personnel.
Ladies, this is the way your healthcare system treats the men in your lives. They're too proud to say anything & they don't want you to worry so he'll be with you but one day, sooner than you may think, he'll be gone forever.
Sooner rather than later all because of an uncaring healthcare system.
Is this what you want for your man, your son, your grandson's?
If not, please join us and tell congress this cannot go on any longer. Your loved one's lives may depend on your help.
Regards,
NTT
Hello,
The article re men's health in the New Haven Register can be read here: https://www.ctinsider.com/news/nhregister/article/Men-s-health-care-gets-higher-profile-at-14420441.php?cmpid=gsa-nhregister-result&_ga=2.141436594.1440506556.1568416732-880875352.1568416732
It's interesting that after all the article's emphasis on men, the nurse navigator is a female. I'm confident that the intake nurse is probably female. There is still no mention of how male nurses might help the situation. Those of you on the East coast might wish to "inform" the institutions mentioned in the article of the true needs of male patients.
Reginald
NTT, go to it! Though my medical and personal experiences do not fit fully qualitatively and quantitatively with what all has long been discussed here, I can't ignore what everyone here is writing with references and what is repeatedly in the news and issues brought up by ethics and medical education listservs to which I subscribe and write. So I clearly understand that the medical system needs an "overhaul" and one as soon as possible. I hope others here follow NTT's action to "spread the word" to effective resources with the goal of preservation of patient dignity for each and every gender and regardless of arguments regarding high or low statistics. Every patient counts. ..Maurice.
Good Morning Ladies & Gentlemen:
Reginald, you'll be happy to know I put my Banterings hat on then too Tallwood to task about being a men's clinic & why they aren't a true men's clinic & how they might fix it. Their Nurse Navigators are female. All but one APRN is female. PA-C is female & they have many female MD's on staff.
Then while I had the hat on I did some more snooping around.
The Milana Family Foundation traditionally raised money and awareness for charities that benefit children in need.
When the family patriarch got prostate cancer, their focus shifted & in 2018 they created Man Cave Health. https://milanafamilyfoundation.org/
They are trying to get men to take better care of their health & get that prostate checked out. To do this, they transform a waiting room into a man cave in hopes of luring more men to come in & get checked.
Mount Sinai's urology Dept. in NY has their first attempt. They are hoping to open a Man Cave in every major city in America.
As with Tallwood, I've emailed their Executive Director to inquire how they plan to keep men coming back because not all men want to or will talk about their intimate male medical needs in the presence of female healthcare workers.
Her name is:
Jackie Lomtevas
Executive Director
631.393.5713
800.535.9096
jlomtevas@mancavehealth.org
Their intentions are good but if there's a nightmare behind that man cave door, many men won't go back.
That's it for now.
Regards,
NTT
NTT, again, GREAT! ..Maurice.
NTT.
I called the Man Cave a month or two ago and asked if they employed any male nurses in back since they call themselves a man cave . I was told no , the back room is all female . I asked but received no explanation on why not . Doesn't sound like much of a man cave to me . A tv with a game on and some sports memorabilia doesn't make for a man cave . Do they really think that is all it will take to get men to come in . Thankyou Misty for this tip/find . AL
A dissection of the basis for patient "speak up" regarding gender.
Could we change the explanation of why a patient of one gender is selective of the gender of the physician, nurse, tech, etc that such is based NOT on fear of sexual misbehavior or personal feelings of embarrassment or ability to carry out a function but that individual of the same gender can relate better to the patient's individual issues. "Will that person of my gender better understand my personal concerns as a patient here than one of the opposite gender?" Would that be your view? Understanding concerns trumping misbehavior. There is a difference between the two explanations. ..Maurice.
Good Evening:
Al I agree. I told her if it's just a lure to get men in yes they'll go that one time but if they value their dignity & privacy like many men & you don't have all male teams behind the curtain, that won't be back & word will spread fast it's just a lure because they are not staffed by male providers they have a mixed bag.
Dr. B. you said "individual of the same gender can relate better to the patient's individual issues"
Our medical community believes its okay to put females with males no matter the circumstance which makes NO sense as they can never truly empathize with a man because they don't have the equipment no matter how hard they try. They just make it worse.
On the flip side you'll NEVER see a male nurse or tech with a female patient.
Men are just 2nd class citizens to the system.
Regards,
NTT
The medical world likes to ambush. So let them be ambushed. Let there be a large gathering, preferably televised. A speaker gets up to speak about male healthcare and begins talking about the dignity violations and he/she puts the idea out there that it's the leading cause of men avoiding medical care. Let there be many widows present and family members of the patients who died or suffered long term in case the medical workers attempt to gang up on the speaker. Then the speaker/ patient family members challenge the medical workers to prove them wrong.
Dr. Bernstein wrote: "Will that person of my gender better understand my personal concerns as a patient here than one of the opposite gender?"
The scope of male-specific medical conditions is but a small piece of the overall "exposure" issue in medical settings. I'd agree that male staff might be more understanding and empathetic when it comes to those male-specific matters, but most of what men encounter is not male-specific. Being bathed or showered. Catheters. Skin exams. Most surgeries and ER scenarios. Physicals. Urodynamics. Medical Asst and Scribe observers.
It isn't better understanding that I am seeking. It is the comfort, privacy, and dignity that far more readily comes with same gender intimate care than it does with opposite gender. I have changed and showered in open locker rooms and gang showers literally thousands and thousands of times over the past 55 years. Never have I been made to feel uncomfortable or embarrassed. Never have I observed another male behaving inappropriately in these settings. I thus have no qualms about exposure to male medical staff.
On the other hand I have been made to feel uncomfortable and embarrassed by female medical staff that have been inappropriate. Most of them may do a good job of maintaining their gameface most of the time, but female healthcare staff do see healthcare through a sexual lens. They wouldn't insist on same-gender care to the extent that they do and avoid their own places of employment to the extent that they do if it was purely clinical to them.
Avoidance is the path of least resistance.
NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME 104. YOU CAN CONTINUE TO CONTRIBUTE YOUR COMMENTS ON VOLUME 105.
..Maurice.
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