Bioethics Discussion Blog: Preserving Patient Dignity (Formerly Patient Modesty) Volume 111

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Friday, May 08, 2020

Preserving Patient Dignity (Formerly Patient Modesty) Volume 111










"Manning up" as a patient in a patient-doctor or patient-nursing staff relationship may end up
losing the very tool for improvement and change.  This was emphasized by Biker in his
Comment in Volume 110: "to the extent men have manned up rather than spoken up, we are guilty of shifting all the blame onto the healthcare establishment rather than owning up that we do share some of the blame for the way things are. By our silence we have enabled those who in turn took advantage of the situation to perpetuate the matriarchy of medicine".

If you look carefully at the above graphic of Satiri published by Wikipedia via Google Images: (Satyr leaning on a tree trunk. Roman copy of the Imperial era after a Greek original of the Late Classicism) 
you will see that the "tool" for action and change had been broken off, missing.  I think this  graphic supports the analogy.  Attention to "manning up" by the man involved may have led to missing
important potentials for valuable change in the medical system beneficial to all men.   Thanks Biker for providing an entry topic for his new next Volume.  ..Maurice.

AS OF JULY 15 2020 THERE WILL BE NO FURTHER COMMENTS POSTED ON THIS
VOLUME BUT POSTING CAN CONTINUE ON VOLUME 112.

196 Comments:

At Friday, May 08, 2020 9:57:00 PM, Blogger Maurice Bernstein, M.D. said...

OK.. I'll start the conversation with this advice I found:

"Equality can’t be achieved as long as we’re still using outdated language that implies strength or weakness based solely on one’s gender or anatomy."

To me, this is the argument to follow. I think it should be made obvious to the medical profession that both males and females starting at early ages and continuing throughout their lives are equal in their requests and need for attention to their individual and personal necessities in their relationship to the medical profession or indeed their relationship to other resources or activities. Deviation of this equality by any of the service providers is unfair if not worse.

Once this "manned up" or "womaned up" is thrown out, the concept of the preservation of equality of dignity in either or any other "gender" will be accomplished. ..Maurice.

 
At Saturday, May 09, 2020 4:10:00 PM, Blogger Biker said...

Yes Dr. Bernstein, starting young would be good, but the question is how? At issue is the societal norms that healthcare operates within that say girls must have their privacy protected but it doesn't matter for boys. Healthcare will change when society says it must. And currently society is moving in the opposite direction on this matter.

 
At Saturday, May 09, 2020 6:11:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, it is all about PARENTS and supervisors of the "young". It is what demands are made to the youths and how the youths' desires and directions are handled by those whom the youths look to for managements when they are unable. Maybe parents and supervisors of the youths should listen, explain but not order without such explanation to the youth.

It could well be such education and supervision would end up over the years with better understandings by both patients and medical professionals. ..Maurice.

 
At Saturday, May 09, 2020 6:30:00 PM, Blogger Maurice Bernstein, M.D. said...

Let's discuss how the "education and supervision" of the growing child to adolescent and beyond could bring to an end the need or frank behavior of being "manned up" or "womaned up" and thus permit gender equality in services provided all genders as I previously suggested. We shouldn't wait till adulthood to expect some metamorphosis, shouldn't we? ..Maurice.

 
At Sunday, May 10, 2020 6:49:00 AM, Blogger Biker said...

Dr. Bernstein, the nature of societal norms is such that they guide everyday life with nary a thought by the vast majority, but over time they can and do change. Change typically starts with lonely drumbeats by a few that eventually garner media support playing to a sense of right vs wrong. Eventually a tipping point is reached where substantive change occurs either through legislation, judicial action, or simply the general public voluntarily changing its behavior or thinking on the matter.

Coming to your comments about the rearing of children, an example would be girls now grow up knowing that they can be athletes or anything else they so choose. That is the current societal norm but it absolutely was not back in the 1950's. The drumbeats for change that started to be heard faintly in the 1960's eventually grew to a roar and change occurred at every level; legislative, judicial, and acceptance by the general public.

The modesty and privacy of girls that was fiercely protected back in the 1950's hasn't really changed much and can be seen in the recent year controversy about transgenders in locker rooms. Virtually the entire discussion has been biological boys in girls locker rooms. The relative lack of concern for the modesty and privacy of boys continues within that debate in that on the rare occasion it does get discussed, it is almost always from the perspective of the comfort of the biological girl in their locker room rather than the privacy of the boys.

Childhood is definitely the place to begin socializing both boys and girls as being equal in their right to privacy and modesty and parents are where that process should start. However, most parents remain stuck in the old societal norms and that drumbeat for change hasn't begun. If anything it is going in the opposite direction given female physicians and NP's have come to dominate pediatrics as well as family medicine.

Most boys are now growing up only ever having women do their physicals and provide their healthcare. Maybe this newest generation won't have any modesty as a result and if so what we discuss here will fade away as a concern over time. A question I have is will the boy who has had all his physicals and exams since infancy with his female pediatrician or NP become uncomfortable with her in his teenage years? Will his comfort with her as an individual extend to all women in healthcare?

 
At Sunday, May 10, 2020 3:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, thanks for continuing this aspect of the discussion.

Although, I have never wanted frank divisional state or governmental politics itself to be a major issue, to be discussed here, in solving this dilemma for the need for patient equality of gender in their care, I have a feeling that political views do play a role...and probably should be noted and discussed. How does the ongoing issues of abortion, contraception, transgender toilet facilities, marriage between same gender couples and also the current drive for the female gender to politically "speak up" for their gender affect goals for gender equality that we are discussing here?

For example, JR, do you trust the current political makeup or any upcoming political party leader or changes in the country's legislature will hinder or improve the opportunity for the issues you are calling out to be carried out? ..Maurice.

 
At Sunday, May 10, 2020 5:36:00 PM, Blogger Biker said...

In a nutshell, politically in the country right now, anything that might be construed as positive for men is assumed to be anti-woman and thus a non-starter. The concept of win-win has been lost. As has been stated before women choosing female physicians is considered empowerment. Men preferring male physicians is deemed sexist. Women now dominating OB/GYN, pediatrics and primary care is deemed forward movement. Men still dominating urology and a number of other specialties is viewed as a problem to be fixed. We are rapidly approaching the point where it will be a rarity for teenage boys to have any choice in getting sports or other required physicals from other than female physicians or NP's. And I've yet to see an article where female pediatricians or NP's express any concern over the fact that they know it is embarrassing for those boys. The boys just need to get over it is their opinion. That same sentiment carries throughout healthcare when it comes to male patient privacy and dignity. Men are expected to just get over it. This is the political environment we currently live in.

 
At Sunday, May 10, 2020 7:50:00 PM, Anonymous JR Issues4Thought.com said...

I see think most medical providers fit into the liberal end of politics which mean they spout freedom, equality, etc. but don't really mean it. The nurses who were the main ones in the abuse of my not really gay, married husband are Bernie supporters so their violence and double standards are to be expected. In my Twittering and I am rapidly gaining followers surprising to me is most people supporting medical choice, real informed consent, etc are conservatives. Super surprising to me. Also, the legislators I have spoken to on both sides, the ones who are open to change are the Republicans. So as a former liberal, this signals to me that politics has moved to far to the left that it actually excludes dealing with real issues such as quality healthcare for our citizens. I always ask each of them the same question of "What good is having healthcare if the manner in which it is delivered makes it unusable ie. lack of consent, sexual assault, criminal assault with no patient recourse and medical harm being the 3rd leading cause of death in the US beating out COVID at this point?" Really unenlightened politicians want Medicare for All but seniors are the only class of people who must pay the government for insurance-Medicare- and buy private insurance too along with drug coverage etc. Also, Medicare does nothing to protect its clients against being harmed by the medical community. In fact, Medicare may be part of the problem by demanding things of doctors that yes, I said it, unreasonable outcomes. Medicare has also started to implement having certain batteries of tests of certain chronic conditions which may cause some patients to have things done they don't want and if they aren't compliant, being fired by the medical provider who doesn't want to suffer any penalty or not get paid bonuses/incentives. I have plastered Trump, Azar, Biden, and anyone who comes into my orbit asking them what they are willing to do. Healthcare needs to be back to basics of being patient-friendly and letting healthcare providers become human with compassion, skills, etc. Being ran by a big corporation is not the answer. Answering to insurance companies is not the answer. Answering to Big Pharma is not the answer. Medical people should answer to the patient and if there are issues, there needs to be a true course of action that is fair to all involved rather than what is currently in place just a circling of the wagons and protecting the medical community no matter what.

My husband's interview is making a splash and a lot of people are completely horrified that something like this happened. With him and all the others who have suffered deep, heinous harm the medical system will change but change will be harder under Biden or an ultra liberal because most of what they do is lip service. Under Trump, he is letting status quo but at least states still have some power.

I also agree w/ Biker that our current political climate has really hurt men. The Dems have been roasting men for the sexual harassment of women but now the tables are turning as Biden has those very same issues haunting him so they are going to have to quiet down for a while so this may be the time to sneak in changes. Apparently it is only bad when some men assault women according to how they play the political game. However, on the hand, it make some female healthcare workers more angry and more likely to harm their defenseless male patients.

 
At Sunday, May 10, 2020 9:41:00 PM, Blogger Unknown said...

JR, This isn't a Republican/Democrat issue. Not everything is. It's more like people in power amusing themselves at our expense and targeting people who can't fight back. Protesting outlawed. Even peaceful protesting. Vast numbers of letters ignored and emails. JF

 
At Monday, May 11, 2020 5:26:00 AM, Blogger Biker said...

I agree with JF that this is not a Republican/Democrat issue. They differ in how to pay for healthcare but both parties gladly take money from and in turn support big pharma and big corporate-run healthcare to the detriment of physician autonomy and patient considerations. I say this as a Moderate in the middle of the spectrum who has little use for either party at this point. That said I do see the left as being less inclined to be supportive of male-female equality in the delivery of healthcare. Neither party has been supportive of equality, but the left celebrates inequality.

Again, how can it simultaneously be a good thing that women have taken over OB/GYN, pediatrics, and primary care and a bad thing that men still dominate urology and a number of other specialties? In a nutshell they are saying women need to totally dominate every aspect of healthcare with only token numbers of men allowed around the fringes. Equality is clearly not the goal and it is foolish to think this mindset is not playing out in the delivery of healthcare. While this trend continues, the right doesn't give a crap so they're not being our advocate either.

 
At Monday, May 11, 2020 6:14:00 AM, Anonymous JR Issues4Thought.com said...

JF,
Dr. B. asked about politics and I told him my impressions especially from all the people and their profiles on Twitter. Most who say they support Medical Freedom, true Informed Consent, Autonomy at least on Twitter are conservatives. Most medical workers seem to have a left leaning views. They are the ones making the political statements. It is what it is. The thing about the left leaning that I don't understand is most support a woman's right to abortion--Her Body, Her Choice--but when it comes to patient rights--My Body, My Choice--they remain in favor of the medical community. Conservatives for the most part don't believe in abortions except maybe in certain circumstances so rarely her choice but on the other hand believe in patient rights. Of course, there are exceptions to both sides. Really odd?

Let's not forget the mainstream media's part in protecting the medical community who is their biggest advertisers. Let's not forget the legal community that protects them too along with the government agencies who really never change their views no matter who in power. Hospital administration is also guilty of not mandating change but it is the decision of every worker whether they will harm or not. You cannot mandate humanity, compassion, morals, etc so it is those workers who ultimately are the issue bc no one is forcing them to do what they do. They make those decisions. The textbooks outline a different mode of care. Most do not want that kind of care themselves but willingly choose to foist that inhumane care on patients assigned to them. Yes, the atmosphere may foster it but when it comes down to it, they are the ones choosing to do it.

It is just like with Informed Consent. There are currently laws and guidelines but they don't work. Patients still have procedures done without consent. There are blanket clauses that basically allow a dr to do whatever they feel is necessary. (I have one of those blanket clause forms in my possession.) There are blank lines that drs. have filled in after the pt has signed the form. Verbal conversations are not being translated to the form as pts are asked to signed the form w/ those items not on the form. Pt are signing the forms after they are being given sedation. Informed Consent was meant to protect pts not harm them. So we need better laws. We need laws with criminal consequences bc procedures done w/o consent is actually criminal battery. Taking a knife to someone in real life results in a criminal charge in real life. We need criminal consequences for criminal actions which unnecessary exposure falls under too. We can't mandate compassion, etc but we can mandate criminal punishment for their crimes.

 
At Monday, May 11, 2020 6:17:00 AM, Blogger Dany said...

Doctor Bernstein,

In order to have any traction, "educating the youth" must begin with enpowering them to be able to make meaningful and significant decisions about their healthcare needs. I don't know if the current societal climate will ever permit those changes. I have given this some thoughts and here is a few things I believe could improve the situation:

1. Allowing youth to choose a provider they feel comfortable with, not someone their parents (mostly mothers) likes. The very young may not have much say in this but as puberty happens (in both gender), things certainly have the potential to be a lot more embarrassing for them. Parents ought to be aware of this and be willing to make changes as necessary. It does not do any good to have someone growing up with feelings of resentment toward their PCP. A teenager is more than capable to decide hwo they are comfortable with and who they don't want to see again.

2. Allow youth to make critical decisions about the care they receive. If a young patient makes the decision of not wanting a certain aspect of care, they should be allowed to do so without any form of coercion (yes, I know, no one is "coerced" but - drawing on my own experience - it sure feels like saying no is impossible).

3. Do not impose chaperones on them. Especially the teenagers. Have staff of both genders available, otherwise do away with it altogether. It's not helping the situation and again, will only increase the level of resentment they will feel toward their PCP if not the entire system.

4. Parents must be advocates for their children, in that they must support their decisions and not become complicit in enforcing unwanted care. Not doing so will only result in feelings of betrayal toward their parents.

I am sure that, given enough time, I could come up with a few more but consider this a rough draft.

Dany

 
At Monday, May 11, 2020 6:57:00 AM, Blogger Biker said...

Following what Dany said, this is what we did. My kids had a male pediatrician but when our daughter was approaching puberty my wife switched her to the female NP that she was seeing. Our daughter was very shy and would have been mortified to be examined by a male doctor as a teenager. Our son stayed with the male pediatrician until he aged out.

The flip side question I pose is what I said in a prior post. How many mothers (or fathers) will advocate these days for their sons and seek a male pediatrician as their sons approach puberty? Few is my guess. Modern day feminism would say they were sexist for doing so, in effect making political correctness a higher priority than their sons being embarrassed. Of course they don't consciously see it in those terms but rather cling to medicine's
memes of healthcare is gender neutral for males/females are entitled to all-female care.

 
At Monday, May 11, 2020 7:47:00 AM, Anonymous Anonymous said...

JR, If blank lines are on consent forms patients have to sign then we need to take pictures of those consent forms. Part of the problem is lawyers only taking easy cases. My brother , in recent years won $10 thousand dollars in a court case. Over a medical condition. After his lawyer fees ( and I think his doctor also ) he only received $450. When he questioned his lawyer about it, he was told that he
(the lawyer ) worked hard on the case.
There needs to be given different titles and wages for lawyers who turn away cases they can't easily win. Their wages should also reflect their lost/won ratio. What the plaintive will get after the cases are won should also be made known. And of course that the lawyer gets paid whether he wins or loses. JF

 
At Monday, May 11, 2020 8:30:00 AM, Anonymous JR Issues4Thought.com said...

Biker is correct in what he said but it happens here in Indiana I must work w/ Republicans. I was just saying the common people I run across seem to be divided that way. It is the common folk conservatives that support patient rights whereas it is the common fold leftists that do not support patient rights. Of course, you will find exceptions to this on both sides. I am neither at this time as I grew very disillusioned w/ the Dems during the O'Bama years and I am certainly nowhere near Her or anyone else at this moment. I do not believe in Medicare for All bc Medicare is sick system so why would we want it for everyone? The medical lobbying groups own politicians from both parties body & if they had souls just as they own most media outlets. I think an agenda that is pushed is most men are bad and that is severely affecting how healthcare is delivered. Yes, it is true that women still have issues but those issues eventually come to light but issues for men never do.
A state legislator told me any change to give patients more rights will be a very hard fight as the medical lobby do will block anything that benefits patients. She said they have a long history of it. That is why it has to be a combined public effort of education, outcry along with legislation to make those changes. Legislators must see the public really wants it for them to defy the medical lobbies.

 
At Monday, May 11, 2020 9:36:00 AM, Anonymous JR Issues4Thought.com said...

JF,

Taking a pic would be helpful except most of the time you are not in the position of taking pics. Too many times you are in pre-op naked w/ IV lines in you when they say, "Oh, by the way, sign this. It is what we talked about." Drugged, confused, coerced many will sign it. There are several people on Twitter who signed a form thinking they were agreeing to what was verbally talked about. When then signed the form, the extra lines were blanked. Afterwards, when they questioned what happened, the lines had been filled in to justify what had been done to them. Many forms have what are called blanket clauses that allow drs. to do whatever they feel is necessary which gives them a wide berth to do things to you never even talked about in the verbal conversation. You could lose organs you had no concept you might loose, etc. These blanket forms are dangerous as well as forms that have actual blanks. But you are correct, as soon as you sign a consent form, you need to have a copy in your possession so altercations can't be made as easily.

You are also right that even if you get an attorney to take a case, you usually end up with nothing. Most states have cap amounts on what you actually receive. Like in California, you may be awarded a $5million settlement but CA has actual cap reward set at $250,000 so after legal fees are taken off the top and the 33% bonus must people are left with around $50,000 or so. Not fair at all. There is a proposed nationwide caps of $250,000 which has passed the Democratic controlled House of Representatives and is awaiting a Senate vote. This will effectively kill any recourse patients have for medical harm. But most people do not know that acts that were intentional harm like what was done on my husband are not covered by most malpractice insurance policies hence why finding legal representation was hard. I have been sending his video around and have gotten a lot of positive comments for change about what happened to him.

 
At Monday, May 11, 2020 11:13:00 AM, Blogger Biker said...

I agree that the manner in which consent forms are presented is wrong. Once after being prepped for a colonoscopy (w/o sedation so I had my wits about me) I was given a consent form to sign. I told them I don't sign anything w/o reading it and that I couldn't read it w/o my glasses. They were a little put out by having to get me my glasses back but they had no choice as I wouldn't sign it until they did.

At the former cardiology practice I went to locally, at check in I was handed page 2 of a 2 page consent form and told to sign it. I told them I don't sign anything w/o reading it and that they didn't give me page 1. She said it just gave them consent to bill but I insisted on seeing the full document. She was very irritated that I didn't follow her orders, but she found a page 1 and gave it to me, and I stood there and read it in full before signing. She was not happy.

I forget what it was for but another time when I said I wanted to read it before signing the pre-op nurse told me it just gave them permission to do the procedure and to bill my insurance. In addition to making her give me back my glasses, I also told her that if that was all it covered that it wouldn't of needed more than a couple sentences vs a page and a half of verbiage.

At the former dermatology practice that I had gone to locally the check-in person gave me a form to sign saying I'd received and read their HIPAA notice. I told her she hadn't given me the notice. She started fumbling around looking for one and said they used to have one but she couldn't find it just then.

So yes, the manner of obtaining consents is sometimes handled very poorly.

 
At Monday, May 11, 2020 3:46:00 PM, Blogger Dany said...

A very simple way to address the consent forms issues is to mail it to the patients prior to their admission. It used to be that hospitals would send all manners of information to their patients (pre-opetation and pre-hospitalisation instructions). Surely it can't be too hard to do the same with a consent form. You read it, you sign it (or not), and you bring it with you the day of your hospitalisation. Simple, really.

And, if a more modern approach is warranted, the same can be done with electronic documents. As long as they are of the "Adobe" file type (that would be the ".pdf" file type) as they are harder to modify. And for the security concerned, there are ways to secure a document. PKI (public/private key infrastructure) comes to mind. Hashing technics (that's not a drug, by the way) is another one.

In both cases a phone number should be provided to answer any questions. Obviously, this would only work with planned surgeries and hospitalisations.

Dany

 
At Monday, May 11, 2020 5:20:00 PM, Blogger Biker said...

Dany, once when my wife was having surgery, and she was being handed consent forms to sign in pre-op, I asked the doctor why she was just getting the form now when everyone seems to be in a rush. He said they wanted to make sure they've explained things and have given the patient a chance to ask questions before seeking the patient's consent. He was basically saying it was more informed consent being signed at that time. I can understand that perspective. The problem is that they then expect you to sign it w/o reading it. As we here know there is a whole lot more in the consent form than what the doctor talks to the patient about.

A solution might then be to send the form ahead of time so that the patient can see the fine print, form their questions, and then have the signing in pre-op after speaking with the surgeon.

 
At Tuesday, May 12, 2020 6:27:00 AM, Anonymous JR Issues4Thought.com said...

The problem being with signing a consent in pre-op is that the patient may have the feeling they have no choice but to sign. Oftentimes, what is discussed and agreed to verbally is not actually on the consent form as the form is not explicit. Also, forms have blank spaces where items can be added after the patient signs which has happened enough to cause an alarm. Too many times there is no one in pre-op like Biker to ask the questions as they wait for the patient to be alone. Too often the patient has received pre-sedation and their mind is not clear and therefore legally should not be signing any life altering documents.
There needs to be an audio recording made of the verbal conversation which is immediately available for the patient or the patient needs to have an audio device to record the conversation themselves. Some mistakes in doing more than agreed to may be honest mistakes as surgeons do see a lot of different patient but that honest mistake may be devastating to a woman who thought she was only having a cyst removed and wakes up from surgery being told she will no longer be able to have the children she was planning to have. True informed consent should protect both parties involved.
The thing about the patient bringing the form to the hospital is the doctor hasn't signed it and it still can be altered or if you have made alterations, the doctor may refuse to sign it.
Each informed consent form should be tailored to the case of the individual patient. They can do this through the EHR system which tailors MRs to the type of procedure done, etc. All the risks and what ifs can be covered so the patient may agree or refuse each one. They generally don't give true informed consent bc their reasoning is all the info would scare a patient but isn't it supposed to be informed consent? How can one be informed if only given the "nice" part of the needed informed process? Each area like do they want med students should have a separate opt in or opt out. There should be multiple signature areas. We need to stop the weaponization of informed consent against patients.

 
At Wednesday, May 13, 2020 8:16:00 AM, Blogger Biker said...


Maybe just to clarify it all in my mind but I thought I'd take a stab at summarizing what I see as the broad outlines of the patient privacy/modesty/dignity matters that we discuss here. The complaints tend to fall within three primary buckets:

- Egregious violations such as JR's husband's abuse and Mr. Kirschner being exposed as entertainment for the female staff.
- The cavalier manner in which male patients have been needlessly exposed in ways the same staff would never have done to a female patient. Numerous examples of this have been shared.
- Simply being modest and not wanting opposite gender exposure in medical settings, even if done in an otherwise professional manner.

The double standard that is applied in all three groupings centers on:

- The meme that men have no modesty which for practical purposes gets translated into meaning male staffing is not necessary and that male patients do not need the same degree of privacy routinely afforded female patients.
- The meme that every woman who works in healthcare is a professional for whom all male patient exposure is purely clinical.
- That violations by female staff against male patients which do get caught almost universally go unpunished. Male staff that do to a female patient what the female staff did to Mr. Kirschner would be promptly fired and likely lose their licenses. It doesn't appear the female staff that traumatized Mr. Kirschner suffered any penalty at all. If men are not supposed to have any expectation of or right to privacy, then these kinds of things aren't really offenses to be taken seriously.


 
At Wednesday, May 13, 2020 10:04:00 AM, Blogger Unknown said...

JR, I MIGHT have a solution to the blank lines on consent papers. The patient could draw x's all across the lines or write other things in. THEN sign the consent forms. JF

 
At Wednesday, May 13, 2020 11:32:00 AM, Anonymous Anonymous said...

Hello,

Let's look at consent from a physician's point of view. Oh! Mr./Mrs Smith wants his/ her surgery this way, with X, Y, Z, etc. OK. Let's change our entire protocol to accommodate him/ her. In which eon do you think this will happen? Maybe the 12th of never. Presently, the BUSINESS of medicine won't allow this. Don't sign our form the way we want it means that you don't get our services. Find another facility. I know. I've tried it. Informing Medicare is no help. They say that the hospital can enact its own non-discriminatory rules. I've found that the best approach is to get your dr. to advocate for your wishes. After all is said and done, when you get to the OR, he controls the shots.

Reginald

 
At Wednesday, May 13, 2020 12:58:00 PM, Blogger A. Banterings said...

JF,

The legal way to alter a contract is to cross out what you do not want, initial and date it. On pages where there is no change, initial and date.

Do NOT only sign the last page because they can easily replace your page with a original page.





-- Banterings



 
At Wednesday, May 13, 2020 3:34:00 PM, Anonymous JR Issues4Thought.com said...

JF,
Unfortunately I know of a woman who happens to be here in Indy w/ me that put xxx's through the lines. Guess what? The doctor did a totally different procedure on her than she had even signed for. She is currently at the 3 panel level in a lawsuit. She is all over Twitter & has an extremely large following. We are working together. The monster was supposed to take a pimple size cyst from her leg but ended up cutting out 5 inches of muscle from both legs ruining her ability to walk, run, drive a car, etc. I know of others the xing out didn't work for.

Banterings,
Many consent forms say that cannot be altered. Many hospital are now going to electronic editions which give no way to cross out what you don't agree with. My husband had to write in the signature what he disagreed with cramping it into a very small space. You have to cross out any blank lines so they can't write in them after you sign them but even that is not a guarantee they will go rogue.

Reginald,
That is so correct that for all the planning once you are under you have no control over what they will do. Many forms have that blanket clause which allows the dr. to basically do whatever they want. Too late after the fact.

And then there is what happened in our case that he never consented but said what he wanted and they defied him and only they signed the consent form which constitutes medical battery which most malpractice insurance does not cover. This needs to be a criminal offense.

Biker,

Good summary of the abuses. It is very clear that the dignity of the male patient is totally not respected.

 
At Wednesday, May 13, 2020 9:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Except for JF, where are the members of the medical profession who can read what you all wrote and present their view or explanation of the concerns written here by patients.

As Moderator, I will not set forth my arguments except I have and will continue to offer "speak up". If any nurse or physician refuses to listen to or explain issues which the patient has "spoken up", that nurse or physician is in the wrong profession. I have never told my first or second year medical students that physicians have some privilege to remain silent to patient concerns. I told them to listen fully and then communicate to the patient their understandings. ..Maurice.

 
At Wednesday, May 13, 2020 11:01:00 PM, Blogger 58flyer said...

Again,

Legislation, legislation, legislation.

We have to turn to our elected officials to legislate and put into law that what will protect the patient.

58flyer

 
At Thursday, May 14, 2020 6:18:00 AM, Blogger Dany said...

The problem I see with consent forms and other situations where patients are keep in the dark is that they DON'T want you to know. Or at least they don't want you to have too much time to think about it.

And that is because they know most patients will balk and won't go along with their plan. And they don't want that. So... What they do is find ways to obfuscate the information or present it to the patients at a time they are at their most vulnerable. Or at least unable to clearly assess and comprehend that information.

It's kind of like those car or truck advertisements you see on TV. Looks pretty good; the shots are superbly filmed, the music is epic or at least uplifting. Everything is designed to entice you. And then near the end you'll get a few lines of tiny prints flash across the screen. Don't blink or else you'll miss it.

The healthcare industry doesn't want you to think too much about what you are agreeing to have done and how. It makes things more difficult for them (which ultimately cuts in their profit margins). Or they know you're not going to like it so they pull a fast one on you, hoping you're not going to look to closely at the details.

I will say it again, the problem is a systemic aversion to transparency. And, I will add that it is designed that way.

Dany

 
At Thursday, May 14, 2020 6:40:00 AM, Blogger Biker said...

There is a hierarchy to seeking change, and perhaps the most important of all is the first level. This is doing as Dr. Bernstein has stated many times which is speaking up. Effecting change one provider, one practice, or one hospital at a time has a cumulative effect. Change may be slow that way but things do change.

The next level is writing articles and posting replies to articles as the opportunities present themselves. This is hit or miss as well but again these are opportunities to tell others it is OK to speak up and to plant seeds of change with healthcare staff that may read it.

The highest level and which offers the greatest potential if successful is advocacy such as JR has been attempting. Even if the desired big change doesn't come about there is still benefit in getting the issue into the public dialog.

Men's interests may be low on the societal priority list in the current era but that doesn't mean there can't still be small victories.

 
At Thursday, May 14, 2020 12:51:00 PM, Blogger A. Banterings said...

JR,

Under the Americans with Disabilities Act (ADA), EVERY BUSINESS must provide access for disabled people. If your husband was blind, you can request a Braille form. If he has problems with eyesight, then he can request a paper copy.

Under contract law, ANY contract can be modified as long as both parties accept. The drones that hand out consent forms just take them and file them.

I deal with contracts for a living. I punch holes in them all the time.

You modify a contract by signing it.




-- Banterings



 
At Thursday, May 14, 2020 12:53:00 PM, Blogger BJTNT said...

58flyer said...
"Again,
Legislation, legislation, legislation."


That's the approach, but not with existing politicians because the AMA has enough money to buy them off. We need our grass roots undertaking to produce a list of requirements for care giving changes that we can present to first-time candidates running for office, along with a financial contribution. After we have elected a handful of these new lawmakers, they can push for a law that will incorporate our changes.

Biker is correct in that it will be slow, meaning we need to stay the course expecting years before change.

BJTNT

 
At Thursday, May 14, 2020 9:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Does anyone here see the OVID-19 pandemic, which may be going on for a long, long time providing any patient beneficent change in the relationship and behavior of the medical staff toward patients, regardless of gender? What dynamics of all aspects of medical treatment, OVID-19 or all the other illnesses might this pandemic medical response alter to the benefit of all patients?

As an example of change, do you think that the HIV epidemic from the starting years over time to now has made any changes in how medicine or even the general public has looked and acted upon this sexual infection and the individuals who have been infected?

-------

I hope you all have noted (particularly if you go back and look at the earlier Volumes), how we have now have entered into discussions more about ways of creating changes in the structure and behavior of the medical system and its relationship to patients of any gender Generally, these current Volumes are less in my long used term "moaning and groaning" and now currently attending more to discussing ways for making change. To me this current approach is what is currently the most valuable.

Again, I emphasize as Moderator, I would really appreciate having direct input here by current members of the medical profession. Can't we encourage those members to come here and write anonymously their support or rebuttal or ideas regarding the concerns and hopes of those of who are currently participating on this blog thread? ..Maurice.


 
At Friday, May 15, 2020 5:32:00 AM, Blogger Biker said...

Dr. Bernstein, I expect telehealth will become more commonly accepted as a result of the current pandemic situation. Both my wife and I have had such visits and I'd say they are generally adequate for follow-up type purposes. That said I do not see it as a net positive. One aspect is that it further distances the patient as a real person from the doctor. You become just a voice on the other end of the line. Adding video to the mix would soften that somewhat but the infrastructure in many rural areas is very much lacking in terms of high speed internet and cell phone coverage. This is something our urban centers of power just don't adequately understand.

The other thing is that it forces the doctor to be totally reliant upon the patient to accurately describe symptoms and status. I imagine what doctors see when doing an exam is sometimes very different than what the patient might be saying. Some people are naturally inclined to exaggerate or to do the opposite, minimize. An in-person visit allows the doctor to make their own more informed judgment.

Given the choice going forward I will opt for in-person visits myself.

On healthcare workers joining the conversation, what I have long striven to understand but which still eludes me is how healthcare can be deemed purely clinical when female staff is dealing with male patients and then not be seen as purely clinical when they themselves are the patient. It defies logic to insist upon only female staff for non-ER, non-OR scenarios such mammograms, vaginal ultrasounds, bathing/showering, catheterizing etc. if healthcare is gender neutral and purely clinical. This conundrum is primarily in the non-physician arena.

Staff comfort does not explain or justify it. Male staff would also be comfortable handling intimate exams and procedures for female patients.

If I were able to get a 2nd question answered it would be about the fundamental double standard when wrong doing occurs. Had male staff done to Mrs. Kirschner what the female staff did to Mr. Kirschner, they would have been promptly fired and possibly lost their licenses. I doubt anyone in healthcare could say with a straight face that isn't true. How many accounts have we heard of female staff using pretense to get a peak at certain male patients after word spreads he's worth taking a peak at? Yet in none of those accounts was there also punitive action taken on what was widely known to be going on. We don't hear accounts of male staff doing the same to female patients, probably because male staff know it wouldn't be tolerated. Again, this issue centers on non-physician staff.

 
At Friday, May 15, 2020 6:47:00 AM, Anonymous JR Issues4Thought.com said...

Yes, it will have changed the dynamics of the patient care as they have been allowed to have unabashed total power and control. Without any family able to be present during care of the ill especially the critically ill who are unable to defend themselves, they most likely have been able to expose those poor patients as much as they like. There have been several pics showing unnecessary, overly exposed patients getting treatment so if there are no family members or witnesses to their care, I imagine there care standards as far a dignity is non existent as it is in pre-op and post-op where they certainly don't care about patient dignity.

They have been able to have total control over patients during this time and have been elevated to hero status and they won't easily give this up. We have allowed themselves to make heroes out of all even though many in how they deliver care are not heroes. Patient dignity standards will suffer for a long time because of this hero worshipping phase we have gone through.

So HIV is a sexual infection? I thought you could get it through shared needles/blood transfusions too? Labeling it as a sexual infection by a profession that supposedly is devoid of sexual impulses or feelings when dealing with patients seems a bit odd don't you think?

I think the medical community will continue on their power trip as we have allowed them to have it. They will continue to isolate patients from family and I know personally what harm they can inflict during the time of isolation. In turn, many people will not seek medical care so many people will die unnecessarily as they will not tolerate the medical community having absolute control of them during medical encounters.

 
At Friday, May 15, 2020 8:15:00 AM, Blogger Maurice Bernstein, M.D. said...

I have not published a Comment by "RC" which fully deals with the politics of the handling of the current Corona virus affair by the President and governors and not specifically related to the specific matter of maintaining patient dignity. Our topic here deals with issues of patient dignity and patient modesty and not whether the President has personally behaved right or wrong in his overall management. Yes, that is an important political and public health issue but I don't think it is specifically related to what has been written about here on these Volumes all these years.

I appreciate the comments today by Biker and JR which keep to the Volume topic. ..Maurice.

 
At Friday, May 15, 2020 9:39:00 AM, Anonymous Anonymous said...

JF here. I've talked about this before but a lot of people disagreed with this opinion. Hidden cameras where patient care and examinations occur. That DOESN'T mean cameras pointed at patients genitalia, although if and when modesty violations occur that would be visible also. I saw an article recently that nurses and doctors are murdering/allowing patients to die in a New York hospital. I don't know if it's true or not. But no family around will also mean NO ACCOUNTABILITY! And it shouldn't be the hospital staff in CHARGE of the hidden cameras. In fact that shouldn't even be aware of them. Let them believe some coworker turned them in anonymously. JF

 
At Friday, May 15, 2020 12:37:00 PM, Blogger A. Banterings said...

Maurice,

We have now entered into discussions more about ways of creating changes because we have convinced you that abuses of patient dignity are a real problem that occurs regularly in healthcare. Earlier volumes have you characterizing these as outliers.

How can we move forward on this blog towards solutions now that we acknowledge the problem exists. This is what the profession of medicine is suffering from and little by little, soon the profession will no longer be able to deny that it exists.




-- Banterings



 
At Friday, May 15, 2020 8:42:00 PM, Anonymous Anonymous said...

You asked whether President Trump was at fault for problems with the corona virus. I answered your question. I suppose if I had condemned the president and complimented your liberal governors you would have posted it.

RC

 
At Friday, May 15, 2020 9:32:00 PM, Blogger Maurice Bernstein, M.D. said...

RC, I did not ask about the relationship or political reaction by President Trump with regard to the Corona virus pandemic. My only comment about our government was made on Sunday, May 10, 2020 3:40:00 PM when I posted the following: Although, I have never wanted frank divisional state or governmental politics itself to be a major issue, to be discussed here, in solving this dilemma for the need for patient equality of gender in their care, I have a feeling that political views do play a role...and probably should be noted and discussed. How does the ongoing issues of abortion, contraception, transgender toilet facilities, marriage between same gender couples and also the current drive for the female gender to politically "speak up" for their gender affect goals for gender equality that we are discussing here?

For example, JR, do you trust the current political makeup or any upcoming political party leader or changes in the country's legislature will hinder or improve the opportunity for the issues you are calling out to be carried out?


None of what I wrote was directly related to the current President's actions or reactions to the Covid pandemic. I wanted to extend the discussion about patient dignity to include governmental actions or inaction relative to the primary topic of this specific thread topic, patient dignity and patient modesty.

However, I could start an entirely different thread to discuss the ethics of the way the biologic human catastrophe of the current pandemic is being handled in the United States and around the world.

But here and now the discussion pertaining to our discussion of patient modesty widened to patient dignity should be limited to their issues I gave as examples as noted above in my prior posting. ..Maurice.

 
At Saturday, May 16, 2020 10:41:00 AM, Anonymous JF said...

There's danger of people dividing up over political parties even on this blog. It definitely divided up our family. I heard that even marriages fell apart over it.
My vote would be the population in general have a much more active role in making laws. The lawmakers role would be to override when the general population comes up with laws that aren't workable. We also need lawmakers who are willing to work for reasonable wages. They are overpaid and have no accountability. If many people write or email or make any effort to communicate, there needs to be record of that.

 
At Saturday, May 16, 2020 12:15:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, thanks for your comment today about political division among us all relative to governmental actions or alleged inactions.

I am currently working to set up a new blog thread topic regarding the bioethical aspects of the current pandemic. Yes, bioethics and laws are intimately involved in the elements for discussion of this topic. (One, for example, is when and to whom it becomes time to "call it quits" when resuscitation is being carried out when there is time or equipment limitations because of the patient load and professional responsibilities. I look forward to constructive contributions by many readers who come to my blog itself but have never previously contributed.

I don't want the communications on the thread to be simply back and forth arguments regarding praise or shame of red and blue political parties or one country vs another country. The blog thread topic should deal with the following of ethical principles, to be discussed, in dealing with the fight with this pandemic.

Does anyone here including RC have any suggestions regarding the construction of this new blog thread? ..Maurice.
p.s.-Just as our topic here has been ongoing for 15 years, I suspect COVID-19 concern and topic for blog discussion will not suddenly end in a few weeks.

 
At Sunday, May 17, 2020 3:28:00 PM, Blogger Maurice Bernstein, M.D. said...

well, I finally got my new topic blog thread up and running. It is titled "Bioethics and Dealing with the COVID-19 Pandemic".

The topic is not strictly dealing with patient modesty or patient dignity but with the ethical, philosophical, civil and legal approaches to the management of this dominant world-wide problem. What is needed from the public is an understanding of the many elements of such a pandemic and approaches to limits its trauma utilizing for example the 4 principles of ethics:autonomy, justice, beneficence, and non-maleficence. There are potentially productive and potentially destructive results which could be identified as of value or of no value or destructive in any political policy. The goal of the public in this world-wide disaster is to sort out one from the other and follow and contribute to the path to safety and health for all. ..Maurice.

 
At Monday, May 18, 2020 7:26:00 AM, Blogger Maurice Bernstein, M.D. said...

Greetings all! I want to thank JF and Biker for already contributing their ideas to my new blog thread regarding the bioethics issues related to the Covid-19 pandemic. Both of their comments were in line with the subject matter pertinent to the new blog thread, fresh and not a simple carryover of the material covered here.

As I have said before, I welcome our participants or just readers on this thread to contribute to the new one but you all should recognize that based on my monitoring, a population of visitors will be coming to the new thread based on its distinct topic coverage and likely not of specific interest for the ideas and groans written on this "Patient Dignity" thread.

So again thanks to the startoff by JF and Biker and I hope more here will contribute their view of the ethics principles as specifically related to the ongoing Covid-19 infection on the new thread. ..Maurice.

 
At Monday, May 18, 2020 7:32:00 AM, Blogger Maurice Bernstein, M.D. said...

As an Addendum to what I just wrote above: remember.. this "preserving patient dignity formerly patient modesty" will hopefully continue to be active with commentary pertinent to that topic begun 15 years ago. ..Maurice.

 
At Tuesday, May 19, 2020 9:25:00 AM, Anonymous Anonymous said...

Hello,

I submit to you the URL of a doctor who understands empathy.

Reginald

https://suneeldhand.com/2020/05/19/how-doctors-should-communicate-over-the-phone-during-covid-19/

 
At Tuesday, May 19, 2020 11:35:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks Reginald for your link to the physician. Actually what the physician advises represents an act beyond simply empathy but also meets the ethics criteria of autonomy and beneficence. Because your posting is appropriate for publishing on my new blog thread "Bioethics and Dealing with the COVID-19 Pandemic". I will explain on that thread, the reason I made the conclusion. ..Maurice.

 
At Tuesday, May 19, 2020 4:38:00 PM, Anonymous Anonymous said...

I think JR was right when she said that the medical world appears to be left-leaning. Anyone that opens their eyes can see that things like abortion, multiple genders, angry feminism, the "Medicare for all" scam, misandry, disrespect of Christian values, authoritarianism and intolerable hate comes from the left. The way I've been treated by female nurses makes me think that they absolutely despise me for my gender and possibly my religion and want nothing but revenge for the way men treated women hundreds of years ago. T

 
At Wednesday, May 20, 2020 10:40:00 AM, Anonymous Anonymous said...

T, I agree with JR about ALMOST everything! But not the left/right stuff. With this Corona Virus crisis, I predict that MANY women will get abortions. Democrats AND REPUBLICANS. I can really only go on what I see in my own life with people I know and plenty of women I know have had abortions. Funded abortions for their daughters also.There isn't a marked difference between the parties amongst my personal friends and family members.
I have always been against abortions but now I can't say I wouldn't have gotten one under certain circumstances. I'm to old to get pregnant now but would help raise a baby or two if it came up. I'm sorry you were treated badly with your medical care. I suspect that a large number of people, especially males avoid care because of the shabby treatment. JF

 
At Wednesday, May 20, 2020 10:45:00 AM, Anonymous Anonymous said...

Hello,

After a woman says, "No!" once to a sexual advance, the next advance is a crime. For a man in the same circumstances the number is 3, not 1. Please see the interesting situation where the male is the "victim". (Or can a male ever be a victim?)

Reginald

https://www.foxbusiness.com/lifestyle/nfl-player-united-airlines-sexual-assault-flight

 
At Wednesday, May 20, 2020 3:54:00 PM, Blogger Biker said...

Reginald,the meme that men can't be sexually assaulted and that men welcome any sexual advance is pretty deeply entrenched in society. I'm surprised the flight attendants took any action at all.

In most settings men can deflect unwanted advances. The captive audience nature of the airplane scenario in the article makes that somewhat harder to do. The far more common and more difficult captive audience scenario is in healthcare where women can get away with inappropriate behavior while wearing the mantle of "professional" and professing everything is purely clinical. Most don't take advantage in that way but some do.

Given healthcare staff tend to gravitate to the aspect of healthcare that best suits their interests, I do question what is it about urology that attracts female nurses, techs, MA's and scribes to it.

 
At Thursday, May 21, 2020 8:45:00 AM, Anonymous JR Issues4Thought.com said...

Biker,
Well said. No matter what they say, females like the feeling of power & control over men & what better way to have that than in urology? The exposure aspect is what gives ultimate power & control. Exposure of genitals throughout history has been used to exert power & control. That is why it is done. It puts the naked person at a severe disadvantage. It is about mental mind games. Usually female patients are left totally exposed. It does happen but not as frequently.

T,
Thanks for your comments. I have done much research & have found most medical "professionals" are left leaning. It is also true that most right leaning individuals that I have come across do support patient rights more often than left leaning. That's not to say there's some from both sides w/ different points of view. This is just an observation on my part. I have a fairly large following on both FB & Twitter for patient rights & I have a friend who has a very huge following. I have went through most profiles to see their political leanings to determine my opinion. Plus the nurses who sexually abused my husband are Bernie/Joe supporter per their social media. That's what prompted me to investigate if this was representative of the medical community.

JF,

I too primarily disagree w/ abortions except in certain circumstances. I do not know of any women who have actually had abortions so I cannot say about their political leanings but where I live is mostly Republican and a very backwards state.

There are many men on social media who have had the same sexually abusive medical treatment we talk about here. It is way too many for it just to be a rare problem but seems to be a problem everywhere. That is why I am very active in getting something done. No patient, male or female, should have to have their autonomy, personal dignity, or any other rights denied/defied in seeking medical care. There is no valid discussion in disagreeing with all patients have access to humane, compassionate, respectful, dignified, and true informed care.

 
At Thursday, May 21, 2020 10:49:00 AM, Blogger A. Banterings said...

JR,

Here is your suggestion put in action:

Russian COVID nurse wears see-through protective suit over bikini at work

Patients are naked in front of nurses enough. I believe that ALL healthcare providers should dress this way. It would make the naked patient feel more comfortable.

Here is a perfect example of an instructional video on the Male GU Exam. We all know the things that are done wrong in it, so I am not going to rehash them. Note that I comment:

"Let' bring a female audience in to watch. Just because this patient does not mind does NOT mean that everyone is comfortable. Also, the patient was NEVER told that he could refuse the audience; this is NOT informed consent.

Do NOT forget that men can be victims of sexual abuse and the number abused by women is way underreported. Many are abused in practices and hospitals: abuse under the guise of healthcare. Having an audience in the exam room, especially a female, may be (re) traumatic and many patients endure the suffering in silence. WVERY provider should be practicing TRAUMA INFORMED CARE and seek ONGOING EXPLICIT consent.


I am all for implementing this new dress code for providers. I believe that we should let patients decide...






-- Banterings







 
At Thursday, May 21, 2020 10:54:00 AM, Blogger Maurice Bernstein, M.D. said...

I wrote a important Commentary to my new blog concerning the ethical principles involved in the issue of imprisonment of criminals or those yet not found guilty by trial in crowded prisons during this current COVID-19 pandemic and their increased risk of infection and death.

The reason I bring this up here on this blog thread is that I think the matter is definitely related to the matter of human dignity which needs to be preserved.

I would think that Comments to this topic be made on my COVID-19 blog thread:
Here is the exact link to the narrative I wrote about this subject on that thread:

https://bioethicsdiscussion.blogspot.com/2020/05/bioethics-and-dealing-with-covid-19.html#c1647832827972457184

I look forward toward your "dignity" Comment there if you have something to say. ..Maurice.



 
At Thursday, May 21, 2020 12:38:00 PM, Anonymous Anonymous said...

Hello A. Banterings,

I watched the GU Exam video in your post. Denise, the medical asst, was there to help the doc. However, I didn't see any help. Did I miss something? Was she necessary? The doc introduced her saying, "... she's here to assist .. OK ...." Wouldn't a more dignified approach be to ask, "Is that OK with you?", instead of sliding the OK in the middle of the statement? Again, apparently, there's no problem with a female during a male exam. Would the doc be so cavalier in introducing his asst., George, during a pelvic exam? Strike that previous line. It would never happen. Why do men put up with this?

Reginald

 
At Thursday, May 21, 2020 2:54:00 PM, Blogger Biker said...

banterings, I watched the video too. It was amazing how the doctor was so careful to explain how the exam would be done and to get consent before starting it, but then to exclude altogether asking the guy if he was OK with having an audience, and a female audience at that.

Doctor Bernstein, use this video with your students as an example of how not to conduct an exam.

 
At Thursday, May 21, 2020 9:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, thanks for the suggestion. I will take a look.

Misty, thank you, thank you for bringing up an important issue of denial of family visits to hospitalized patients during this pandemic. It beings up ignorance of a least 3 ethical principles. ..Maurice.

.

 
At Thursday, May 21, 2020 11:08:00 PM, Anonymous Anonymous said...

Reginald, If this same male doctor were to do a pelvic exam on a female patient and use a female chaperone it still would be equally bad as that video you all are talking about because it would be an opposite sex staff member and a same sex member. JF

 
At Friday, May 22, 2020 4:38:00 AM, Blogger Biker said...

Coming back to that GU exam video, I wonder whether the doctor would bring in a female observer if he was examining another doctor, or would he instead give a fellow doctor a degree of respect he doesn't give to ordinary patients.

My other question is whether it is current standard practice to bring in observers for male genital exams. A few years ago when I switched to a new urologist he did a full genital exam but w/o any observers. Was my urologist not following standard practice or is the doctor in the video using outdated procedures as concerns observers?

 
At Friday, May 22, 2020 8:32:00 AM, Blogger Dany said...

Bantering,

You are no doubt aware already but this "educational video" is another attempt at normalizing the use of chaperone during genital exams. Denise, bless her professional status, is nothing more than a chaperone in disguise. Now, I wonder why the doctor failed to introduced her as such (that's a rhetorical question, btw).

A more pernicious aspect of this is that it makes the practice of misleading patients by not announcing a chaperone as such permissible.

Dany

 
At Friday, May 22, 2020 1:50:00 PM, Blogger A. Banterings said...

I agree with all the comments on the assistant (chaperone).

I also thought of what Maurice says about speaking up and an incident that I had.

My experiences as a child has created a phobia in me about everything medical. When I go for blood draws or shots, my wife goes with me to hold my hand. I do not look at all. Totally freaks me out. I also have an extremely high tolerance to pain.

So I am having IV antibiotics and they cannot get the cannula in a vein where they can see blood. On the THIRD attempt, the nurse who was practicing less than 6 months (and an IV nurse was not available) starts "TWISTING" the cannula in the vein and is going "in-and-out" with the cannula. I am sitting there as stiff as a board, eyes closed, ENDURING THE PAIN. I was literally frozen with fear.

My wife (who is a medical assistant) finally told him to STOP. In retrospect, I WAS SPEAKING UP. The fact that someone sits quietly through such a painful experience IS SAYING SOMETHING. The nurse was NOT LISTENING. He did not ask how I was doing, if he should continue, or have any freaking sense to get someone more experienced. He was going to keep going until he got it or I was dead.

An hour later, no IV nurse available, so he had the brass ones to say he needed to try again. This time I told him to get someone else. (A nurse with less than a year of practicing...) The whole stay for antibiotic IV infusion was painful, frightening, etc.

Needless to say that this experience has caused me PTSD. I have flashbacks, dissociative reactions, hyperarousal, distress with reminders of trauma, avoidance of trauma-related physical reminders, and intrusive thoughts/feelings. I feel that I have lost control over my healthcare and have great anxiety over anything medically related.

I have seen people like Maurice accept intimate medical care and I thought that this was an irrational fear. Because of this and another incident (delayed diagnosis), this irrational fear has been rationalized.

I was making progress, it is easier to dispel imaginary fears. Now that I have suffered MEASURABLE, CLINICAL HARM twice, and of course all the psychiatric trauma that accompanies it. Now I need to be convinced that I am safe in the healthcare system and in control before addressing rational fears.





-- Banterings






 
At Friday, May 22, 2020 4:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I understand and hope this COVID-19 effect on politics, medical profession and individual's personal and private life doesn't further decompensate your attempt to be as free of symptoms as possible..to move toward a degree of recovery. ..Maurice.

 
At Saturday, May 23, 2020 4:38:00 PM, Blogger A. Banterings said...

Maurice,

Thank you for the sentiments. Despite my PTSD from the profession of medicine and my phobia of it, I do not fear injury or illness. I have been regularly visiting friends in N NJ and NY (right outside NYC). I have been on a cocktail of OTC and Rx (self prescribed of course) before they were even considered in the US. Some of the cocktail ingredients include ascorbic acid (vitamin C) and progesterone.

I regularly put myself in very dangerous situations (ice climbing for instance) as a means of taking control of my body. This stems from my abuse by the profession of medicine. I also use it as a way of validating to providers my phobia. I show them my pics of doing things most people would not even entertain. I use it to say I think you are silly for being afraid of climbing a 600 ft tall icicle, just as you think my fear of needles is silly...





-- Banterings



 
At Saturday, May 23, 2020 6:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I understand and appreciate your comments about your personal responses. What I do suspect is still the challenge for you to provide the emotional and even perhaps physical support for conditions regarding your mental and physical health which is not be provided or has been mis-provided by the medical system professionals. It probably still is a challenge to convey to them the points that you are attempting to make. Again, thanks for reminding us of your response. ..Maurice.

 
At Saturday, May 23, 2020 8:27:00 PM, Blogger A. Banterings said...

Maurice,

I have basically opted out of healthcare. I write my own prescriptions. If I want to do testing, I am back to direct-to-consumer testing, including (completely) anonymous blood testing.

I was working with a good PCP (for ADHD) until he did NOT respect me saying "NO" in two situations and I was physically (not severely, but it was MEASURABLE clinical harm) AND psychologically harmed.

Now I am taking back control. NO MORE preventative care. No cholesterol, A1C, etc. I was acquiescing as a token to my PCP anf because I foolishly trusted him.

I like when people f**k up because now I OWN them. Because the iatrogenic harm is ongoing, there is NO two year statute of limitations for malpractice. If he tries to fire me as a patient, I will destroy his career and his retirement.

I don't blatantly say that, but I will lay out what happened without assigning blame. I will blame the healthcare system.

This is how we speak up as patients. Now I get the care that I want.







-- Banterings






 
At Sunday, May 24, 2020 8:56:00 AM, Anonymous Anonymous said...

One possible positive change this Covid 19 crisis MIGHT bring about is doctors relying more in what their patients SAY instead of doing examinations so much.
I know that that isn't ALWAYS for the best but often doctors want to do examinations for the purpose of making a better wage. And by stringing a patient along and not giving an accurate diagnosis in a timely manner, doctors get morw money than ever. Not enough Accountability there. There needs to be evaluations. Maybe consultations tape recorded. Wages should reflect job performance. Titles changed according to what a doctor will or will not do. Also I would like set prices for medical procedures. I want to pay a routine monthly medical bill INSTEAD of health insurance. Our lawmakers have voted against that but why shouldn't we get to vote for or against that ourselves? For every overpaid person somebody else must be underpaid or overcharged. No way around that. And as the saying goes Behind every great fortune is a crime. JF

 
At Sunday, May 24, 2020 2:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I think you need and must find a physician who understands you and is willing to spend time to make you as comfortable as possible with your concerns and medical problems. At some point "doing it alone" may not be in your best interest or emotional feelings. I, myself, as a physician, may self-diagnose but would never consider self-treating except for trivialities. I know from your writing that you are not having been or are being subjected to trivialities. But..in the final analysis you could not and should not be treating yourself for all that troubles you. I admit, finding that professional help that is interested primarily in you, yourself and not some personal self-interest may be a difficult chore and you obviously tried before and "lost". But, I think it is essential that look more to accomplish that challenge--the physician whose interest and goal post for healing is YOU and YOUR HURTS. Don't give up and self-treat. There must be someone you will find.. so don't give up. ..Maurice.

 
At Tuesday, May 26, 2020 7:18:00 AM, Anonymous JF said...

Dr B, WHY do you think you couldn't self diagnose? You could probably be approximately as accurate as another doctor doing it for you. Maybe if the college was a more responsible wage we could have many more doctors and there'd be more accountability from them. I kind of think more self treatment MIGHT be the way to go if people could force themselves to study up. At least to the point where doctors need patients as much as patients need doctors. Without that kind of equality we can always be mistreated by the medical staff who desires to mistreat us.

 
At Tuesday, May 26, 2020 8:26:00 AM, Blogger Maurice Bernstein, M.D. said...

JF, if you look at the current medical news and journals at this time of the COVID-19 pandemic, you will read that doctors do need patients for their financial and mental health. With some loosening up in parts of the United States and clinic or hospitalization for elective procedures are beginning to be permitted, for example, more routine visits with your doctor may be coming but with return soon of ongoing COVID flareups divorce between patient and doctor may still be an ongoing reality.

And yes, that means that patients for the foreseeable future may require self-medical education more than previously and self-treatment.

What I wrote above is real and is happening now. However, self-education and self-treatments will always have limits even with methods of self-electronic diagnosis and self-treatments. There is a reason why medical school education to become a physician is a 4 year exercise and even after 4 years more knowledge and experience is necessary before a physician becomes fully educated in medicine. But who knows what the future may bring in this upset and dangerous world and perhaps this respite from everyday professional care to self-diagnosis and management may be what will be a major public behavior in the future or even near future. COVID-19 is now known to attack and damage many bodily organs beyond the respiratory tree and even attack the healthcare providers in their work or at home and therefore it will end up with any "mistreatment" if present as exercised by the now "medically-educated" patients themselves. ..Maurice.

 
At Tuesday, May 26, 2020 11:26:00 AM, Anonymous Anonymous said...

Dr B, Of COURSE doctors need patients. Just not certain individual patients. And we need them/you MORE than you need us
(individuality ) I seriously doubt my family doctor has even noticed that I haven't been to see her in a couple of years. But I can't swing paying Health Insurance AND pay for medical care. JF

 
At Tuesday, May 26, 2020 2:47:00 PM, Blogger A. Banterings said...

Maurice,

This is a good doctor. I trusted him enough that I allowed him to examine a lump on my testicle. The problem is that he had a good medical education. He diagnosed properly and pushed the only treatment he was taught (inpatient IVV antibiotics). It was the hospital staff that caused the harm due to an excessive patient load due to one of the worst flu season.

The second issue was that he was pushing middle age cancer screening and I refused. He kept pushing as he was brainwashed to do. He needs to learn critical thinking and customer service skills. I could have done IV antibiotics at home.

As to self Dx and self treatment, there will come a day when we have the Doctor Mc Coy tricorder that will diagnose instantly. Although artificial intelligence is not there now, it has been more effective in use with imaging studies than humans.

90% of what PCPs deal with is repetition. Using AI (via Google), one has a 90% success rate self diagnosing. Physicians are mere mortals, if they can learn the art of healing, then ANYONE can.

Finding one who cares about me is not going to happen. Consider that the DRE. The fear of this causes many men to avoid the doctor (whether it is recommended for them or not). Reference: Masculinity and the Body: How African-American and White Men Experience Cancer Screening Exams Involving the Rectum

Countless physician websites and research say men would do screening "if they knew that they can start with a blood test first."

So I decided to see if there is help for someone who is opposed to such an exam. Theoretically, there should be multiple providers that would work wit a man to help him get through this. I have found NOTHING.

The only things out there is saying that it is fine "IF YOU KNOW WHAT TO EXPECT." Others say man up, seek psychological help (mostly CBT for fear of doctors), it is an important screening (no support for those who decide not to screen), shaming, just get over it, etc. The cancer sites are worse.

The CRC sites (for colonoscopy) all say that you will be sedated. For some people, being awake and in control may be what they need to get through it.



CAN ANYONE HERE SHOW ME A WEB SITE THAT HELPS ONE GET THROUGH A PROSTATE EXAM, RECTAL EXAM, GENITAL EXAM WITHOUT SAYING "JUST DO IT", "HERE IS WHAT TO EXPECT", OR "JUST GET OVER IT"?

CAN YOU MARICE, POINT ME TO ANY RESOURCES FOR HELPING ONE GET THROUGH THIS (INCLUDING THE WEB SITE OF A PROVIDER WHO SPECIALIZES IN PEOPLE WITH THIS AVERSION?


You can't say this is not a common problem, the CDC says 25%-50% of people not being screened for different cancers.



So he messed up. This is leverage against him. I OWN HIM NOW. Why would I want to find another doctor? They all say they are compassionate, want to help you, blah, blah, blah... This is marketing fluff. Most, like you use to believe Maurice (when I first started posting here) that this CAN'T happen, these are outliers who are cray, etc.

Getting a new doctor means they all want blood tests, baseline, physical exam. That means getting hurt again. NO MORE!






-- Banterings






 
At Thursday, May 28, 2020 12:26:00 PM, Blogger Maurice Bernstein, M.D. said...

The preservation of patient dignity means also the preservation of patient autonomy.
I just want to inform those reading this blog thread that JR posted an important conflict within the expression of patient autonomy as applies to COVID-19 pandemic but also referring to other examples in our society. Click here to join the conversation. ..Maurice.

 
At Saturday, May 30, 2020 4:29:00 PM, Blogger Maurice Bernstein, M.D. said...

There is so much concern now about how long it would take to obtain a proven effective vaccine for the prevention of illness and death by the CORONA-19 virus infection. Well, I found a numerous cartoon related to the length of time to prove the effectiveness of an "immortality vaccine' if even one could be invented. I have used this cartoon to present an introduction to the issue of "Ethics of Immortality". To inspect and perhaps contribute a though click here. ..Maurice.

 
At Saturday, May 30, 2020 4:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! I meant "..contribute a thought" ..Maurice.

 
At Saturday, May 30, 2020 5:40:00 PM, Blogger A. Banterings said...

NO ONE TAKING ME UP ON MY CHALLENGE ON A WEBSITE THAT HELPS ONE GET THROUGH AN INTIMATE EXAM IF THEY ARE A VICTIM OF ABUSE OR CAN'T ENDURE SUCH AN EXAM?

WHAT ABOUT A PRACTITIONER THAT SPECIALIZES IN WORKING WITH SUCH PATIENTS?

THE FACT THAT NOT A SINGLE SOURSE WAS PROVIDED (ESPECIALLY BY THOSE OF US WHO SUFFER FROM OR ADVOCATE FOR PATIENTS ABUSED UNDER THE GUISE SAYS THE PROFESSION DOES NOT CARE.





-- Banterings





 
At Saturday, May 30, 2020 6:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, do you think this research article is pertinent to your interest and concerns? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349219/

..Maurice.

 
At Sunday, May 31, 2020 5:36:00 AM, Blogger Biker said...

Dr. Bernstein, banterings is certainly better versed in reviewing studies, but it amazes me that studies of this nature always fail to include staff gender as a variable. Is this because they are oblivious to the fact that staff gender might be an issue for many patients? Or is it because they know no practice is about to hire any male staff based on the results so why bother pointing out that its an issue?

I have never had a urodynamics study and hope to never need one but I just cannot see myself standing there naked from the waste down for 30 minutes or more while a female medical asst or tech, maybe two of them, catheterize me front and back, place monitoring patches, fill my bladder, and then observe me urinate. This is about as undignified as it gets.

I will also add that these studies only represent people who have consented to the testing. My guess is that there are lots of men that simply refuse to have the testing done. I have always taken whatever tests or exams my doctors have recommended, even if somewhat embarrassing, but I think urodynamics testing is one I'd refuse if they didn't have male staffing for it.

 
At Monday, June 01, 2020 9:03:00 AM, Anonymous Anonymous said...

Hello,

WSJ Sat/ Sun May 30/ 31 Page A13 had an article entitled "The Overlooked Disparity: Coronavirus Kills Mostly Men". It mentions NYU Langone's Preston Robert Tisch Center for Men's Health. The article also states, "... some patients are women who followed doctors to the center or simply find it convenient." Wow! Would men even be allowed entrance to a women's clinic? Watch the video in the website. (https://nyulangone.org/locations/preston-robert-tisch-center-for-mens-health). Click on the video and notice that at 21 sec. you'll see a male receptionist. At 29 sec and 49 sec you'll see female receptionists. That's two to one for the females in a men's clinic. Would someone like to give the clinic a call to determine the ratio of female to male nurses? I'd guess that the initial answer would be, "I don't know"? When pressed for an approximation, my bet goes to a preponderance of female nurses. NB - the video shows only doctors talking to patients. No nurses are ever seen. Interesting. Has biker's consistent point been totally vindicated - no male nursing staffing. The WSJ article also mentions that the author's (Daniel Akst) search on Google yielded 3.8 million men's health clinics and 24 million women's health clinics. Are there really 7 times more women in the US than men? However, I'd like to end on a happy note. Go back to the NYU Men's Health website and scroll down to Our Team. Notice the first person on the team - Stephanie Allen NP - PSYCHIATRIST. Is there a message here for men? Cheers.

Reginald

 
At Monday, June 01, 2020 2:55:00 PM, Blogger A. Banterings said...

Maurice,

In regards to the "emotional discomfort related to urodynamic testing" study, I am seeing flaws with it. First off, 60% of the participants were female. Women are afforded more dignity in choice to gender and 90%+ of nurses/technicians/assistants are female. Women are also more desensitized to invasive medical procedures (childbirth, gynecological) than men.

I would love to see this broken down by male/female responses. I bet more men were uncomfortable. Also, 62.1% had a previous urodynamic test and 53.7% had a previous cystoscopy. 64%+ are over the age of 65 years old. These demographics are also prone to learned helplessness. This is the simple explanation of how learned helplessness occurs:

Undesirable event ---> Perceived lack of control ---> Generalized helpless behavior


In deed it is a common occurrence in the elderly and patient populations. Being an elderly patient makes one even more prone to this occurring. Reference:

Learned Helplessness in the Elderly

Social Antecedents of Learned Helplessness in the Health Care Setting

How Learned Helplessness Can Impact Patient Satisfaction Nursing Essay

Learned Helplessness and Chronic Illness

The Practice of Respect in the ICU


Finally this is a very good reference: When Patients and Their Families Feel Like Hostages to Health Care

Patients are often reluctant to assert their interests in the presence of clinicians, whom they see as experts. The higher the stakes of a health decision, the more entrenched the socially sanctioned roles of patient and clinician can become. As a result, many patients are susceptible to “hostage bargaining syndrome” (HBS), whereby they behave as if negotiating for their health from a position of fear and confusion. It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one's better judgment. When HBS persists and escalates, a patient may succumb to learned helplessness, making his or her authentic involvement in shared decision making almost impossible.

This includes not speaking up about discomfort.


Big flaws in this study as you can see.







-- Banterings









 
At Tuesday, June 02, 2020 12:02:00 AM, Blogger 58flyer said...

Not to highjack the current and very valuable discussion, I want to relate my experience with my dermatologist during today's (Monday's) office visit.

As many of you here remember, I posted my experience with my dermatologist at this approximate time last year. It didn't go so well, and I filed a complaint. Mainly it concerned a female scribe who sat in on the exam. And no name tags.

This time, I was ready. The only problem was I allowed myself to get worked up and worried. I was determined not to allow the scribe, or any other person, in the room for the exam except for the doctor. I left my cell phone in my truck, so I wouldn't be distracted. With the covid thing going on, I was the only patient present. At the prescreening, I saw my pulse was 119 bpm, it would normally be about 70 or so. During the workup, the MA recorded my BP at 240/109. That was the highest I have ever seen. I had taken my BP meds 3 hours prior to the appointment, and just to be sure, I took another pill 1 hour prior. That really scared me. I felt fine though.

The MA told me to get undressed and cover with a large cotton sheet which was the same as last year. She said if I took off my underwear the doctor would exam that area but if not, he would not examine the area. I opted for the full exam. As she was leaving, I asked her if she would tell the doctor that I preferred that he bring no assistants with him for the exam. She said she would relate my request, no problem.

The doctor came in by himself. I don't know for sure if he remembered me from the last years complaint, but he seemed distant. Last year he was so talkative with the female scribe who also joined in on the conversation. Now, it seemed awkwardly quiet, so I made some conversation myself. If I hadn't, it would have been really quiet. No doubt he remembered. With no underwear, I got the full exam, which is what I paid for. Once done with that, he left me to dress except for my shirt, as I had a lesion he had to remove with cryo. He came back in and took care of the lesion and that was the end of my visit. The MA said she wanted to take another BP before I left, but she forgot, as did I. I am now scheduled for next year at this time.

I felt like I had asserted for myself, and is was no big deal at all. I would like to think that other men are making their preferences known since they so readily acquiesced to my request. Plus, everybody had a name tag on. My BP is now much lower.

58flyer

 
At Tuesday, June 02, 2020 9:59:00 AM, Blogger Maurice Bernstein, M.D. said...

58flyer et al: There is absolutely nothing unethical or "wrong" with a patient setting the patient's own limits for an examination or procedure. Patients have the ethical right to their autonomy when relating to the medical or surgical management of their symptoms or procedures. All my professional life, I have listened to patients and have asked and discussed with them issues which I had noted they had not brought up. However, the physician has the responsibility to listen and discuss the issue with the patient (or family as needed) and to present to them the facts or considerations that may affect the patient's decision or which the physician cannot professionally carry out or accomplish. And finally, it is patient autonomy to make the final decision with the only exception being in a life and death emergency when there is no immediate available advance directive or family or other patient surrogate and the patient is unable to understand or is unconscious.

Again, I want to emphasize that as in 58flyer's case, the issue does not have to be a clinical diagnostic or therapeutic issue. It can be of some other situational matter. It becomes the patient's final decision regarding the actions to be taken next after being educated by the physician regarding the clinical or administrative issues involved. This is all patient autonomy and physician responsibility. ..Maurice.

 
At Tuesday, June 02, 2020 10:29:00 AM, Blogger Biker said...

58 flyer, I don't recall if I shared my derm visit from earlier this year, but I can relate to yours. When I had my 1st ever skin exam it went badly. I filed a complaint first with the head of the derm practice and upon no response, with Patient Relations. In a nutshell the primary complaint was I asked for the female LPN and female scribe to not be there and then the male Resident I was scheduled with walks into the room and immediately shakes his hands at my genitals asking if I had a problem with women. He then wasn't interested in hearing a response from me.

Their policy had been an LPN and scribe observe all exams, and they only hired females for those roles. Patient relations was aghast when I described how the Resident behaved and they agreed men should be entitled to privacy. The result was a policy change that allows men to ask for no female staff upon checking in, and I was reassigned to have the head of dermatology as my physician.

My next visit I adhered to the new policy and wasn't hassled for indicating no females in the room. The doctor was walking on eggshells though given it was only about a month after resolution of my complaint and because I caused a bit of a scene before he came in. Literally at the moment I finished completely undressing and was reaching for a gown, a woman (not sure if LPN or scribe) opened the door as she said "OK to come in". She couldn't have timed it more perfectly. I shouted "No, I'm not ready" but it was too late as she already had the door open as I stood there naked. She exited immediately, shutting the door and I shouted even louder "I said no I wasn't ready, which part didn't you understand". I suspect anyone in any of the examination rooms would have heard me. That may have been why the doctor was walking on eggshells.

Fast forward a year and again I'm not hassled for my request, but this time a female manager comes out to tell me my request will be honored and she'll take care of it. I tell her I know its more work for the doctor to not have a scribe and that one can come in so long as she steps out or faces away for that part of the exam. The doctor then comes in and immediately tells me my privacy will be protected, and he even took great pains to position me so that the scribe couldn't see even if she wanted to.

Earlier this year I go for my exam and learn they now have a male scribe but he is assigned to someone else that day. I expect a repeat of the prior year but this time the doctor skipped the genital part altogether after just asking me if I have any issues there. The record then stated I had a full exam. He clearly was in a rush and probably just didn't want to take the extra couple moments to position me correctly for a full exam.

I'm thinking next year when I go I'm not going to say anything upon check-in so as to see if I am flagged being I'll know if he walks in with two women or not. If he does I'll just ask the LPN to step out and tell the scribe she'll need to face away for the genital/rectal part.

 
At Tuesday, June 02, 2020 12:57:00 PM, Blogger A. Banterings said...

Biker and 58 flyer,

You experiences show how the cancer of paternalism is alive and thriving in modern healthcare. Thankfully, there is a corporate structure that takes customer service very seriously. Eventually, their corporate masters will beat the paternalism out of them.

Things such as having a policy that LPN and scribe observe all exams are deemed medical necessity and the only way to do things. This is remnants of "because I am a doctor and I say so."

What Biker should have said is ...I suffer PTSD from prior abusive medical care, so under the Americans with Disabilities Act (ADA), I am requesting the reasonable accommodation of no females present in the exam room..."

When you schedule your appointment, ask how you go about making sure that they will be ready to accommodate your legal disability. Right away, they will think wheelchair, visually impaired, hearing impaired, etc. You have now associated your PTSD, anxiety, etc. with what are commonly accepted disabilities.



I guess we can safely say that my challenge was unmet because support for people suffering such things should just [paternalistically] get over it, man up, disassociate, and allow the exam. What does this say about the profession of medicine???

So here is my next challenge: Can anyone point to a website, web community, discussion, etc. that SUPPORTS people who choose NOT to screen for cancer?

Everything that I see says "just do it" and "that is how they found my stage 3 cancer and it saved my life..."






-- Banterings





 
At Tuesday, June 02, 2020 3:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Maintaining patient dignity and the dignity of the medical system within a pandemic, take a look at this public education graphic presentation . Do you think this presentation explains fairly but briefly "How Hospital Care Might Change During a Pandemic"? ..Maurice.

 
At Tuesday, June 02, 2020 3:46:00 PM, Blogger Biker said...

banterings, while the derm practice was unresponsive to my initial complaint, Patient Relations at the hospital was very responsive. I went there in person w/o an appt. on account I was at the hospital for another appt. The woman asked me if a trainee (a male) could sit in with us before he was brought into the room. I recounted my experience and as I said they were aghast when I demonstrated the hand waving in front of my genitals and repeated what he said. I as well told them I find it kind of creepy to just have women there watching and I could tell from the guy's body language he agreed on that one. The woman tried reaching the Practice Manager by phone while I was there but she didn't answer. We communicated via email after that until it was resolved.

When making that first appt. the scheduler was verbally hostile towards me for asking for male staff (and I included that in my complaint). The schedulers have been very professional ever since my complaint. Maybe I helped change things?

On the cancer screening matter I am going to disagree. My high grade bladder cancer was only discovered at age 51 because I went for my annual physical and the doctor did a urine test. The urologic oncologist told me I'd of been terminal by time I had any symptoms. A brother who was 53 had colon cancer that was only discovered because his primary care doctor prevailed upon him to get a colonoscopy based on his age. He didn't have any symptoms and the cancer was approaching the point of spreading beyond the colon. Even I am on an every 3 year colonoscopy schedule due to pre-cancerous polyps having been found. As recounted previously three other siblings died young (47, 54, 59)and so while most families aren't as unhealthy or unlucky as mine has been, I do whatever tests they recommend.

 
At Tuesday, June 02, 2020 5:40:00 PM, Blogger BJTNT said...

Biker,
In all my many years of receiving medical care, I have never had an MD that didn't knock before entering the exam room and I have never had a single caregiver [other than MDs] that every knocked before entering. If the medical institution administrators cared the least bit about patient respect and dignity, not to mention modesty, they would instruct/demand/enforce that all caregivers knock before entering exam rooms.
BJTNT

 
At Wednesday, June 03, 2020 12:47:00 AM, Blogger 58flyer said...

Thanks to all who responded to my last post.

BJTNT, On this visit I described, the MD did not knock but just walked in. At least this time I was given plenty of time to get undressed and cover myself with the sheet before he did come in, and he was alone. Over the course of the many years of my healthcare experiences, it has been a mixed bag of people just walking in and those who knocked first.

Biker, I can see there are differences in how you were treated and how I was treated. Everybody just does their own thing I suppose. In my exam, I was laying on the exam table and the MD did the exam with sequential draping. That I very much approve of. I cannot imagine having to drop the gown for a full nude exam standing up, if that was the case for you. And then to have female observers. The policy change you mentioned, I wonder if the male patient has to ask for no females, or if he is given a choice at all. I think that most men would not know to ask.

Banterings, I hope you are right about the corporate structure taking customer service very seriously. Also, in my experience those employees assigned to scheduling have no clue about what the patient is to encounter, much less as to what their policy is on PTSD. They are generally not medical personnel, just clerical.

Next Tuesday, I have my first visit with my new Urologist. As I reported earlier, I have had 2 doctors refuse to take me on as a new patient with this Urology practice. I was able to connect with a management person who placed me with one of the senior Urologists as a new patient. He has not had the chance to review my file and make a decision about me. Hopefully we can move forward with this practice so I can get treatment for my prostate cancer. I have verified that they do have male staff as assistants so I very much want to go there. Plus they are local.

58flyer

 
At Wednesday, June 03, 2020 5:49:00 AM, Anonymous JR Issues4Thought.com said...

Most all will knock but most all will be entering as they knock not caring about the answer as they assume they have the right to enter. After all they are on a schedule. They are in a hurry as their time is valuable but your time is not as you probably have already spent much time waiting.

I had a woman tell me other day that women should not have male nurses for intimate care but it makes no difference for men having female nurses for intimate care and many actually enjoy it as they get a sexual charge out of it. It just goes to show that even the public is very misinformed.

Oftentimes, it is not that the patient has not set their own limits but it is those limits are purposely ignored and the patient has no way to counter this from happening especially during a surgical setting. Many patients have had that verbal surgery talk and have the consent form handed to them during pre-op with sedation drugs flowing their veins and told to sign this form about what they talked about. Because of the drugs and they feel coerced, they sign. The form of course does not have on there what they talked about so the surgeon is saved from malpractice claims. The form can also be altered. Many institutions have come up with ways to disallow an altered form to be accepted (that is if it is altered by the patient). Many have requested same gender care only to have it denied and then they are caught in the deer in the headlight scenario that med providers count on happening.

So my question is why do some medical providers have posted they do not allow for patient recordings of the encounter? If they are providing a true account of the encounter themselves, what do they have to fear from a patient recording the encounter in order to have concrete proof of the encounter? Of course, patients do not have to follow those rules and have the right to record.

 
At Wednesday, June 03, 2020 8:13:00 AM, Blogger Biker said...

58flyer, good luck with your upcoming appt. I have my annual cystoscopy coming up later this month and can understand the nervousness going into these kinds of exams even when I know I've been scheduled with a male nurse. In the waiting room I'm still allowing maybe a bait and switch will occur until a male nurse actually comes out for me, and then once prepped I lie there wondering if the doctor will walk in with an entourage of female medical students. This practice has never done those things to me, but having been ambushed in the past elsewhere I assume it can happen again anywhere. I don't think most who work in healthcare understand how hard it is to regain trust once it is violated.

You are correct my dermatologist does not do exams with the patient lying down. He does the torso,legs, and arms while sitting on a table, and then the genital & rectal area, and perhaps the back of the legs while standing up. My 1st full exam with him when it was just the two of us in the room did result in my standing before him totally nude. The gown had come down onto my lap when he examined my upper body and then he had me stand up rather than telling me to put the gown back on first.

For the next one with him when there was a scribe in the room, I made sure to put my gown back on before standing up, though he had me shielded from her anyways. He very much was paying attention to my privacy on that one.

On the knocking thing,anyone who does not wait for an OK to enter is signalling the patient that they really don't care about the patient's privacy. Of course usually the patient is dressed, but better to ask for an OK than to try to remember each time what state of dress the patient might be in.

 
At Wednesday, June 03, 2020 2:59:00 PM, Blogger BJTNT said...

CA often sets the trend, not always in a good way. In my many years of medical care in SoCal the closest I remember a caregiver [non-MD] even come to "knocking" was opening the door part way and slowing sticking her head in the door while entering, but never speaking a word until inside the room. One qualification on my comments - I was thinking of office visits, not hospital stays. Also, MDs knock and enter, they don't wait for permission.

What choice do you have in a hospital after an emergency admittance?

During my four ER visits and three hospital stays in 2019, I was given so many benzos that I feel lucky to remember my own name. The medical community party line is that benzos don't affect memory, but this is a little too self-serving to accept at face value. I would like to see the longitudinal study on benzodiazepines affect on memory.

Last year I experienced these specialists in hospital settings. The female gastroenterologist should have her photo in the dictionary for the definition of medical paternalism. The male gastroenterologist should carry the clock-in machine that watchmen carry with the keys in remote areas. That way he could sneak in and turn the key and leave w/o having to actually talk to the patient in bed. The ENT specialist reminded me of my assigned MD for company annual health check-ups who was lost for a response when you said hello to him.

Over the years, I have left a number of PCPs [not specialists] because of the caregivers proving to themselves that it's all about them with patients just objects to be processed.

I only expect MDs to have a bedside manner. That's why I'm quite happy with my current PCP who has a personality. I've only had one other MD [an ophthalmologist] who had a personality. My PCP's staff [includes non-touch labor] are typical - meaning bad, but I hope I can tolerate them.
BJTNT

 
At Wednesday, June 03, 2020 3:17:00 PM, Blogger Maurice Bernstein, M.D. said...

To those who are expressing their views but specifically their prior and even their current or immediate interaction with the medical system, I suggest that you may well have different views because of strongly different experiences within the medical system then those others who are simply "readers" of this blog thread and, who knows, may have had only relatively "trivial" clinical matters with the system. (Remember, not all patients present clinical symptoms which require exposure of "sensitive" bodily parts for examination.) Not all patients, as "grownups" are interested or participate in clinical screening examinations.

What I am getting at is that there will be readers here who may find that they have not experienced "all the bad" professional behavior that has been written here by others. And perhaps, because of this, with no experience, they feel they have nothing to contribute here.

Frankly, if I am correct in my above assumption, since this is a "discussion blog" (note our blog title), I do wish that missing group of visitors here participate by writing about not only their experiences but what they personally know about others in their lives.

I am, with no intent, trying to discourage posting what has been the narrative presented on this blog thread over the past 15 years but it would be great to read the experiences of others who while I must admit now could be the "statistical outliers" which early here I admit I, wrongly? attributed to those who have taken to writing their experiences here.

Perhaps the only solution to what has been expressed here by our writers is just "don't get too sick" so that getting your furnace repaired will occur more frequently than having to enter the medical system.

Let's all stay well especially in these pandemic times. ..Maurice.

 
At Wednesday, June 03, 2020 7:14:00 PM, Blogger BJTNT said...

Dr. B.
Thanks again for using your expertise, time, and patience in maintaining this bioethics discussion blog thread.
BJTNT

 
At Wednesday, June 03, 2020 7:37:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, you're welcome. As you may know and as I know having actively participated in hospital ethics, regularly, for also a bit more than 30 years, still a hospital committee member and an active participant on three professional bioethics listservs."Patience to reach a conclusion" is an important factor in dealing with the subject of bioethics. What, at one time, one may think of something as "ethical" may become "unethical" or vice versa. What that means is that the philosophic concept is not always static but is "flexible" in various degrees. So.. that is the reason decisions in ethics but specifically bioethics requires DISCUSSION of the issue.

That's why I look for "discussion".. ..Maurice.

 
At Thursday, June 04, 2020 8:54:00 AM, Blogger Maurice Bernstein, M.D. said...

By the way, you might be interested to read and perhaps write a Comment there on a 2012 blog thread topic which I see in the past 2 days have received dozens of views from what appears to be students from University of South Florida. The title of the presentation is "A Doctor's Decision: Whether or Not to "Call the Cops".

The Introduction is as follows:
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.



The rationale for presenting the thread topic to our visitors here is with regard to issues which bring up the possibility
of impairing the dignity of the mother of a symptomatic child.

Since the topic seems to be of current student education interest you might want to write a response there. ..Maurice.

 
At Thursday, June 04, 2020 10:43:00 AM, Anonymous Anonymous said...

Even if you contact Children's Services you won't get any results. Whenever Children's Services actually intervenes and helps out, it's a rare occurrence. An anomaly. And its widespread, not confined to one area. The most dysfunctional organization in existence. JF

 
At Thursday, June 04, 2020 12:25:00 PM, Blogger A. Banterings said...

The George Floyd protests have shown us that society is no longer going to allow institutions to exempt themselves from the expectations of society. That was also seen with protests against excessive lockdowns by governors. There is going to come a great awakening. Healthcare has already put itself on the wrong side of society by trying to extend the stay at home orders.



-- Banterings





 
At Thursday, June 04, 2020 1:07:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, I got your view of Children's Services. But, my question is: is such a behavior, perhaps "cultural clinical assumption" on the part of the mother warrants the physician by reporting to some governmental child care organization actually degrades the dignity of a mother, the mother who assumes to maintain her parental duty and dignity by carrying out her cultural act of "coining"? How about the physician first reading up about "coining" and then explain to the mother the potential clinical harm it may pose to her child? Or what behavior on the part of the physician would you suggest? ..Maurice.

 
At Thursday, June 04, 2020 2:31:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, with regard to your last post, I would agree that even in medical practice vs the patient population, what is happening in the George Floyd protests may well prognosticate how the patient population (all of us) is going to handle the defects in the medical system behavior or in fact misbehavior. I guess this particular blog thread itself and what has been written here, may be a minor example of what may be the directions taken by the patient population (which means all of us) in the future.

However, with regard to the "wrong" of "stay at home" to prevent viral spread in this still active pandemic and what may be observed in the upcoming near future, that remains to be seen. ..Maurice.

 
At Thursday, June 04, 2020 5:34:00 PM, Anonymous Anonymous said...

What happened to George Floyd isn't anything new. What IS new is large numbers of people unemployed or under employed and not happy about it. Not having a job frees people up tp go protesting and unfortunately some are going to loot and destroy property and assault people. Partly I think the criminal elements undermine the protesters but then again, would the protesters be listened to at all without the #!$@ holes acting out? I sure don't know. I live in the Orlando area sp I get to see the #!$@ hit the fan. JF

 
At Friday, June 05, 2020 6:43:00 AM, Anonymous Anonymous said...

I would suggest a new improved Children's Services. With the laws voted for by the people in general. As far as that boy and his mother, a case worker assigned who listens to the boy separately from his mother. Quality work can't be done if employee's are to swamped with work to do their jobs well. JF

 
At Sunday, June 07, 2020 6:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Whatever you think about the The Joint Commission, their motivations and biases, this link to a series of videos dealing encouraging patients and families to SPEAK UP to their healthcare providers and institutions seem to me to support the SPEAK UP advise we have come to agree on this blog thread is an important act in the preservation of patient dignity. Take a look. What is your opinion? ..Maurice.

 
At Monday, June 08, 2020 10:15:00 AM, Anonymous Anonymous said...

I have a tendency to not speak up but when it came to violating my modesty there was no opportunity anyway.
Otherwise about Covid 19, my job recently required us all to be tested for it. No nose swab was horrible for me. I got my test Friday and will get the results in approximately 5 days. That same day we learned that one of our patients tested positive for it. She had fallen and been sent to the hospital. HOPEFULLY she contacted it at the hospital because otherwise she had to have gotten it from a staff member. We're in quarantine and our elderly don't ever go anywhere other than the hospital with the Corona Virus going on. JF

 
At Monday, June 08, 2020 11:18:00 AM, Blogger A. Banterings said...

Maurice,

This is called "let someone else deal with your problem." Don't bother the Joint Commission with these problems. [So stop calling us.]

As Travis Tritt said in his song; "here's a quarter, call someone who cares..."

This is not a solution, this is passing the buck. What if the patient is speaking up and the provider is NOT listening?




-- Banterings






 
At Monday, June 08, 2020 11:35:00 AM, Blogger Maurice Bernstein, M.D. said...

And how about euthanasia which is now legal in Canada as a ethical and rational way to handle the threats and complications of the current Corona Virus pandemic. I have posted a link to a pertinent article published yesterday on the subject on my current COVID-19 blog thread. ..Maurice.

 
At Monday, June 08, 2020 7:48:00 PM, Anonymous JR Issues4Thought.com said...

We currently have euthanasia. It is called hospice. Hospice is used when a hospital decides it is time for someone to die. Hospice is probably a greater money-making venture than the Canadian system bc the US medical system does not if it does not provide for ample profit for the medical community.

Just did an interview today for radio about why keeping patients warm before, during, and after procedures is extremely important. Keeping patients warm is more important than providing for convenience of medical staff to have them naked for unnecessary, prolonged periods of time. Every degree lost in body temperature could result in serious consequences for the patient's recovery or even death. So why are so many patients stripped naked for prolonged periods of time? Why is wrong with medical providers that they don't care about patient outcomes more than their own convenience?

 
At Tuesday, June 09, 2020 8:03:00 AM, Anonymous Anonymous said...

At my last job I was a med tech and we would distribute the medicine to the patients. Including narcotics. Even though we were paid approximately what a fast food restaurant worker makes. And one thing that I noticed is patients who were dying would be SWAMPED with medicine. They were never going to be alive long enough to take that medicine. But that one last chance to make extra money off of that patient was not to be wasted. JF

 
At Tuesday, June 09, 2020 9:41:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings has contributed some interesting links within the his most recent posting on the new blog thread dealing with the ethics of immortality. There are reasonable rationales for standing up against such research directions toward that goal. Today, I have published some of the text to one of Banterings' links. Perhaps, others here would like to comment there on the topic of immortality. ..Maurice.

 
At Tuesday, June 09, 2020 11:01:00 PM, Blogger 58flyer said...

So, today I had my first visit with my new urology provider, Advanced Urology Institute of Florida. It is a large practice, with many offices in Florida. As expected, they do things differently than with my last provider. There were 3 doctors assigned to the suite, one of them female. As a result, I encountered mostly female patients in the waiting room. When I was called, the MA escorted me to the restroom and asked for a urine sample and told me when done to just come on around to the nurses station. No flowmeter like the last doctor. A BP check showed 209/90, which disappointed me as I had taken a double dose of Lisinopril a couple of hours before. She correctly guessed my nervousness. She then grabbed a portable bladder scanner with a built in handle, squirted some lube on the probe, then asked me to follow her to the exam room. She had me lay back on the exam table and untuck my shirt. She pushed the probe against my belly below the belt line and then wiped off the lube with a paper tissue when done. Didn't even have to unbuckle or unzip. Talk about doing things differently. She said the doctor would be in shortly.

Soon enough, the doctor arrived. He wasted no time in getting information and had the benefit of my records from my last provider with him. He didn't seem perturbed by anything and even thanked me for getting him the records and having them for this first visit, though his staff had done all that. I carefully explained the abuse history and my need for male assistants. To my relief, he verified that male staff was available and said my request was not unusual. I relaxed after that. Instead of going right into another biopsy, he suggested an MRI of the prostate. They have the latest technology high resolution MRI machine right there in the building. He said a male tech ran the machine. Great! He said if there was a need for another biopsy they could do it under general anesthesia right there at that office. He was aware of the procedure shorts and said I could wear them if it helped me. I breathed a sigh of relief. Things were looking great. As expected, he checked junior and the twins, and I found it odd to have to turn to cough with a face mask on. Old habits. Nothing unusual about the DRE.

He wanted a new PSA and asked if I was fine with a female doing it. I said I was only concerned with females when it involved direct genital exposure, other than that females could do anything. Back at the nurses station for the blood draw, I encountered the only puzzling MA behavior I saw that day. The MA asked which arm I wanted her to take blood from and I answered either was fine. She was new to the practice. At that point another MA came over and said to never ask the patient for the preferred arm since in her experience it just adds more pressure to her and she might mess things up. I didn't think it was right for her to say that in the presence of the patient as her experiences were her own and not necessarily that of other MAs. I felt the MA actually doing the draw was respecting the autonomy of the patient, something I very much appreciated. I didn't say anything but if I get alone with that MA in the future I might say that I think she was right and the other MA was wrong to impose her way of doing things on the first MA.

Other than that everything went just fine. I feel good about this practice and look forward to getting my cancer and BPH taken care of. The MRI is scheduled for July 1st

58flyer

 
At Wednesday, June 10, 2020 8:56:00 AM, Blogger Maurice Bernstein, M.D. said...

58flyer, I am pleased to read that the process of the entire visit turned out so well for you and your underlying former concerns. I suggest that the "urology institute", by their professional attention to their needs measured with the patient's needs with regard to urological illnesses has created an understanding and practice that may attend to both needs much more satisfactorily to all than in institutions where urology is just one of many specialties including other services provided to patients.

For an institution to directly and specifically deal with a "patient sensitive" area of the patient's anatomy has provided them with an anticipation and response to every patient which is understanding and supportive of the patients' personal concerns. Whereas in hospitals and general clinics the focus of attention in these matters may be just "hit or miss". 58flyer, thanks for disclosing to us your experience. ..Maurice.

 
At Wednesday, June 10, 2020 10:33:00 AM, Blogger A. Banterings said...

Here are a couple ethics questions that perhaps Maurice can answer. I am also interested in what other people think as well.

What duty does a physician today, have to the public (society), all patients, and/or their specific patients if during their medical education they performed intimate exams on anesthetized patients without consent?

Let us be realistic, they will know incidents where there was no consent, such that 10 students line up to perform an exam on an anesthetized patient.

Granted, there may be some instances where the attending assures them consent was given, but the student is not absolutely sure.




What duty does a physician today, have to the public (society), all patients, and/or their specific patients if during their medical education or in practice they coerced (discharge them as a patient, cancel a maintenance Rx, not sign a form, etc.) a patient to undergo something they did not want (a procedure, intimate exam, student participation, etc.)?



What duty does a physician today, have to the public (society), all patients, and/or their specific patients if during their medical education or in practice they witnessed another provider not respecting their autonomy, wishes, or dignity?



My answer is simple, these are violations of human rights. There are no statutes of limitations on human rights violations. Although I would be willing to accept if the provider makes a public acknowledgement (online letter, letter in the waiting room, etc.) and is making atonement by making arrangements at ALL medical encounters of having (multiple) student participation or volunteering as a standardized patient.

What does happen, no provider (when asked) was ever taught this way and they have never seen it happen. It does happen, but that was at other (unnamed) medical schools. They are compassionate individuals; OR they say that was acceptable practice and was legal then (and probably still is).

One final note: I have called for burning down the profession of medicine and letting patients and society replace it with what they want to see. I have been ridiculed for this notion with people saying this is an impossibility, and we just need to make what we have better.

In the wake of George Floyd, the City of Minneapolis is disbanding their police department and replacing it with something completely different called community policing. As discussed on the immortality thread, healthcare says/implies that without us, you are going to die.


We have fixed the churches, and now we are fixing the police. What other institution abuses under the guise of care...

Change is coming, and most of us will be here to see it. I look forward to the day that the "witch hunts" begin. Just as in the George Floyd case, those who stood silent and those who spoke up but still went along with their superiors WILL be held accountable.










-- Banterings









 
At Wednesday, June 10, 2020 4:06:00 PM, Anonymous JR Issues4Thought.com said...

Not all churches have been fixed ie. news articles about child sexual abuse by pastors, priests, youth ministers. There is outright stealing from coffers, etc. There is still the attitude of my religion is superior to yours and if you aren't of my religion, you are an immortal sinner. There are stills wars over religious philosophies.

Community police? Won't work. Anytime ANYONE is given power is can go to their head hence the issues with neighborhood crime watches and even homeowner's associations where the head guy is seen walking around the neighborhood with clipboard in hand to write down violations.

The biggest issue with the medical system is hardly anyone is willing to admit there are issues. You have humans in charge of other humans or at least they think they are in charge and have bee allowed over the years to have that authority go unchallenged to the point now walking into a medical facility especially a hospital, you are treated as if they own you body and soul. You are theirs to do with whatever, however, and have whoever involved in your care. There are no boundaries except on paper which apparently mean nothing and will not be enforced when (not when not if) violated. You can do all the pre-planning you want to try to ensure your wishes are abided by but in the end, it is really their decision as to whether they will or not. And they probably won't if there is any sedation involved as sedation has taken the place of physical restraints to gain cooperation.

I have read so many articles about the pelvic/rectal exams only to come back to their same argument of you went to a teaching hospital for treatment so your consent is implied. Besides it is the duty of patients to allow medical staff to learn for free on them in order to help them make big money later on. Seems fair that you trade your dignity/rights in order for them to advance their career?

The same about ER. You're there so it must mean you gave the right to do whatever they please to you even though there are different degrees of emergencies and not all emergencies are as time critical as the next one but all must lose that non-recognized right to autonomy in order to get emergency or after hours treatment.

We actually need better people in the medical system. We need real oversight. Patients need real power. We need less administrators and bean counters along with less insurance companies actually making treatment protocols. We need caring medical staff who actually recognize the patient as a fellow person who is in charge of their healthcare treatment. A medical provider is just an advisor and skill service provider. Everyone involved in the healthcare process must recognize for the patient it is #MyBodyMyChoice.

 
At Thursday, June 11, 2020 9:15:00 AM, Anonymous JR Issues4Thought.com said...

Here is the link to go to listen to the interview with Cindy Schwarz of WAXE Radio and will be playing on IHeart Radio. Go on FB to Patient Rights Info if you would like to hear it.

 
At Thursday, June 11, 2020 9:43:00 AM, Blogger Maurice Bernstein, M.D. said...


Yes, JR the medical system has a science offspring who might have the potential of creating human immortality, the ethics of which I want discussed on my new blog thread. And it is there where I provided a link to a published discussion regarding the pros and cons of such a creation. ..Maurice.




 
At Thursday, June 11, 2020 11:32:00 AM, Blogger A. Banterings said...

JR,

When doctors practiced independently, it was much worse. There was no one to complain to above them. Now, with them being no more than retail employees they have superiors. Bike and 58flyer both chronicle changes when complaints are made to admins higher than the practice level.

Then there is the added incentive of deep pockets for liability lawyers. Just look at Dr. William Ayres: Timeline of a notorious child sex abuse case.

Why were there so many victims that did NOT file lawsuits? How much could liability attorneys get from a sole practitioner? Just look at those that are affiliated with large institutions (deep pockets).





-- Banterings







 
At Thursday, June 11, 2020 1:01:00 PM, Anonymous JR Issues4Thought.com said...

Banterings,

That theory doesn't work with all large corporation hospitals. The hospital from hell is one of them. Made complaints--they simply didn't care & said go elsewhere if he didn't like how they done things. They have a fully staffed legal dept. to fight off any malpractice & they self fund their malpractice insurance. All drs there are owned by them. Since legal is paid salaried, they have no issue dragging things out and carrying out any type of legal scheme they choose. There is another giant corporate in California with the same mo. Biker and 58flyer were lucky. Many others aren't so lucky. Big corporations are known for poor customer service such as cable companies, telephone, software, etc. They are so big they do not have to care and usually don't. I don't have the exact solution but I don't think bigger is necessarily better.

Casing point a smaller hospital chain here locally accommodated my husband's request that I be present while he had something done while a bigger one said no and would not budge.

As far as lawsuits, most attorneys around here seem to think the bigger they are, the more aggressive the hospital is in their legal matters.

 
At Saturday, June 13, 2020 1:29:00 PM, Blogger Biker said...

I'm inclined to agree with banterings that the advent of hospital-owned medical practices is likely a positive for the reasons he noted but it is not a guarantee that patient dignity will be respected. Just as with any business, it comes down to the culture of the organization, and usually the tone of the culture comes from the top. If the top is ethically challenged or focused solely on the bottom line, that is how the organization is going to function even if there are many good people working there. Hospitals are no different than any other business in this regard.

What I sometimes wonder is whether the size of a hospital matters in terms of what we discuss here and similarly whether the setting matters. By setting I mean big city, suburban, rural, and also by region in the country. Certainly urban societal cultures are very different than rural societal cultures and the underlying culture of New England is very different than the south or the southwest for example. Does this play out in medical settings, and if so how?

 
At Saturday, June 13, 2020 10:20:00 PM, Blogger Maurice Bernstein, M.D. said...

To me it is interesting looking back at blog topics I put up years ago but are still being read and written to years later. Many of these blog topics are specific issues perhaps common to what has been written on our blog thread here and I think would be worthy for those interested to take a look. Here is one from 2009 but with responses continuing for over a year. The thread is titled "Things I Don't Want to Tell My Doctor and Things My Doctor Shouldn't Have Asked!". Take a look..you will see responses covering both sides. ..Maurice.

 
At Monday, June 15, 2020 10:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Consider: The Lost Art of Dying. ..Maurice.

 
At Monday, June 15, 2020 11:05:00 AM, Anonymous Anonymous said...

Dr B. I never want to be told I'm dying. At least I think I wouldn't. I have Type 2 Diabetes and one of my sisters died at age 54 of that. An aunt died at age 59 of Type 2 Diabetes. I'm 60. I have reasons for wanting to stay alive and working. I feel very uneasy with the thought that I might die. JF

 
At Monday, June 15, 2020 11:46:00 AM, Blogger Maurice Bernstein, M.D. said...

JF, do you think that your chronic illness, age and family history affects how you attend and care for your assigned patients? Another way of asking: how does your appreciation of your personal self-dignity criteria, particularly relative to your mortality affect your work? I have a feeling that such personal views and concerns affect the behavior and expressed empathy of all involved in patient healthcare. ..Maurice.

 
At Tuesday, June 16, 2020 8:47:00 AM, Anonymous Anonymous said...

I've seen for a long time that inside of every old person is a young person. I have pretty much always loved our elderly patients. I have been accused of liking all of them. But I don't/haven't liked all of them. If and when I've been impatient it's usually because I've pushed myself too hard. Too many hours. Not taking care of myself outside of work. JF

 
At Tuesday, June 16, 2020 9:20:00 AM, Blogger Maurice Bernstein, M.D. said...

JF raises an important issue pertinent to the matter of the best relationship between the doctor or nurse and their current patient. How emotionally close should it become? We talk about the need for empathy to be expressed by the professional to the patient.But is a closer relationship truly better for the patient both emotionally and for some therapeutic goal? Would this feeling and expression of "love and concern" or even "liking" (as been attributed to JF for the patient) be for the patient's benefit and reduce the potential for the emotional and professional behavioral trauma that JR described happening to her husband?

How close a caring or "loving" emotional relationship should the doctors and nurses look towards each of their patients which would permit the profession to help preserve patient dignity but also prevent actions which would be destructive of that dignity?

..Maurice.

 
At Tuesday, June 16, 2020 11:26:00 AM, Anonymous Anonymous said...

Hello,

Thank you JF for being so compassionate to those you tend. I'm sure that all of us would like to have someone like you at our side in times of illness. Thank you.

Reginald

 
At Thursday, June 18, 2020 10:27:00 PM, Blogger Maurice Bernstein, M.D. said...

To All: Read the posting I wrote today on the blog thread related to the ethics involved in COVID-19 pandemic. The posting is about "telehealth" and "telemedicine" which has sprouted further with the pandemic. This approach to diagnosis and treatment may be the technique, when the pandemic is past, and the solution to the issues of medical professional behavior written all these years on this blog thread. What do you think? ..Maurice.

 
At Friday, June 19, 2020 7:37:00 AM, Blogger BJTNT said...

Reference: What is Telehealth?, NEJM Catalyst, Feruary 1, 2018.

Quote:
"They also require payers to reimburse telehealth services at the same payment rate as in-clinic services."

"Moreover, payers, like employers, may be lured by decreased medical expenditures and consumers may be motivated by the convenience and promptness of care that it offers."
Unquote:

The medical lobby is quite effective. Same payment rate + decreased medical expenditures = greater profits for medical institutions.

BJTNT

 
At Friday, June 19, 2020 2:36:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, good point. But maybe the patient will by participating "at home",outside the clinical physical environment, there will be a greater sense and actuality of patient autonomy. If, as fully described here over the years, the professional avoidance of patient autonomy can be and will be substantially reduced, perhaps it will be considered by the patient to be worth the "same payment rate".

By the way, I am not writing from personal professional knowledge since "tele.." was not yet in my professional era except for a phone call from a hospital ER at 2am informing me regarding a patient present or a patient making a phone call regarding a new symptom or request for a medication.

Times have changed and are with "tele.." changing further. ..Maurice.

 
At Saturday, June 20, 2020 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

I hope every one of the readers or contributors are well and stay well having not being personally or family affected by COVID-19 illness. Many present underlying medical conditions have been described here Volume after Volume. Hopefully COVID-19 will not be another for you all. ..Maurice.

 
At Monday, June 22, 2020 2:44:00 PM, Blogger Maurice Bernstein, M.D. said...

With a paucity of recent Comments, though still we have readers attending here, I thought I would copy my introduction to a worthy topic that deals with patient dignity and may be the basis for much patient consternation with the medical profession. It is the use of medical cliches by your doctor or nurse.



Ethicist Greg Pence writing in Newsweek comments about his experience with his college students’ writings which include clichés (tired,old expressions). He writes “When I grade written work by students, one of the phrases I hate most is ‘It goes without saying,’ in response to which I scribble on their essays, ‘Then why write it?’ Another favorite of undergraduates is ‘It's not for me to say,’ to which I jot in their blue books, ‘Then why continue writing?’"I also despise the phrase ‘Who can say?’ to which I reply, ‘You! That's who! That's the point of writing an essay!’" One may be critical of Dr Pence’s sarcastic responses, though his points about the use of clichés are valid. He describes a not uncommon confusing use of clichés in medical practice: “The language of medicine confuses patients' families when physicians write, ‘On Tuesday the patient was declared brain dead, and on Wednesday life support was removed.’ So when did the patient really die? Can people die in two ways, once when they are declared brain dead and second when their respirators are removed? Better to write, ‘Physicians declared the patient dead by neurological criteria and the next day removed his respirator.’”

Writing in clichés can make reading boring but speaking in clichés, I think is even worse, especially if the words are coming from your physician. I think most patients want clarity in what their physician says to them and clichés are often less than clear about what the physician is intending to convey. How would you feel about your doctor who, with a chuckle, tells you “an apple a day keeps the doctor away” or “an ounce of prevention is worth a pound of cure” or “time heals all wounds”? The problem with clichés are simply they have been used so much within so many different contexts that they lose their meaning and confuse the significance of what is trying to be expressed. Sometimes they can appear paternalistic or they can appear thoughtless. In medicine, clarity of thought and expression is essential and patients should not need to “read between the lines”.


..Maurice.

 
At Tuesday, June 23, 2020 5:39:00 PM, Blogger Biker said...

I don't mind cliches being they are so easily understood, though I haven't really noticed if my doctors have been using them with me. If they have they fit the conversation in a way that was appropriate.

What words I don't want to hear are highly technical phrases that lay people aren't likely to understand, unless of course the doctor then explains those phrases. I have a master's degree and an IQ of 130 something but no medical training whatsoever. Use cliches and I know what you are saying. There are a lot of medical terms that I don't understand however.

 
At Tuesday, June 23, 2020 9:33:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, thanks for your personal feelings about cliche. To me, I look at that form of communication in medicine, as I had written, an unnecessary ambiguity and have, in the past, actually discouraged my early year medical students from using it. There should be more specific ways to convey information or questions to their patients. I would look to physicians to specifically educate patient and family and throw away any of that ambiguity in communication. ..Maurice.

 
At Wednesday, June 24, 2020 5:38:00 AM, Anonymous JR Issues4Thought.com said...

I have had many people on Twitter talking about medical harm. I am gathering information for a new patient website. One thing we talk about are ways to prevent medical harm. A couple of suggestions have been having someone with you at all time of your choosing whether it be a spouse or a paid advocate. However, a paid advocate might not truly represent you if they are part of the medical system and if any money is coming into their business per the medical community. Another way being discussed is having camera recording all medical encounters whether they be room cameras or even having all workers wear bodycams. I see the validity of video but I am concerned about storage of the video as the medical society would probably misuse the footage as they have already proven to be untrustworthy.

I have also in my conversations come across a female dr who is married to a surgeon. This surgeon is into photography. So he does surgery and then excuses himself and lets someone else do the surgery while he gets his personal camera and takes pictures. He then shows them to the family and gets' "permission" for the pics. The woman and I had a heated conversation about this as I said unless the patient gave explicit permission for the dr to use his personal camera, then it is a violation of HIPAA. She said the consent form allowed for pics. I said it was for hospital owned equipment and not equipment that their children could access and view the pics with their friends. She then got nasty. Then she said he would scrub back in which is really bizarre that taking pics w/ his camera takes priority over doing the surgery. I personally disagree about the use of any personally owned equipment for patient pics/information. There is no way to safeguard where info on personal equipment ends up. This is a huge breach of patient privacy and is how patients can be exploited. Her reasoning was the OR cameras were sterile but somehow his camera that could go to the zoo is more sterile? And since she couldn't defend she then took up w/ personal attacks on me which is generally how most medical people will defend the indefensible.

 
At Wednesday, June 24, 2020 5:42:00 AM, Anonymous JR Issues4Thought.com said...

This is an excellent article given to me by someone I tweet with. It does a great job of explaining why abusive doctors (and nurses too for that matter) get away with their crimes for so long and sometimes forever. Explains why what happened to my husband didn't matter to the hospital. It probably is a joke around the hospital about that nurse like it was for Sparks all those years.

http://doctors.ajc.com/why_abusive_doctors_not_caught/

 
At Wednesday, June 24, 2020 11:58:00 AM, Anonymous Brian said...

Funny I saw this blog.. I posted the below on MedTwitter today. I got 1 reaction from 1 Dr, It's more than Sad.
Man up. I get what it means, I've been doing it my whole life. But did she really think it was going to work on an 8 yo? Probably not. But if that doesn't work bully em.
I was barley 8, shy, in a hospital for the 1'st time, away from family for the 1'st time, alone for the 1'st time.
It wasn't abuse, maybe lack of compassion. And besides, he's just a little boy. This is a hospital. Check your modesty at the door.
Just because she left the door to my room open and made me undress in front of it where anyone in the hall could see me. What's the problem? He's just a little boy.
Then had me lay on the bed and didn't bother to draw the curtain. So anybody walking by in the hall had a clear view. Man up kid!
Your just a little boy. We see people naked all the time. What the heck do you need modesty for?
Then let a 13 or 14 yo girl come in the room while I was naked on the bed. When I tried to run for the bathroom stopped me and asked me where I thought I was going. And told me to lay back down and hold still. What's the issue?
That she didn't bother to drape me or cover me. Is there a problem? We see people naked all the time. When that girl walked to the front of the bed and I was so far beyond humiliated. I can only describe it as shock.
Big deal kid, man up!
We see people naked all the time. It’s no big deal. What do you think you have that's so special?
That I was fighting so hard not to cry in front of that girl so I wouldn’t look like a baby. Man up dude! When the girl left and I couldn't fully control it anymore I felt a tear run down my face.
When you asked me why I was crying and I shook my head to say no, leave me alone. I don't want to tell you why I'm crying because I know your a bxxch? The 1'st bxxch I ever met. Another 1’st!
When I finally buried my head in the pillow and burst into tears. As I calmed down enough and told you I was crying because that girl saw me and I was embarrassed.
When you smirked at me and to this day I remember the words. "Oh stop it, your just a little boy. Those girls work here and see little boys getting xx all the time. So you just better get use to it. Now stop acting like a baby and stop crying."
Man Up as they say! And if that doesn’t work bully them! Doesn't matter that your 8 and their 30.
So the girl saw you naked. Big deal. We see people naked all the time! Your just a little boy. Why do you think you need modesty?
I could say what hospital it was, but I won't out of respect for the nurses that worked there and were very compassionate. And also for the times we are in now with countless medical workers risking their lives to protect us.
Do I forgive her? I hope I do, I mean to. It's just that it hurt so bad and still does. But it wasn’t intentional.
PedNurses/Doctors, please I beg you take a little extra time with children. Their scared enough as it is. Be compassionate. You can traumatize them for the rest of their lives if your not.
We know you have to do what you have to do, but some kids are scared. Protect their modesty and emotions. Treat them with some respect.
And for God sake if you see someone doing something wrong step in.
If you could share and raise awareness about how vulnerable kids are. They deserve better from the medical community. You have to police yourselves. Stand up to protect a kid that can't protect themselves.
Sometimes when people do things over and over they develop a casualness about it. Treat every child as special. Otherwise you could cause long lasting psychological problems for them.
I'm living proof how someone's lack of concern had a devastating impact on my life.
I can’t help what my brain did to protect itself, I had no control over it. Loosing my memory, having a scar in my mind for the rest of my life.

Special handling of children should begin in med school and be a mandatory course for all!

 
At Wednesday, June 24, 2020 2:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Brian, thanks for participating and telling your story. I would be interested though also in the words from the "1 Dr" (without identifying the doctor by name if given).

BJTNT, I found your very first posting to this blog thread from 10 years ago, Feb. 18 2010 and I will republish it below. Anything changed? ..Maurice.

Thu, Feb 18, 2010 11:57 am

This is my first post. Thanks to Dr. B. for hosting an interesting and worthwhile blog.
Generally, I agree with the comments and criticisms of MDs.
Patient modesty is a good theme because it is symbolic of the problems in medical operations {MO}. There is a pervasive culture in medical operations so divorced from the patient that I am not optimistic that medical operations will ever change to benefit the patient. And why should MO change because it has the political clout that even a patient revolt won't result in change. The AMA is no longer known for their Journal, but for being a powerful political lobby. At least one year the AMA [although only 1/3 of MDs belong to the AMA] received the "prize" for being the organization [not industry] that made the greatest dollar donations to politicians.
MDs have the clout to prevent any study of medical operations that are not dominated by MDs. Any non-MD attempting to study medical operations is denied access to pertinent data. If a study is published w/o a preponderance of MDs involved, MDs fall all over themselves criticizing the study.
Dr. B.'s blog will be a catharsis for us posters, but the likelihood of any significant changes benefiting patients are small to none. I hope that the up-coming generation of new MDs will listen to our comments and the following generation will actually make some changes.
Is this thread way past any more examples of the disrespect of our humanity by medical operations, especially regarding patient modesty?
BJTNT

 
At Wednesday, June 24, 2020 3:04:00 PM, Anonymous Anonymous said...

Hello,

I'm finding much difficulty controlling my (prescription controlled) blood pressure. How can one read JR's post re Earl Bradley (former doctor) juxtaposed with Brian's heart-rendering account, without becoming FURIOUS!!! My head spins when I try to comprehend 1200 children molested and, an average age of 3 yrs. Dr. Bernstein, you have often asked for our input re what should be included in your students' curriculum. I'd like to suggest that the Atlanta Journal Constitution's article re Earl Bradley and Brian's post should be incorporated in a required seminar. This should not be a lecture. Students should come to a consensus, in a seminar format, about how this travesty is to be STOPPED!!! This must be done IMMEDIATELY - not, if and when, we can "address" this. (This summer should provide you with adequate time to incorporate this seminar into your syllabus.) How could other health care "professionals" have turned a blind eye??? When I read stories like these I think of 1938 across the pond and the laments, "how could anyone let this happen?" I'm having a difficult time parsing the difference.

Reginald

PS Brian, I am so sorry for you. I pray that you will find some peace. I also pray for the 1200 and, their stolen sanctity.

 
At Wednesday, June 24, 2020 4:30:00 PM, Anonymous JR Issues4Thought.com said...

Reginald,

Sadly enough the crimes against children hasn't stopped as the medical professional is committing crimes against adults which is why most of us are here--because in some manner we feel molested or for me, someone I love was molested. Even sadder, in my journey I am undertaking to chart a different course in how healthcare is delivered, I have run across too many men that have suffered medical abuse as children. To me that is surprising bc I was not too long one of those who was uneducated and didn't realize how common medical sexual abuse of men was. Didn't really cross my mind. But now I know differently.

The Bradley case clearly illustrates what is wrong with the whole system. They know about wrongdoing but turn a blind eye to it. They laugh and say such things "Is so and so up to their old tricks again?" The medical boards and administrators turn a blind eye to it. This is the issue when a community self-polices--there is a protection racket that shields them from consequences as the harm flourishes. People like Bradley choose their victims. Rather you agree or not, elderly and sedated adults are prime targets because they too represent a vulnerable population just as women did in the past but have been educated. Men like my husband never dreamed of sexual abuse and most will remain silent. And society today is full of man-haters especially the older men and many medical workers think of themselves as social justice warriors which entitles them to dole out punishment to any who fit the general description of an offender. The medical community gives shelter and protection to the ones who wish to harm. These med workers may be a minority but their harm is great as you can see by the Bradley story. There is no warning labels that comes attached to them so we can see the virtual stranger holding our fate in their hands is themselves mentally ill. Nurses by far have more access to patients than doctors.

You can see from Brian's story not much has changed from the way a little boy was treated to how grown men are treated today. There still is not any thought given to personal privacy and male patients are still bullied and shame into submission. This is done far more often than the more concentrated sexual abuse my husband suffered. Most men at some point in their medical encounters will experience this type of behavior. My husband did but didn't think much about until after he was suffered "criminal" sexual abuse. That is the norm for medical care for male patients and the new "norm" for male patients is likely to be even worse.

 
At Wednesday, June 24, 2020 5:51:00 PM, Blogger Biker said...

Brian, thank you for sharing your story. Reading it made me realize something that I had never connected the dots on so to speak. Though out of necessity I have tolerated many intimate procedures by female staff, in my mind one procedure that I could never allow is being bathed by a female staff member. Now I realize why for me that particular procedure is in a class of its own beyond even things as invasive as cystoscopy prep.

At age 11 (a few months shy of 12 and with a few pubic hairs sprouting as I was just beginning puberty), I was in the hospital for a few days for a surgery. A female (no idea what she technically was) walked into the room, and with the door open and me visible to anyone walking by or coming into the room for my roommate, and without saying a word to me, yanked my gown off leaving me totally naked on the bed. She proceeded to give me a bed bath. I was so humiliated that I couldn't speak. When she was done she put a gown back on and left having never spoken to me.

I'm sure she forgot about me by time she moved on to the next patient, but here these many years later I still remember her and how she treated me. Hopefully nursing & med schools have progressed in how they teach students to work with kids.

 
At Thursday, June 25, 2020 4:21:00 AM, Anonymous Brian said...

Dr, to answer your question the Dr on twitter did what I asked, they posted it to people that followed them. They didn't actually make comment. Then to be transparent, let me add a few comments. This did happen a long time ago. I think the medical profession has made a lot of progress in how they treat patients. I don't think they had a choice. Many parents stay with their children in the hospital, even overnight, and even with grown children. That wasn't the case in my day. On to what I implied about twitter. I did post the Tweet as they say to the MedTwitter forum, but I'm not sure how twitter decides what to show to whom. I I implied many doctors saw this, and I really can't honestly say that. I think sometimes we get caught up in the passion of what we feel and maybe imply things we shouldn't. When I thought about it I felt I needed to correct that. We have to be transparent or we loose credibility and that only hurts the cause. Now days even if what you say is factual, people will twist it. So we have to be careful not only about what's said but what's implied also.
I posted it to Twitter and here when I saw the subject, man up. It did kind of fit my point. I was passionate about trying to not let this happen in some other form to another child. So I wanted to raise awareness about what could happen inside a child's brain when their humiliated. I kind of expect or maybe hope that med schools teach about patient modesty today, but I have no clue if they do or not. My point was they should and need to. People do get casual when they see 100's of people naked, so they need to keep that in mind and put it in check.
Now is there a problem still today like years ago? I don't know. Do I expect the medical system to make changes if it really only impacts 1000 people a year? No. But I do expect people in the medical field to police themselves and step in if they see something wrong. Yes, but maybe easier said then done. There are good people in the world, and they will step in.
Lastly I'm recovering thru prayer and forgiveness. I found if you don't forgive, it can eat you up inside. It took me 40 years to figure that out. That's just some personal advice on what helped me. But what happened to me I don't feel was intentional. Kind of makes it easier to forgive.
I have 1 other ugly story about how they used me for a nursing class, but I don't feel a need to share that. I think today they use dummies for a lot of training. And hands on teaching is done more in very small groups of 2 or 3. At least that's what I saw when my wife was in the hospital for the birth of our children. I think I've written probably more than was needed.

 
At Thursday, June 25, 2020 8:57:00 AM, Blogger Maurice Bernstein, M.D. said...

Brian, there is absolutely no clinical need for a patient to be examined naked. Even a dermatologic exam can be effectively performed in a series of localized exposures. Our students are taught that a general physical exam is not performed on a naked patient because beyond the issue of the patient's bodily modesty, such total exposure can produce shivering or muscular contraction which interferes with palpation and auscultation. There is no need to expose a patient's breast (male or female patient) when the abdomen is being examined. (However, the students are taught if one finds an abdominal bruit (abnormal vascular sound) they should slip the stethoscope, under the gown, up from the abdomen to the chest region of the heart to be sure the sound is not a transmissible heart murmur, a significant clinical difference. Just as our students examine each other in anatomic segments, they are taught that this is the approach when they examine their patient.

I know I have written about this previously but it is always worth repeating. ..Maurice.

 
At Thursday, June 25, 2020 10:56:00 AM, Anonymous JR Issues4Thought.com said...

That may be the way physical exam is being taught but too often in practice that is not the way it is being done. Too many patients are being stripped naked and left naked as it seems to be more of an issue of exerting power, control and humiliation over a patient rather than the actual need of a patient being naked for any medical reason. So how does that personal criminal instinct in medical providers get cured? Or does the medical community continue to let this unwarranted abuse of patients continue to take place? Does the medical community not realize although we may comply with their barbaric request because we are to vulnerable/ill//etc. to challenge them at that moment they have destroyed patient trust in them by violating a patient so deep it forever leaves invisible scars? Is it the goal of medical care to leave patients with invisible scars because they dared to seek medical treatment?

 
At Thursday, June 25, 2020 2:28:00 PM, Blogger Maurice Bernstein, M.D. said...

JR, I have never heard of or seen a living patient "stripped naked" in my entire medical career.
That's also including the numerous surgeries I observed. Yes, entry operating room focal coverings were removed but always promptly replaced with sterile coverings. In the emergency room, clothing was serially removed, underlying body was examined and coverings replaced. I understand that some dermatologists inspect the uncovered body (after request to patient with explanation followed by patient permission) although as I have previously noted at USC, students are taught serial uncovering and covering is diagnostically appropriate for total skin exam. Finally, "stripped naked" has never happened to me in my various personal experiences as a patient.

"Stripped naked and left naked", without patient's understanding or acceptance as a behavior by physicians or nurses is a behavior I never have never never observed or heard of as a physician.. EXCEPT, EXCEPT, EXCEPT..and I may have written about this here previously:

In my many, many tours with a second year medical student class of 6 students to our county coroner's examination rooms.. every single deceased patient laying on exam tables is totally and fully undressed, naked,-- man, woman or child-- and the observation of the body and the cutting autopsy by the pathologist is performed without covering the body. And so, yes, except potentially in gross anatomy course, that is the only time students see a fully naked "patient" or possibly touch one.

This is my experience with regard to this subject. ..Maurice.

 
At Thursday, June 25, 2020 4:01:00 PM, Anonymous JR Issues4Thought.com said...

Dr. B.,

My husband was stripped naked and left for about 30 minutes before and about 50 minutes afterwards. Oh, I forget they left on his socks so he did have some covering. He was only covered during the procedure by the drapes. As I said, maybe it is taught differently and maybe you haven't seen it but it does happen. Look what happened to Mr. Kirschner. He was also left naked. CS was also stripped and left naked before and after her procedure. It happens. Maybe you haven't witnessed this but it does happen probably more than anyone of us imagine. Is "promptly" a 30 to 50 minute time span? I am not questioning that all might not do this but I am pointing out it does happen. This type of human rights violations leave permanent mental scars forever bc most patients who suffer this type of degradation are aware of how they are being violated but are powerless to stop it. That is why it is so closely related to rape. Yes, I know it is not supposed to happen but it does. It is those who are violating patients in such a manner that I am concerned with not those who abide by the protocol you say you follow.

 
At Thursday, June 25, 2020 5:32:00 PM, Blogger A. Banterings said...

Maurice,

You have heard of it before. I have referenced it in my writings. I will repost these links:



MEDICAL TREATMENT OF PEOPLE WITH INTERSEX CONDITIONS AS TORTURE AND CRUEL, INHUMAN, OR DEGRADING TREATMENT OR PUNISHMENT

3. Medical Display, Genital Photography, and Excessive Genital Exams



CLASS ACTION COMPLAINT

Plaintiff Doe was traumatized by baseless, invasive strip- and cavity-searches.



Fairfax Hospital Patient Files Class Action Lawsuit Over ‘Unjustified’ Strip, Cavity Searches



Nude Pics While Patients Were Passed Out

A Louisiana doctor is accused of taking naked photos and video of female patients—including cancer survivors—but he says the snaps weren’t sexual.



Naked Patients in the General Hospital: Differential Diagnosis and Management Strategies



Doctor accused of filming naked patients, posting child pornography on social media



That does NOT include all the people posting on this blog that recounted the same thing happening. Just because you have never experienced it personally, does not mean it doesn't occur.

This conversation seems very familiar to me...

Absence of evidence is not evidence of absence.





-- Banterings




 
At Thursday, June 25, 2020 7:31:00 PM, Blogger Maurice Bernstein, M.D. said...

JR, Banterings et al: Just as what is currently happening throughout our USA with regard to police "misbehavior" or worse "murder", there should be investigations and trial and punishment, if found guilty..the same should be happening throughout the medical profession. The MD or RN or other medical system titles should not protect anyone from investigation, trial and punishment.

It is terribly ironic that what is happening in the current viral pandemic with regard to the police (where so many are participating and providing what is needed in this time of medical crisis) can be also
present with regard to the medical profession itself, many of whom are risking their lives and mental-emotional health and yet in both there are some from each profession who are engaged in virtual or full criminal behavior. And in both professions, those professionals should be identified and subjected to appropriate penalties for their illegal actions.

Right? ..Maurice.

 
At Thursday, June 25, 2020 10:47:00 PM, Anonymous Anonymous said...

Hello Dr. Bernstein,

There's one caveat to your recent post. The police who commit crime are being punished, usually quickly and severely. This cannot be said of medical malefactors. As reflected by the recent posts, Stanley Weber, Larry Nasser and Earl Bradley molested thousands (Bradley - 1200 himself). Their justice was not swift. They molested for years with no sanction from their knowing colleagues. When will the "blind eye" be recognized and excised? Who among the medical profession will be bold enough to take a stance?

Reginald

 
At Friday, June 26, 2020 6:27:00 AM, Anonymous Brian said...

I'll say the only place I've seen patient nudity as a casual norm is in the hospital, but it for me was never the Dr's. It was always the nurses. The operating room is different. I went in for emer appendicitis. Was good they sedated me before. I was laying there nude, getting my stomach area scrubbed, anesthetist setting up while I watch all the people in the theater drink coffee and watch. It just didn’t bother me because of the sedation. Very thankful for that. They were just doing what they needed to do.

I did have 1 general checkup with a Dr where the nurse told me to take my cloths off but leave my underwear on for the Dr. I was uncomfortable waiting like that. When the Dr came in he was alone which I was relieved. Still, I never went back to that Dr. I don’t think in that instance it was anything more than just odd. The thing here is we're all individuals. That might have been traumatic for someone else.
Take Bikers reaction of being bathed. Someone else may have a different reaction.
I kind of understand that because the incident that caused me to loose my childhood memory and traumatized me might not have had the same impact on someone else. So Med School just has to teach the upmost caution and maybe emphasize to Dr to pay attention and try and read a patient, their reactions. Not easy to do, but it's all they can do.
I'll agree with Dr B. There are abusers in all professions, all walks of life. Priests, Dr, Nurses, School teachers. We have to be on guard against them. And protect our children. I don't hate all nurses because of what a few did to me, although to this day I'm nervous around them.
The church had to implement testing to try and weed out would be sex abusers from the priesthood. I don't know if the medical profession does that or not. Maybe they should. Still, won't be 100%.
On a side note, I'd like to thank you Dr B for spending your time hosting this. I think those of us that have been abused, some intentional some not, are in the minority. So spending time on this is appreciated.

 
At Friday, June 26, 2020 11:05:00 AM, Anonymous Anonymous said...

Reginald
Maybe it seems to you that the police are corrected quickly because of the recent cop murdering. Suspects and THOSE cops are having to account. But police brutality has always been around and has often been ignored. I have experienced police bullying and harassment. Just never been physically abused. One cop came at me like he was going to body slam me. But he didn't. He was targeting my friend who I happened to be with. Had I not seen the harassment they were heaping on her I don't know if I could have believed it or not. Last night my niece was badly beaten by her boyfriend of 7 years. Her injuries were very much visible. The police were called but no arrests made. I mean it's good that he wasn't taken and murdered or tortured but showing up and doing nothing isn't good either. Where is the in between? JF

 
At Friday, June 26, 2020 11:38:00 AM, Blogger Maurice Bernstein, M.D. said...

Think of this possibility regarding the misbehavior or worse of those working in the medical profession: Laws created by U.S. Congress. Look what is happening now in the U.S. Congress with regard to police misbehavior or worse and though the pending legislation is currently gone in the U.S. Senate, there may be Congressional confirmation for laws on this police issues when (if) Democrats control the Senate next year.

What I am getting at is that: "why not Congressional laws relative to the "misbehavior or worse" by physicians and nurses? To start that and to do that requires patients strongly bringing attention to this issue to the Congress.
I think I may have mentioned this before. But now what recent news about police has stimulated Congress to try to act may encourage patients to inform Congress about the medical system of the United States. If the medical system doesn't do anything about what bad things done which have been described here, the best approach would be to bring it up to Congress to drop some strong laws into the medical system's basket. ..Maurice.

 
At Saturday, June 27, 2020 10:23:00 AM, Anonymous Anonymous said...

Hello,

Dr. Bernstein is it naivete to think that “… laws on this police issues when (if) Democrats control the Senate next year. … the best approach would be to bring it up to Congress to drop some strong laws into the medical system's basket. ..Maurice.”? Are laws or the Democratic party the panacea to medical malfeasance?

Look around at the conflagration of our cities and the destruction of our monuments. In the late 60’s the black community with which I worked in West LA would say that this was the result of a lack of “home training” and the failure of the schools to teach manners and morals. And please don’t confuse manners and morals with religion, as one LA school administrator did, when I stated this to her. Apparently, neither she nor the LA Board of Education, knew that instruction in manners and (previously called) morals was MANDATED by the CA Ed Code, before I brought this to their attention. (Please see CA Ed Code 233.5 a) You may also wish to undertake the tedious research (as I did) of the entire LA school curriculum to see if any time is set aside in grades one through twelve for instruction in manners and morals. I found NO TIME.

It truly is a seamless garment. There is a lack of home training (family). There is no instruction in manners and morals (schooling). There is a “cancelling” of religious values (Church). There is a lack or respect for law and order (Policing). Are we really to look to Congress and the Democratic Party (or any political party) for the preservation of our society and the remediation of the medical community’s lack of respect for individual human dignity?

Reginald

 
At Saturday, June 27, 2020 11:53:00 AM, Blogger Maurice Bernstein, M.D. said...

Reginald, I am sure most of the police are trained finally to be humanistic and professional to all, law-abiding citizens and those who are suspected of breaking the law. I feel confident that those professionals working in the medical system are trained finally to be humanistic and professional when interacting with all patients and the vast majority of both professions follow their training. Repeating: I would say that both the police and medical professionals follow their "h" and "p" training but there certainly are exceptions, many of which have been widely publicized. Perhaps it is time for both the police and medical profession teaching and working behavior and actions be scrutinized and defects in training and working misbehavior or worse (criminality) be promptly identified and attended to provide justice to both professions. The national criteria for such attention, change and scrutiny for the entire nation will be best initiated by United States congressional action, Democrat and Republican. That is my opinion and I think it is time for a rehabilitation of both professions so that it is not just "most" but "all" police and medical workers maintain a clean professional and humanistic behavior we all expect from them. ..Maurice.

 
At Saturday, June 27, 2020 5:06:00 PM, Blogger Biker said...

Dr. Bernstein, even with humanistic and professionalism training there is still a significant definitional disconnect in that the starting point within medical & nursing training is that medicine is gender neutral. No matter how much they might want that to be true it simply isn't for a significant portion of patients, even if most patients silently go along with it. If they would at least admit that it isn't gender neutral then we'd probably see efforts to recruit more men into non-physician roles and we'd see better protocols put in place as concerns ambushing patients, erring on the side of efficiency vs minimizing exposure and so forth. Just training staff to be polite isn't enough.

 
At Saturday, June 27, 2020 7:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I can sincerely and knowledgeably inform you and the others on this blog thread that in my experience as a medical school educator, students are made aware and their behavior is observed regarding the concept of the importance of the patient's gender in communication, physical examination and of course in the relationship to various gender pathologies. I have never heard that students are oriented that patients should be communicated with, examined or otherwise attended to as some "gender neutral" patient--whatever that is.

Yes, of course, there has been over many, many years degrees of asymmetry with education and medical practice of students and later professionals in terms of gender practices. There is, however movement these years toward uniformity and equality in such matters compared to the past. But, obviously, in some areas of clinical management there still is inequality of professional gender in specific medical areas. Hopefully, patient and governmental pressures will, though salary and changes in professional responsibilities provide more professional gender equality so to integrate better with the personal requests of the patient.

Until these changes occur, all observations of inequality, and inability for the patient to access a professional with a gender of the patient's choice or inattention or gross misbehavior, the response is, as always, "speak up!" And what I am saying is that "speak up" should go beyond the professional but to their "bosses", to the legal system and, yes, to our governments. ..Maurice.


 
At Sunday, June 28, 2020 4:23:00 AM, Blogger Biker said...

Dr. Bernstein, by gender neutral I don't mean how the patient's gender is perceived by healthcare staff but rather the underlying assumption on the part of those that work in healthcare that staff gender doesn't matter to the patient. It is only by making believe that the gender neutral mantra is true that they can justify the norms of 100% female non-physician staffing in urology & dermatology practices and at boarding school & college health services where many students receive primary care. And so forth.

Speaking up sounds good and can help but it does no good, at least in the near term, if the staffing is 100% female.

 
At Sunday, June 28, 2020 10:02:00 AM, Anonymous Anonymous said...

Hello,

Dr. Bernstein,

The National Academies of Sciences, Engineering and Medicine has a Committee on Women in Science, Engineering and Medicine. (sEE https://www.nationalacademies.org/cwsem/committee-on-women-in-science-engineering-and-medicine) Would you be interested in encouraging the AMA or any other medical group to form MINE (Men in Nursing Effort)?

Reginald

 
At Sunday, June 28, 2020 11:12:00 AM, Blogger Maurice Bernstein, M.D. said...

"Sure", I would. And here is the beginning for men in nursing--
American Association for Men in Nursing

And from their site:

Mission
To shape the practice, education, research, and leadership for men in nursing and advance men’s health.


Vision
To be the association of choice representing men in nursing.

The purpose of AAMN is to provide a framework for nurses, as a group, to meet, to discuss and influence factors, which affect men as nurses.

Organizational Structure
AAMN is a national organization with local chapters recognized and sanctioned under the Bylaws of AAMN. However Chapters may have independent bylaws and a separate dues structure. Membership in the national organization does not require membership in a local chapter.

AAMN is governed by the board of directors who, under the organizational bylaws have the right and responsibility to administer the business activities of the organization to include decisions related to the expenditure of organizational funds.

AAMN's Objectives Include:
Encourage men of all ages to become nurses and join together with all nurses in strengthening and humanizing health care.

Support men who are nurses to grow professionally and demonstrate to each other and to society the increasing contributions being made by men within the nursing profession.

Advocate for continued research, education and dissemination of information about men's health issues, men in nursing, and nursing knowledge at the local and national levels.

Support members' full participation in the nursing profession and it's organizations and use this Association for the limited objectives stated above.

AAMN's Values:

​Integrity: Consistently open, honest, _A commitment to pay it forward for our current and future colleagues as well as our continued pursuit to define caring for men in our community_ethical and genuine interactions through collaboration and support.

​Inclusion: An unwavering stance on attracting the best of the best to our profession based on characteristics and principles, and not by gender or racial demographics.

Empowerment: To support to all of our members to fulfill their potential and providing any opportunity or support we can to set one up for success.

​Excellence: Envisioned by our pursuit of lifelong learning and always looking for opportunities for improvement in education, clinical quality, and leadership.

​Innovation: Vehicle in which we execute our other values and to set the standard for all professional nursing organizations to connect through new technology and approach for sustainability and growth, not only for our organization but the overall profession. Our process of creating value by applying novel solutions to meaningful problems



Read the words carefully. I am not sure that the goal is to ignore the desires and needs of male patients. This organization may be the place to start "speaking up" specifically with regard to providing male nurses for those patients who desire care by male nurses rather than nurses of the female gender. I can't believe that this organization has been developed simply to provide males a paycheck from a system which has been dominated by and encouraging the participation by female nurses. ..Maurice.

 
At Sunday, June 28, 2020 3:49:00 PM, Blogger Maurice Bernstein, M.D. said...

He contracted COVID-19 from a staff member in his nursing home, developed pneumonia, and was then hospitalized at St David's.

Texas Right to Life claimed that he was refused food and treatment for coronavirus there for six days before his virus death on June 11, 2020.


Read the story and listen to an interchange between wife and physician which I put on
my Bioethics and Dealing with Covid-19 Pandemic" blog thread topic. ..Maurice.

 
At Monday, June 29, 2020 6:42:00 PM, Blogger Biker said...

I had my annual cystoscopy and for the 4th year in a row I was able to have a male nurse do the prep. This proves that urology practices can do the right thing if they want to. For me there was no embarrassment at all which made for a very relaxed atmosphere for this otherwise very intimate procedure.

This is the same hospital where a male sonographer (who I had for something non-intimate) that I got into a discussion with said he had been hired specifically to better accommodate male patients for things like testicular ultrasounds.

It is the same hospital where the bladder ultrasound I had with a female sonographer did not involve any exposure vs my 1st bladder ultrasound at a different hospital involving full exposure by a female sonographer.

It is also the hospital that made a protocol/policy change in response to my complaint about my "female staffing in the room for dermatology exam" complaint.

They aren't offering male staff for these things but they are at least responsive to men that speak up. Not ideal perhaps but far better than most places. I feel respected there in the manner I am treated.

 
At Monday, June 29, 2020 9:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I am pleased to read your personal followup. I personally hope more institutions are willing to listen to their patients' requests and have the interest and resources to meet them.

Perhaps you can contribute the identification of your institution to Misty's website section titled "Find a Men's Clinic With All-Male Medical Staff".

..Maurice.

 
At Tuesday, June 30, 2020 9:39:00 AM, Blogger Biker said...

Dr. Bernstein, the urology dept. doesn't have all male staff but rather they've had at least one male RN these past several years. This most recent one was the 3rd male nurse I've had so I don't know if they've had turnover or they have more than one. When I first went there and inquired they only had one but its been several years now. The woman I spoke with apologized that they only had one male RN to which I responded that is one more than most have and that at least they're trying. I don't know about whether they have male MA's or other male non-RN staff that might be in on a patient exam as I have only been there for cystoscopies.

I will add that my male nurse requests do cause a ripple in their workflow, but they don't make that my issue and they never say a word about it. It is a large practice and as with most practices the nurses & other staff aren't assigned to specific doctors but rather just keep taking the next patient in line so to speak, perhaps differentiating only between patients there for matters needing a nurse vs those for whom an MA would suffice, and the intake sheets providing that differentiation to them. For example, after I checked in yesterday I heard another guy checking in early for an appt. scheduled for 20 minutes after mine with my doctor, so he was clearly the next patient after me for this specific doctor. After checking in the woman at the desk prints out a label that she attaches to a form and puts it on the side counter. When the staff are ready to take another patient back they stop at that counter, pick up a slip, and call the name of the patient they want. A woman came out, picked up the slips there, and then took the guy whose appt. was after mine. Mine would have been labeled either "male nurse" or perhaps with the male nurse's name so she skipped me and took the next patient scheduled for my doctor. Clearly my nurse was busy with another patient and so they quietly rearranged the schedule to accommodate me. Something similar happened last year and the male nurse apologized for the delay trying to make it their running behind rather than their accommodating me. I just played along with it telling him no apologies needed, that I'd rather wait while they give some other patient that needed more time the time he needed, that their schedules were more complicated to manage than mine.

 
At Tuesday, June 30, 2020 4:33:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, from what you write, I could summarize your story with the following unfortunate but realistic conclusion:
"Patients need Patience".

As you and perhaps others here know, I have the most recent blog thread "Ethics of Immortality" which presents some interesting "yes" and "no" alternatives to the subject.

However, for our blog thread Volumes here, I was thinking of another concept which would be fitting: "Ethics of Immorality" . And here is a LINK to an article which dissects much of everything those writing here currently are finding in the medical profession behavior and more. Let me know whether this sums up you all are facing:
not immortality..but immorality. ..Maurice.

 
At Thursday, July 02, 2020 4:39:00 AM, Blogger Biker said...

Dr. Bernstein, yes patients need patience if we want to be better accommodated. In my example I didn't mind at all having my appointment delayed a bit so that I could have a male nurse do my cystoscopy prep. Patients have appts with doctors, not RN's. RN's are randomly assigned to patients in a "who's next" manner and used interchangeably. Being I am the one wanting to operate outside of that "who's next" system it isn't unreasonable that there might be a delay, so yes some patience may be needed. That they accept my request in a respectful manner and honor it speaks well of them and is far more important than the fact that it takes a few minutes to make it happen.

 
At Thursday, July 02, 2020 9:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, as you know I have written again and again to "speak up" (to the healthcare provider) when things presented to patients (or even family) are confusing or unwanted. But in order to achieve the patient's goal and wishes, "speaking up" may need some understanding of how best to perform that action.

Biker, based on your postings, it seems you have some valuable skill in how to "speak up" and I wondered if you could share your view and techniques and cautions which you think would be valuable for others to consider when they feel the need to "speak up". ..Maurice.

 
At Sunday, July 05, 2020 2:09:00 PM, Blogger Maurice Bernstein, M.D. said...

Would you all agree that male patients within the medical system are themselves "vulnerable" to what happens to them as compared to female patients or would a more realistic term would be "targeted"? Do you see the difference in these two terms? Which, of the two, would you say is the most realistically descriptive of what you all have been writing about all these years?


By the way, grammar (how concepts are fairly described in words from the doctor to the patient} is, in my opinion, an important practice for a medical student to learn. "What a doctor says" is one thing but "How the doctor says it" is another.

OK.. now back to "vulnerable" vs "targeted" in the medical systems approach to the male patient. ..Maurice.

 
At Sunday, July 05, 2020 4:15:00 PM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Everyone is vulnerable in a medical setting. We are in the hands of someone we may not know and, who may not really care about us (especially as unique individuals). "Targeted" implies a disposition of premeditated desire to harm. I wouldn't impute this to the majority of health care personnel. I'd suggest that men are often considered contemptible or inconsequential. Some female personnel may have contempt for males because of the abuse suffered at the hands of men. Similarly, the dignity/ modesty of men is often viewed as inconsequential. "They're just brutish men, with no need for dignity/ modesty." Their exposure is inconsequential. I would suggest that the prevailing attitude towards men is, ho-hum, their dignity/ modesty is inconsequential with a sprinkling of contempt for any male not wishing to conform to the inconsequential profile.

Reginald

 
At Sunday, July 05, 2020 4:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks Reginald for your dissection of the issue. I go along with "Everyone is vulnerable.." And that is also as we think about Man (Mankind) but the issue is, of course, about men (the gender) who place their dignity and lives in the hands of the medical system. Again, thanks. ..Maurice.

 
At Sunday, July 05, 2020 5:05:00 PM, Blogger Biker said...

Dr. Bernstein, On Friday I had answered your communication question and assumed you were just away for the holiday weekend when it didn't appear.

On your newest question I would say that all patients are vulnerable but that some men are targeted (young/fit/good looking or simply worth looking at vs the average guy).

 
At Sunday, July 05, 2020 6:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, first.. I never received your response to post regarding "how to speak up". I await your advice.
By the way, Los Angeles County and city are in a general "stay at home" governmental directive so no holiday weekend "away" activity was encouraged even between family households. ..Maurice.


 
At Sunday, July 05, 2020 10:14:00 PM, Anonymous Anonymous said...

Dr. B
In case you missed it the senate Republicans put forth some great police reform legislation that not one democrat voted for. The medical world is so corrupt, equaling only the democrat party, that there will never be any decent legislation for medical corruption or police reform.

cr

 
At Monday, July 06, 2020 5:49:00 AM, Blogger Biker said...

Dr. Bernstein, I'll try to recreate my thoughts on communication per your request.

I try to always practice what I call the "I'm OK, you're OK, but we have this issue that needs to be resolved" approach. It got this in grad school in what at the time I saw as a fluff course but which proved to perhaps be the single most valuable course I took in my master's program. It served me well in my corporate career. In a nutshell, it is attacking the message, not the messenger and seeking to make the other party your advocate rather than your adversary. It is seeking solutions that are win-win which entails allowing the other party to help craft a solution rather than simply demanding they accept yours.

I always try to remember what the role of the person I am speaking with is. It is not the scheduler's or the check-in desk's fault that the practice doesn't have a male staff member for your procedure. They didn't do the hiring so putting them on the defensive isn't going to help. It is similarly not blaming the female nurse or tech doing the procedure. They are simply doing the job that they were hired and trained to do. Someone else assigned them to you. Your choice is to emotionally vent and have them subsequently talking with the rest of the staff about the unstable angry guy or you can try to make them your advocate by staying calm and polite. Simply state your disappointment given how embarrassing the procedure is and how you wish the practice made more effort to respect the modesty and dignity of their male patients. Maybe you'll get a "let me see what I can do" from the scheduler or check-in person or a "how about we try doing it this way" or "I'll do my best to keep you covered" from the nurse or tech. At a minimum your chances of the subsequent staff chatter being more sympathetic to their having caused you embarrassment will be greatly enhanced. It doesn't help you that time but it might just plant a seed that will bear fruit down the road.

In following up with the people who do make the staffing decisions, be polite and be clear as to what you want from them. Don't rant or go off on tangents. Offer your specific solutions but also be open to their suggesting solutions. Again, try to make them your advocate rather than your adversary.

When you encounter the ardent feminist or the staff member who just doesn't care how you feel or you get the proverbial "you don't have anything I haven't seen", don't let them get under your skin. You cede your power to them if you do. In response to a "you don't have anything I haven't seen " type comment, maintain your calm and tell them that was uncalled for and that your modesty/dignity is equally important to that of female patients; that it is a safe bet the overwhelming majority of women who work in that hospital would object to a male staff member performing that same exam or procedure on them if they were the patient. If they don't change their attitude in a way that is satisfactory, ask to speak with the charge nurse or their supervisor. It is a waste of your time and energy to argue with people who simply demand you yield to them. Elevate it to someone who is professional enough to have an I'm OK you're OK constructive discussion.

My last comment is simply keeping my focus on the most important items rather than every possible offense. You will be taken more seriously that way. Nobody listens to people that complain about everything and for whom nothing is ever good enough.

 
At Monday, July 06, 2020 10:50:00 AM, Blogger Maurice Bernstein, M.D. said...

cr, I don't think that political debate is pertinent to the issue presented by this blog thread. The Democratic party did present their police reform legislation. But now, it is time for both political parties and all to read what Biker wrote today as the methodology of resolving a conflicting problem. It's the "I'm OK, you're OK" approach to resolution of a divisive issue.
"Offer your specific solutions but also be open to their suggesting solutions. Again, try to make them your advocate rather than your adversary."

Thanks Biker for your well written and appropriate methodology when there is conflict in an issue or behavior. ..Maurice.

 
At Monday, July 06, 2020 4:51:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way (actually it's not just "by the way"--it's important) I notice on my site monitoring program that we have a lot of visitors who are coming to this specific volume of this specific topic and are not "contributing"--not writing about their own experience, their own understanding of medical system problems and their own thoughts and advice. And I see those visitors are coming back and coming back.

I encourage all those non-writing visitors to express their own experience and recommendations for improvement in the medical system. And remember, you can remain anonymous (as those who have been contributing here) with the use of a simple unique pseudonym and not your name.

So, visitors, let's hear from you too and become contributors. ..Maurice.

 
At Tuesday, July 07, 2020 2:05:00 AM, Anonymous Anonymous said...

Dr. B
You inferred that nothing will be done in the senate about police reform unless the democrats take the Senate. My statement was pertinent as a debate to your statement. (The democrat "legislation" in the House was ridiculous) But I'm afraid that both political parties have been bought by the medical industry so nothing will ever get done about that.

cr

 
At Tuesday, July 07, 2020 10:00:00 AM, Blogger Maurice Bernstein, M.D. said...

cr, I am not sure that I inferred what you suggested. I think that police reform should be an agreement by both political parties just as needed reform in elements of the medical system including healthcare costs and payments should be a "together" agreement and conclusion by both political parties.

Yes, we need the medical industry but as in all of medical practice, the orientation should be by all parties involved attention to the needs of the patient and not extra income. Firemen should have a goal to "put out the fire" and save property and lives. All the elements of the medical profession and through govenmental acts should should display and carry out the same goal. ..Maurice.

 
At Tuesday, July 07, 2020 3:02:00 PM, Anonymous JR Issues4Thought.com said...

cr,

What Dr. B. said in his post sounded very political to me as he said "...when(if) the Democrats..." in the June 26th post. It made it sound as if the other party was doing nothing but they is not at all true. They can do nothing bc neither party will cooperate at the present with one another. I was very taken aback by this but then most in the medical profession are progressives especially in certain areas which may explain why patient dignity is not a big issue for them.

 
At Tuesday, July 07, 2020 3:49:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, I agree but what followed set the importance of the public looking toward the Congress to make corrections: " But now what recent news about police has stimulated Congress to try to act may encourage patients to inform Congress about the medical system of the United States. If the medical system doesn't do anything about what bad things done which have been described here, the best approach would be to bring it up to Congress to drop some strong laws into the medical system's basket."

As Congress has taken a hand in so many aspects of the medical system certainly, professional misbehavior should be another aspect---particularly since in many situations it is the federal government that is involved in contributing $$$ into that system. That is the basis for encouraging those writing here with misbehavior complaints within the medical system to bring it to Congressional attention beyond my old expression "moaning and groaning" on this blog thread, as an example. ..Maurice.

 
At Tuesday, July 07, 2020 5:58:00 PM, Anonymous Anonymous said...

Dr B, That was JR. JF

 
At Tuesday, July 07, 2020 7:04:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, I apologize to you. It was JR to whom I was responding. Thanks. ..Maurice.

 
At Tuesday, July 07, 2020 7:22:00 PM, Anonymous JR Issues4Thought.com said...

The problem with trying to Congress to do anything is again the hold the chokehold the medical lobbyists have on the politicians. The medical lobby is probably the strongest and richest. They own most politicians body and if they had souls, their souls. If the medical lobby doesn't want reform there will no reform. By the way, the own politicians on both sides of the aisles. They believe in equal opportunity corruption. There have been patients who have tried to talk with politician but to no avail. They simply do not care. The only way they will care is if the public becomes educated enough and starts to speak out/up and lets them know as a collective whole, how healthcare is delivered needs to be reformed/changed. Right now, the mass of amounts of money and power the medical community has speaks louder than patient harm. I have grown my Twitter following and have regular conversations. Sadly, though many who are called patient advocates have sold out to the medical community. We need major reform on informed consent, patient autonomy, patient dignity, medical record falsifications and criminal consequences for intentional harm or even reckless acts like in everyday life. We need to change medical oversight and no more self-policing as this just makes wrongdoing flourish. We need to give patients immunity from legal action if they speak out against medical treatment they have received. This would be like vaccine makers have immunity from any and all harm. No one should have greater harm done to them when they seek medical care. We need to recognize this happens and put an end to being complacent with allowing harm to happen and even flourish. No patient should have to live in fear of what was medically done to them and what might medically be done to them in future. Medical treatment should erase basic human rights.

 
At Wednesday, July 08, 2020 8:04:00 AM, Anonymous Brian said...

I'm confused on how some of these things can be regulated and others just have to be dealt with by a change in attitude. In my specific instance, no regulation in the world would fix what happened to me. I don't think it was even intentional. But I tell you when my mother got to the hospital and found out what happened there was holy crap to pay. She went and got the head nurse and had me tell her what happened. Knowing my mother I would guess 1/2 the floor knew something bad was up. The head nurse genuinely looked concerned. Her only reply was "It will not happen again". Too late for me but maybe we saved some other kid from the horror. You can't regulate that. It takes common sense, compassion, and leadership.

My other more current experience is I won't get a colonoscopy done anymore because I can't find a Dr here willing to do it without sedation. I had 2 done when I lived in Georgia with a Dr that had no problem doing it like that. Here, none that I've found. From someone who has had 2 of them, I see no need for sedation. Maybe it’s easier for the Dr, but no medical need. Yet they want to charge over $1000 for the sedation and an anesthesiologist. It's not because of the money, I won't do it because I don't trust anyone, not even myself if you can believe that. I will not be sedated unless absolutely necessary. So the dilemma. This really isn't something that can be regulated. Dr's can say they have some legitimate reasons for doing it. But do they really? For me sedation is a line I won’t allow anyone to cross unless I'm combative. I'd rather die.

I get the feeling some of what the medical profession does is for convenience. Talking with a ICU RN, she said they sedate all patients put on a ventilator because some patients "fight the tube" and it's for their comfort. So I guess the thought is just sedate everyone. When I asked her why not just sedate those that fight, there was no answer. Not happening for me. I'm pretty sure I wouldn't fight it. Take it from someone that gets their cavities filled without Novocain. Sedation is out. Even if I die. But how do you regulate that?

 
At Wednesday, July 08, 2020 10:57:00 AM, Anonymous Anonymous said...

JR.
In my opinion the reason the people in charge made the veterans completely undress in the presence of females and the reason patients are made to completely undress or otherwise be ambushed all the exact same reasons. Maybe the staff in general don't mean it that way always but somebody created those ways of doing things.
As far as getting the power to financially fleece the general population and control every aspect of our lives, it would probably take a long drawn out bloody battle in order to get things right. It isn't just the medical world. It's most empowered groups. How often do judges have to account for anything. Or children services? JF

 
At Wednesday, July 08, 2020 3:10:00 PM, Blogger Biker said...

Brian, 5 years ago when it was time for a colonoscopy I figured I would just get it done at the local hospital. When I said I wanted it done w/o sedation I was told no they won't do it that way. I didn't argue with the scheduler or get angry. I simply said, no problem, I'll go to DH and get it done there instead. They already told me they were fine doing it w/o sedation. That got me an immediate "let me check with the doctor", and she got back to me that yes they would do it w/o sedation. Sometimes money talks.

When the day came, the doctor did his darndest to talk me into being sedated. Apparently he had one done recently and couldn't fathom anyone doing it w/o sedation. With the procedure being a pain-free nothing to it kind of event, by time we were done the staff in the room were making fun of him for being such a baby about it.

As an aside Brian, sedation makes me ill which is why I refuse it if at all possible. Maintaining control over my exposure is a side benefit. They are very careful to keep you covered when you are not sedated. I've long wondered to what extent patients are exposed, even if only momentarily, during colonoscopies once sedated.

Not wanting to deal with that whiny doctor again, I did switch to the other hospital for my follow-up colonosocopy a year later as part of my overall switch of all my scheduled care. It is a minimum 1.5 hours drive each way but worth it for me.

 
At Wednesday, July 08, 2020 3:52:00 PM, Anonymous JR Issues4Thought.com said...

JF,

You're right. In this world, there is selective accountability meaning some have to answer like people such as you or I. Then there are others who can do whatever they want and never face consequences. I do believe the concept of having patients naked, gowned, or otherwise originated as a need for power & control. It is done by enemy forces when they capture a prisoner as a means of control & power. The naked person is at a disadvantage in a roomful of uniformed persons & generally will be more submissive & compliant. The gown then makes the person loose their personal identity bc they are clothed just like everyone else in someone else's property thus taking away part of their personal identity. It is all about mind games just as the medical community uses words/vocab. to signal power & control. They try to take above you so you don't understand & you feel compelled to trust what they are saying. They use words like "order, must comply, etc." to show authority & who holds the power in the pt/dr relationship. Their questions are really statement that are supposed to leave no room for a refusal as you are not hearing a question being asked but rather they are looking for agreement. This type of behavior must be a secret class they teach bc most all of them have this attitude even the lowly mostly uneducated MAs.

Brian,
I have written how sedation is the new tool used by the medical community since physical restraints aren't used anymore. Sedation does a better job as it mentally affects your abilities to reason, understand, etc. Versed and fentanyl are their weapons of choice as they each have qualities they need to control the patient. Versed makes a pt. submissive, uninhibited, and loss of memory. Fentanyl makes your physically incapable of moving, gives you a feeling of everything is good & wonderful plus a few other bonuses. They found using these drugs they don't have to deal with pts or pt concerns. Versed can also be a truth serum & many pts do/act in an entertaining manner for the staff. Versed makes you so very obedient like a trained seal. My husband refused both versed & fentanyl but it was injected into his IV against his knowledge/consent so it led to him having a procedure don't w/o his consent that he refused as well as being sexually abused by the female RNs. His exposure was intentionally done to harm him as there was no other reason for genital exposure lasting for hours and for genital exposure before & after the forced procedure. He felt like a captive who just had to lay there & suffer abuse as he could not move & could not form his thoughts into words. Bc of this, he won't seek care again. You are very smart not to want sedation as sedation is used as a weapon against patients in the wrong hands and you will won't know who those wrong hands are until after you have been harmed. I am really involved in social media and sedation harm is real and so is medical harm.

 
At Wednesday, July 08, 2020 4:46:00 PM, Anonymous Anonymous said...

Hello Brian,

As a person who has had two non-sedated colonoscopies, I don't know how you listened to the ICU RN without laughing hysterically. You know that there is no "fighting the tube". Once the colonoscope passes the anus, what "fighting" is possible? There are no nerves in the colon to register distress. There might be a bit of pressure when the scope passes the bend in the intestine; however, that's it. You were given absolute misinformation to control the situation. That control might also involve giving the anesthesiologist and/ or the hospital more work and greater profits. You might have told her that this (ludicrous) "fighting" will not (from two previous experiences) apply to you. Why couldn't you be accommodated?
My GP recommended a colonoscopy. I told him that I'd "gladly" have one, if I could have it done without sedation and with male nurses. He recommended a gastroenterologist to whom I mentioned the same conditions. The gastro agreed and the procedure was done unsedated; and, I afterwards walked away within an hour. There was no sedation "hangover" and no one was necessary to drive me home. Additionally, there was no "fighting" and, no pain.
Most of Europe have colonoscopies unsedated. I guess they fight less. Patients can never attain medical autonomy, if they're given gross misinformation. Maybe it's time to talk to your local medical ethicist.
Please continue your search. You might find an older doctor who won't be intimidated by an awake patient. Take care.

Reginald

 
At Thursday, July 09, 2020 12:02:00 AM, Blogger 58flyer said...

I recently posted that I was to have a prostate MRI. After explaining my past abuse history to my my current urologist, he said that the MRI he was proposing had a male tech. Following that I asked the lady who was scheduling my MRI if they had a male tech and she assured me I was scheduled with a male tech. I have had several lower body MRIs in the past so I wasn't overly concerned about the prostate MRI. The practice gave me an information paper that stated all the things about the MRI, like no sex for 72 hours prior, no gas producing foods for the prior 24 hours, and do an enema about 2 hours prior, and other things that I took little notice of. After this visit, I left on a 2 week vacation with my son to some Civil War battlefields in Pennsylvania and Virginia, so I was not going to worry myself about the MRI until I got back.

Once back home, I got a call reminding me of my pending MRI. I again asked the caller if I was scheduled with a male tech and she said that I was. I then took time to carefully read the MRI information form and it mentioned that I should expect an endorectal coil to be inserted. Wow! So I got online and did some research and found that an endorectal coil (known as an ERC) was an antenna covered by a latex condom and inserted into the rectum to help process the MRI images. Oh Boy! Glad I had a male tech assigned! Glad also I didn't see that before as I would have been worried during my vacation.

The day of the MRI, I did my Fleet enema 2 hours prior as directed. I went to the Urology practice and signed in. I did the usual Covid stuff and awaited my turn. Soon a lady called my name and I was taken aback but I then assured myself she was just to take me back inside. As I walked by her I noticed that her embroidered scrub top indicated she was an MRI tech. Again, I just assumed she was taking me back for the male tech. It was a long walk to the MRI room which was located in another suite. I looked into the MRI room and didn't see any male tech. When stopped at the dressing room, she stated her name and said she was going to do my MRI. I promptly said "no you're not." I stated my previous contacts with the doctor and the other personnel along with names so she would see I wasn't making this up and then asked her what happened to my male tech. She said he was on another case that he was more experienced with and that she took my case. I asked her why, when you have a male patient in an intimate procedure assigned to a male tech, she would think it was OK to just assign it to herself without thinking to call that patient in advance and ask if it was OK to change techs? She looked confused and said that it just didn't occur to her to do that. I asked if she could go exchange places with the male tech and she said that wasn't practical. I asked if I could just wait until the male tech was available and she said the scheduling wouldn't permit that.

I am going to post this in 2 parts so I don't go over the character limit.

58flyer

 
At Thursday, July 09, 2020 12:48:00 AM, Blogger 58flyer said...

Part 2.

The lady MRI tech was respectful and I maintained my usually respectful demeanor so things were not too terribly tense. But my heart was pounding and I was starting to stammer. I felt tears welling up in my eyes and I hoped she didn't see that. I am not a cryer but now it was really getting to me. I needed to stay in control. I am the boss here and my clothes were not coming off unless I was willing, which at this point was not the case. I said I would reschedule but I needed assurance that this would not happen again. She said she could see no way to do that, so I then asked her to introduce me to her supervisor. She said she would bring her supervisor to me right away. The tears were really close to dropping at this point and I turned away so she wouldn't see that. I assumed she went to get the supervisor but when I turned around she was still standing there. The tears dropped over onto my face mask and I used the mask to wipe then away. She asked if I was OK and I said I was. She then left to get her supervisor. She and the supervisor returned quicker than I expected as I was still wiping the tears with my face mask when they came to me. I explained the situation about the male tech that was assured me and naming names so they knew I wasn't making them up. The supervisor turned out to be an RN with an MSN according to her name badge. She asked why I was so concerned about the MRI and I told her about the abuse history and why it had me so upset about this MRI. She said there was nothing to be concerned about the MRI as it was so benign and there would be no exposure. I then mentioned the ERC as being VERY exposing. She asked where did I get that idea! I said from the form I was given the day I scheduled. She then said that they haven't done the ERC since they got the 3T MRI system. The supervisor said where did I get that form? I said from the scheduler and told the name. The supervisor said she would be right back.

The lady MRI tech was assuring me that things would be just fine when the supervisor returned. She had 2 forms, the one I was given and another one I should have been given. The newer form made no mention of the ERC and I apparently had been given an older form. The supervisor said that there were some older forms still floating around that end up being given to patients and that she would make it her priority to make sure all the old forms were discarded. I felt like an idiot at that point but the supervisor told me it was understandable that I felt the way I did especially with my past abuse history. The supervisor and the tech apologized profusely and offered to reschedule. I said I was fine with the female tech and to let's just get this done.

The MRI went off just fine and the tech said I did very well and the images were excellent. She kept apologizing until I said don't apologize any more as it wasn't her fault that I had gotten the wrong information. I sensed she was genuinely concerned for my welfare. She mentioned that there had been some cancellations and no shows for the MRI and I suggested that the old form might have been at fault. She agreed. When it was all done she gave me a hug and wished me well.

I am due to see the Urologist on the 21st so we will see where I stand with this cancer.

58flyer

 
At Thursday, July 09, 2020 9:03:00 AM, Blogger Biker said...

58flyer, it sounds like you handled it very well, and though not initially, once all the info was out it sounds like the staff handled it well too. My guess is they learned a few things that day and that future male patients will benefit as a result of your efforts.

 
At Thursday, July 09, 2020 10:18:00 AM, Anonymous Anonymous said...

Hello,

58 Flyer, I am still astounded at the lack of courtesy that you were shown relative to the change in techs. Even if the change was sudden, you should have been informed at check-in that the male tech was not available; and, you should have been offered a reschedule. Again, I'm wondering if you would have been "instantly" informed, if you were female and a male tech was substituted. Although your visit apparently ended well, the anxiety you endured was unacceptable. You may wish to send a copy of your post to the office so that the supervisor is fully apprised of what you endured. Your statements can then be read by all personnel and, possibly, by the doctor. Please take the effort to inform the office in writing. Take care.

Reginald

 
At Thursday, July 09, 2020 1:06:00 PM, Blogger A. Banterings said...

As the profession of medicine tries to hold on to what little paternalistic power that they may have left, the more that society despises them. The result is a rise in microaggressions and passive-aggressive behaviors towards them as well as other other healthcare providers.


-- Banterings


 
At Thursday, July 09, 2020 2:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, thanks for your patho-behavioral dissection. .. Maurice.

 
At Friday, July 10, 2020 12:11:00 AM, Blogger 58flyer said...

Biker, thanks for the response. I think it was a valuable learning session for them.

Reginald, thanks for the response. Actually, the male tech was working with a female patient. I wasn't provided specifics, and I knew not to ask, but being a urology practice one could imagine something intimate. I feel quite sure he had a chaperone though.

Reginald, one thing I have to keep in mind, following the experience with my prior urologist, is how I may be viewed by the doctor and the staff. I don't want to be seen as a difficult or problem patient. That's what led me to be discharged by my prior doctor. I really really want to stay with this practice, especially since they have male assistive staff, but also since the doctor has hospital privileges, something the prior doctor didn't have. He had to do everything in-house, or it wasn't done. That's a huge limiting factor considering the amount of BPH and cancer treatments available in the hospital setting. So, while my discharge by the prior doctor was distressing, it may have been a blessing in disguise. I don't want to be discharged by the current practice, so I have to choose my battles carefully. I have no doubt I got my point across, given their responses and apologies. In my last post I tried to get my message across right to the point, with as little words as possible. So, I didn't mention everything that had occurred. One of the things that did happen, was after the tech was so apologetic, I told her that I don't cry so easily and I was embarrassed by her catching me with flowing tears. I said to her that I have known my wife for 32 years and been married for 30 of those years and my wife has never seen me cry. Yet that tech had me crying within 5 minutes of my meeting her. So I think I got my point across, no point in pushing it any further.

58flyer

 
At Friday, July 10, 2020 8:01:00 AM, Anonymous Anonymous said...

Hello,

58flyer, I can appreciate your situation. I wish you all the best.

Reginald

 
At Saturday, July 11, 2020 9:49:00 AM, Anonymous Brian said...

I'll add 1 last comment for me anyway.

Wrong is wrong and right is right. It doesn't matter how you spin it or try to explain it.

Culture comes from the top down.

You can go to 1 hospital that sucks or go to 1 down the road that's great. Now if they would just put a sign on the door letting us know who's who. Doctors are the same way. I find there are many more good than not. Same for priests, police, nurses, and on. It's just life.

Never trust anyone 100% unless it’s family or God. That's just a gift I got from being traumatized. And it's paid off for me.

 
At Saturday, July 11, 2020 1:57:00 PM, Blogger Maurice Bernstein, M.D. said...

We are in the 190s with regard to the number of posts written to this blog thread Volume 111 on "Preserving Patient Dignity (Formerly Patient Modesty) during the past 2 months. It is time to move on to Volume 112. For each of the Volumes in the past, I have researched and procured the pertinent graphic for the Volume. I thought, for Volume 112, I would request my readers to offer me their selected graphic for me to select. So for upcoming 112, e-mail me a graphic file you think would be a worthy one to continue with the current conversation.

Write and send the attached graphic file to: doktormo@aol.com for my review and possible use. Thanks.. ..Maurice.

 
At Tuesday, July 14, 2020 10:59:00 AM, Anonymous Anonymous said...

Dr B. I don't see how to get to. Volume 112 JF

 
At Tuesday, July 14, 2020 1:42:00 PM, Blogger Maurice Bernstein, M.D. said...

JF et al, there is no Volume 112 as yet. I have received only one graphic contribution to place on that Volume when created. I am going to wait a bit more for others to also contribute their suggested graphic pertinent to our general topic. Present me with your suggestion as a graphic file. Send it to:
doktormo@aol.com Thanks. ..Maurice.

 
At Wednesday, July 15, 2020 12:41:00 PM, Blogger A. Banterings said...

58flyer,

I have been thinking about what happened to you some more, and perhaps this is something that you need to relay to the practice: Instead of initially shaming you and attempting to force upon you what was convenient for them, the tech should have explored your concerns. This was very PATERNALISTIC. (You should tell them they behaved paternalistically.)

The definition of paternalism is the provider making choices for the patient based on the PROVIDER'S values and NOT taking into account the patient's preferences and wishes.

What they did was TRIGGER and RE-TRAUMATIZE you, and HUMILIATE you in front of the staff. I would question your treatment in regards to their patients' bill of right (all say you will be treated with DIGNITY.





-- Banterings



 
At Wednesday, July 15, 2020 3:59:00 PM, Blogger Maurice Bernstein, M.D. said...

As of July 15 2020, there will be NO FURTHER POSTINGS OF COMMENTS in Volume 111. Comments can continue on Volume 112 ..Maurice.

 

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