What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)
REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD
posted by Maurice Bernstein, M.D. @ 4:04:00 PM
149 comments
FAIR USE NOTICE:
If this site contains copyrighted material the use of which has not been specifically authorized by the copyright owner, it is being made available in an effort to advance the understanding of the ethics dealing with medical practice, medical care, science and scientific research, human rights, social justice and, in addition, the law and politics which cover these areas. It is believed that this use constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed to visitors of this “Bioethics Discussion Blog” without profit to the blog or to those who by visiting this blog have expressed interest in receiving the included information for research and educational purposes. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
The material in this site is provided for educational and informational purposes only, and is not intended to be a substitute for a health care provider's consultation. Please consult your own appropriate health care provider about the applicability of any opinions or recommendations with respect to your own symptoms or medical conditions. The information on this site does not constitute legal or technical advice.
149 Comments:
Doug, I went back and reread the allnurse thread on the surgical team making comments about an obese woman who was out for a procedure. You were correct that the majority found it offensive, I guess I went into it with several other threads from allnurse in my mind including whoar inappropriate which was removed and dealt with nurses taking turns checking out a well endowed male skateboarder who was out, or when they ran the 10 things you are glad patients don't know when they discussed and justified nurses talking about patients including male patients anatomy. Which makes me wonder, was this the case of the nurses having empathy for someone they identified with vs someone they did not. In the other threads they have been more evenly split on whether the we are just human card justifies these behaviors. On this one you were correct, most were openly against the behavior..I stand corrected...goes to show we all view reality from our side of the gown...alan
alan -- We have to be careful about the web. I'm not convinced that allnurses necessarily represents the nursing profession. I've met many nurses who either don't read allnurses or have never even heard of it. Unfortunately, with much on the web, the negative stuff that gets published throws a bad light on the whole profession, and some readers just assume the posts there represent nurses in general. I'll condemn allnurses when I think they deserve it. But I'll also praise them for bringing into the open topics like this one.
Doug I agree, I do however think that allnurses is to a degree representative as much as most probably more than many sites given that the vast vast majority of the posts are clinical in nature, not something someone seeking cheap thrills understands or cares about. One has to apply special caution on annonomous posts as people can distort truth and who they are. Then again talking to any group in person doesn't mean they represent the larger group given the size and diversity of our society.....alan
Alan, you wrote "One has to apply special caution on annonomous posts as people can distort truth and who they are. Then again talking to any group in person doesn't mean they represent the larger group given the size and diversity of our society."
You have quoted correctly the precise philosophy I have held and have explained on this thread previously. Nevertheless, this view does not require that the matters presented anonymously perhaps representing a small group of society be arbitrarily ignored from consideration. ..Maurice.
'Allnurses' may sometimes post thoughts about patient respect. It's ture. Some may even post about modesty. However: when that patient says that modesty and respect is directly associated with that nurses gender, then the degree that they care seems to fly out the window.
Until things change, it will always be about how they feel about our body, and the degree of respect they choose to give it.
Suzy
The site allnurses boasts 566,000 members. In
the united states last count was 2.8 million registered
nurses according the the Dept of labor. That same
department quoted 753,000 licensed practical nurses
and 1.5 million cna's. Additionally, the count was
483,000 for medical assistants.
My observation is that allnurses represents a
cross section of these numbers. Now my conservative
estimate for those members on allnurses who are not
medical personnel,several hundred if that. Why, would
anyone join a site like allnurses ,if you are not in some
way associated with nursing. After all, you would have
to submit an e-mail address, a user name and password
to log on to that site.
How many people would join an automotive forum
for Volvo vehicles,you either love volvo's or you hate
them. Interestingly,many people hate nurses. Medical
assistants hate them,cna's hate them, administrative
people loath them. It seems that they hate each other,
particularly their young,they like to eat them.
Do you know of any other occupation where there
is so much disdain among co-workers. Do you read of
forums among attorneys,physicians or waiters who have
so much disrespect for each other. I'm suggesting that
the negative material we read about on allnurses is
fair, and representative.
The suggestion that the material is a cross section
representative of the nursing industry. This kind of negative
material is not restricted only to allnurses,but rather other
nursing blogs. We have seen and discussed some of these
very negative and offensive presentations as many recall.
PT
What Rodney King expressed on the 3rd day of the Loa Angeles Riots, May 1 1992,
"People, I just want to say, you know, can we all get along? Can we get along? ...Please, we can get along here. We all can get along. I mean, we’re all stuck here for a while. Let’s try to work it out. Let’s try to beat it. Let’s try to beat it. Let’s try to work it out."
I think, PT, this not only applies to the interaction between nurses but between all healthcare providers and applies between the providers and the patients and public. If the goal is providing the best in medical care which involves more than providing the appropriate antibiotic or the appropriate surgical procedure but also providing trust and comfort, then it is essential that all parties try to "get along" and all parties try to "work it out". This means that patients are aware and understand the limitations of the current medical care system. This means that the medical care system is aware and understands the needs of patients. Let's all of to try to "work it out". ..Maurice.
Dr. Bernstein, even if one comes to the conclusion someday this thread no longer serves it's original purpose, one has to give it an A for entertainment from time to time. PT, you have to much time on your hands. Suzy, Doug, and I are working on the start of the site we discussed and will be sharing some things here for comment, which go to the original purpose, but the past couple posts are pretty amusing. I agree with what has been posted, the largest gain will be made by partnering with not attacking providers. I was at a function last night sitting with a nurse I know, she was talking about how the new healthcare bill makes patient satisfaction part of the equation on how they get paid. Think about it, has there been any greater opportunity to ask providers to consider what we are asking for. If we can find a way to make this desire known, and they are willing to provide it we have an opportunity to get them to provide,,,maybe begrudgedly, but mutually benefiting each other. Do we need to hold hands in a circle and sing "why can't we be friends, why can't we be friends"?. Seriously back to a previous point, the diversity of opinion is pretty large, PT I also do not think providers are evil, but you are free to your own opinion......alan
Sorry for the delays in recent posting. I am not receiving some of your posts by e-mail in a timely fashion from Blogger.com for evaluation. ..Maurice.
alan -- I agree. Regarding patient satisfaction surveys. Patients need to make sure they give the system credit for all it does accomplish. Many lives are saved every day, and many people are treated with the utmost respect and dignity. The system is under stress along with many of its workers. When they get it right we need to make sure we compliment them and even post our satisfaction. If they get it wrong, let them know and insist they understand precisely what they got wrong and how to get it right. Work your way up through the system to the top. It's not good enough to just complain.
Alan said. " PT, you have to much time on your hands."
Really.....I'll take that as a compliment, however,
my intention is never to be intertaining. Nothing amusing
about this subject at all.
What you might find amusing is the fact that yes
it is true. Hospitals will be reimbursed based on patient
satisfaction scores,called Hcap scores. For the first few
years if a facility dosen't achieve a certain Hcap score
that facility loses out on 10 percent reimbursement.
Now,Hcap stands for Hospital care assurance
program. That 10 percent will eventually increase to
30 percent.
Here's the bad news Alan. The program only
applies to indigent patients,Medicaid consumers,people
below poverty and people without health insurance.
This means that if you have health insurance,
you don't count. If you have Blue Cross and Blue shield
you don't count. This means Alan that if you have health
insurance the evil nurses and ultrasound techs can
disregard your privacy Alan. Because, those reinimbursements come from the Federal government and the hospital will still get paid.
Your complaints won't matter Alan,if you have
health insurance. We are still back at square one. Did
your female nurse friend explain that for you.
PT
Come on, PT, medicine is more and more market driven. More and more hospitals are actively competing for patients. Clinics and doctors in private practice are competing. Read the newspaper ads in your area. These surveys may not apply to those with insurance, but those with insurance still bring in significant amounts to hospitals and clinics. It's about the money. Follow the money. Patients who get serious about modesty violations, who aren't afraid to take their complaints to the top, who aren't afraid to complain publicly if ignored -- these patients will make a tremendous difference in how hospitals behave in all areas of customer service. That's the key. Don't be afraid to take your business elsewhere, and make it known to those at the top and even publicly why you're doing it. But -- as I said in my last post, patients also need to compliment and praise publicly hospitals and clinics that do a good job. Let them know they're doing a good job and recommend them to your friends and relatives.
What I find (almost amusing) is Maurice's perception that this blog represents a small faction of the population.
The psycho social rules of humiliation dynamic say otherwise and if someone would do the research, it would prove out.
What is small are the amount of people who talk about it.
belinda
I am on the same page with Doug on this one on several issues. While she didn't say it was medicare/medicaid patients I was already aware of it. The conversations I have with several providers are these accounts are viewed from an economic perspective as a bit of a nesecary evil for hospitals. They provide volume but on a per visit basis are not as profitable as private insured. We are the "money customers". As a matter of fact there is discussion of is it worth it to cater to that segment or to just write it off and concentrate on private pay. To Doug's point, I am amazed as I drive the 465 beltway around Indy at how many billboards there are for providers and hospitals and clinics. These boards are $800-1,000 per month, they aren't paying those fees for fun, they are competing. The key as I see it is how to get enough people to understand that we are no longer in the "deity" stage of healthcare where we just accept. I am convinced huge steps could be taken by just asking, but most people don't think they can and don't. If a facility thought it was loosing enough money they would make changes, not out of compassion, but for financial reasons...alan
Doug
For the last several years most hospitals have
found themselves in severe financial straits. The economy
and medicaid cuts,coupled with the ever growing need
for electronic health records,which requires capital and
personnel are the cause.
Hospitals compete for patients through insurance
plans and through physicians. Hospitals may rent a
billboard and advertise, you will be seen in 30 minutes
or less which is a joke. You,the patient are only moved
out of the waiting room into the er whereby the wait
really begins.
Medical facilities certainly are not going to change
their operating procedures because of a few complaints
from patients. Who at your health insurance company are
you going to complain to. I challenge you,call them and
you will be confronted with layers and layers of phone
personnel who will refer you back to your facility where
you received the care in the first place,back to square
one.
But, if you have no insurance, are indigent or
on Medicaid at least you can call a representative
and complain. And that remains to be seen as the
laws of Hcap scores and reinbursements haven't
become effective yet.
Furthermore, hospitals across the country have
seen hugh layoffs and cutbacks. Even laying off their
patient advocates. Who are you going to call or complain
to?
PT
PT -- The whole nature of customer service is changing. The paradigms are shifting. With social medica and the web, customer complaints can quickly go viral. One never knows. You could find yourself on youtube with 2 million hits, then the next day you're on Good Morning America. I could cite you many examples of this during this during the last few years. Savvy businesses, the big corporations, have had to learn this -- many have had to learn it the hard way. I've noted how their customer service has changed for the better. They've learned how to communicate with their customers and clients. They're using facebook and other social media outlets. They're listening.
I will agree with you that most hospitals, and our healthcare system in general, is so far behind the shift that it's almost pathetic. They've evolved in an areana where they have called all the shots. Some have realized this has changed and are working to create better communication paradigms with their patients. Others are completely oblivious to the change, or see it but refuse to acknowledge its significance.
PT, you write: "I challenge you,call them and
you will be confronted with layers and layers of phone personnel who will refer you back to your facility where you received the care in the first place,back to square one."
No. That's not the paradigm anymore. Instead of going back to square one you go to facebook or youtube. You expose them.
You write: "Medical facilities certainly are not going to change their operating procedures because of a few complaints from patients."
No. That may have been the case in the past. But the savvy corporations have learned the hard way that it one takes only a few customers with complaints, sometimes only one customer, to take make a story go viral. Study world news. Facebook has played rolls in revolutions, gathered people together quickly.
This is the new world, PT. And the medical establishment will discover this the easy way or the hard way. They'll either change on their own, or they'll be dragged kicking and screaming into the present.
Doug said
"I will agree with you that most hospitals,and our
healthcare system in general, is so far behind the shift
that it's almost pathetic."
I agree with you Doug and yet,despite everything
that has been said, show me one single facility that
truly embodies this mentality. Show me one facility,
be it a clinic,hospital or imaging center that respects
privacy among male patients. You won't find any, why.
It is the ranks and file within medical facilities
who can initiate this change. It is the female directors,
nursing directors of these facilities who will not
budge on this discriminatory practice.
PT
I agree with you, PT, that concern for male modesty and privacy is not embedded within the written policies of most, if not all, hospitals. But here's where we disagree: A significant number of hospitals have cultures that do regard modesty and privacy in high regard, although the specifics of gender are not in writing. So much depends upon individual caregivers, and I contend that many are concerned with the privacy and dignity and modesty of both genders. The system or the culture of their institution may or not support them, but they still do their best to live up to their ethical obligations. That has been my experience and that of many others I have talked with or interviewed. This is not to say that too many caregivers become part of a negative culture and lose or forget about patient modesty, or that many modesty violations still happen. We also disagree in that a significant number of women still suffer through modesty violations, too, because of the prevalent "gender-neutral" world view within the healthcare system.
Doug
That positive culture that you speak of simply
does not exist for male patients. Statistically, that positive culture exists for female patients by account of the high number of female nurses,over 95 percent along with other support staff.
Consider the hipaa act signed in to law in
1996 by the federal government. Hospitals and other
medical facilities simply could not police themselves
and do the right thing.
Here we are again 16 years later and the
federal government is stepping in again. This time
by creating Hcap, the hospital care assurance
program. Now I assure you it will only be a matter
of time that insurance companies will follow suit,
instituting their own compliance program.
Who should shoulder the blame, the nursing
industry. As hospitals start to close and feel substantial
financial pressure as reinbursements decline perhaps
the culture will change.
How many of those interviewed could recite
one core value?
PT
PT, money will, fortunately or unfortunately, always have an effect on behavior. Money can trump ethics: that is one explanation for the non-ethical COI (conflict of interest). ..Maurice.
Dr. Bernstein:
"Money can trump ethics".
I'm sure that is true in the medical arena. That is also the number one thing that keeps this issue a "non-issue'.
But , money should not trump ethics, and until the medical arena stops benefiting from self-imposed ethical exceptions...patients will continue to sell themselves for medical profits. My loss will always be their gain? Not exactley a moral justification.
Sad but true. money trumps most moral perceptions in our society.
Are we O.K. with that?
Suzy, what you are asking with "money trumps most moral perceptions in our society" can either be to the "good" or to the "bad". The reason is that "moral perceptions" may never find unanimity by everyone. What is morally appropriate or inappropriate may be realistically debated. And so what to some may appear as a conflict of interest, to others, may appear as no conflict at all.
Think of this: maybe if the medical system had more money available there would be more incentive and ability to hire a broader group of healthcare providers (of both genders). Specifically, more money donated or provided from government to nursing school programs would lower the tuition for both genders. More money for medical offices, clinics and hospitals would boost salaries of the employees which particularly would encourage males to join the medical activity rather than going into other better-paying "male" oriented occupations. and then these medical institutions would be able to provide patients the gender each patient desires.
Money sometimes may fulfill beneficent moral/ethical challenges. ..Maurice.
Dr Bernstein:
"The reason is that "moral perceptions" may never find unanimity by everyone. What is morally appropriate or inappropriate may be realistically debated."
We are not talking about brand new and surprising ethical and moral concepts. We are talking about concepts that society supports and accepts until the term "medical" is used...and then perpective expects to be ignored, denied, or tossed out of the window. And worse, it is the people who have the skills telling people that they should not care or have a choice in who performs them. Rather self-serving to be able to re-invent societal norms to fit one's own needs. Think about the businesses that would fail if they all had the "you get whatever you get" attitude.
And, throwing money into a system that has never admitted to date that gender is an issue will not solve a gender based problem. Only when a system can admit it's errors can those errors be fixed. I don't believe that "better pay" would necessarily attract more males to nursing in and of itself. It could, however, result in many well paid female nurses.
Suzy you are on the money, excellent post. I know numerous nurses who work 2-3 days for 40 hours of pay if they work weekends etc. Guess what, I have min, wage employees who work weekends and are paid the exact hours they work and are paid a whole lot less than nurses. the few male nurses I know speak more about the double standard they face than the money they make. The average nurse in my state makes $28/hour the average wage over all is under $20. So pay is not what keeps males out of nursing, percpetion and the status quo keeps males out. Providers cut male orderlies even though they were paid less than nurses...follow the money applies, but it doesn't mean increasing wages will solve the issue...great points Suzy....alan
Real men wear gowns, thats the full page ad in
the magazine Walnecks, a magazine specializing
in antique motorcycles. I'm certain it was not cheap.
The ad features a male in his early 60's wearing
a hospital gown dancing. Apparently,the brainchild
of Dr. Carolyn Clancy. The article is here
www.ahrq.gov/conser/cc/cc050608.htm
If you don't think male nurses are discriminated
against then you really must read this post by Rohon8,
at allnurses,under men in nursing,thread titled,
will I be facing discrimination.
The suggestion is, they want men to be patients,
but not nurses. Its the patronizing and then the double
standard I'm sick and tired of.
PT
Here's the correct URL for that site, PT.
http://www.ahrq.gov/consumer/cc/cc050608.htm
PT the post is truely disturbing to this father of two daughers who, coached, transported, and mentored his daughters friends. I am saddened and disquested by the comment that comes up over and over, even if its not fair its just the way it is, accept it. So glad Martin Luther King or Susan B Anthony didn't follow that. Today it is accpetable to discriminate against men..because thats the way it is...truely sickening...and they wonder why men shun medical care, of they accept discrimination agains their own..my would I as a male feel I will be treated fairly...alan
What's most interesting to me about this "Real Men Wear Gowns" campaign is the use of the hospital gown as a symbol of metaphor.
What does the hospital gown represent?
I can't speak to the profession, i.e. what it means to doctors and nurses. But I can speak to what it means to most patients -- it represents things like loss of control, humiliation, embarrassment, vulnerability and unnecessary exposure. Hidden behind this message "Real Men Wear Gowns" are the old cliches, i.e. "We're all professionals here" and "You've got nothing we haven't seen before."
What seems to be lost in this discussion, or ignored or hidden, is this: In psychological warfare -- one of the first things you do to a person is take away their clothes. That accomplishes much of what I listed above. It takes away their control.
Now, I'm not suggesting that hospitals don't need to see patients bodies to help them. Neither am I saying that hospitals are purposely taking away patients clothes merely to control them. I'm not saying it never happens, but the hospital gown has become more of a custom, a tradition, something that few really question any more. Just put on gown because we're the professionals and your the patients and we wear scrubs and you wear gowns. That's just the way it is.
What I am saying is this: Hospitals need to constantly be alert to what the hospital gown symbolizes to most patients.
That fact that his agency and this doctor has used the hospital as a metaphor -- especially connected to masculinity and manhood -- strongly suggests to me that they are fully aware of what the hospital gown means to patients in general and especially men. They are aware of the gender obstacles men face but see it as irrelevant. They are aware and are saying, as alan suggests, just suck it up. This is the way it is. We are in charge. Enter our facility and we do it our way.
As as side note, it's interesting how the message is framed: Men need to get checked not for their own good, not for who they are or what they're worth as human beings -- but because they need to be around for their families. That is certainly an important and valid reason -- but it's not the only reason.
I'm not saying they will behave this way with patients or treat them disrespectfully. But messages can be read many ways, not just the way their intended.
I must also add that I do believe the intentions of this doctor are good. She wants to save lives.
Continuing on with modesty and hospital gowns and their history and also other issues of medical fashion,
go to Harvard Medicine and read "Johnny Come Lately" (about the development of hospital gowns) but also look at the Contents of the issue for more about dressing fashions in medicine. ..Maurice.
Kudos Doug, well thought out and presented. Remember the well intended add by the American Cancer Society featuring an attractive woman posing the question, what might men be thinking while getting a prostate exam, humm I need to stop by and get some milk...the medical society seems to reflect societies willingness to apply a double standard against males when it comes to modesty...I like the thought you put into the subconcious...alan
Doug,
You make some good points and I agree.
That said, I know for fact that putting a patient in the gown has for years been intentionally used as a deliberate psychological tactic to establish control over them. It's no different than what is done with prisoners - the intent and desired outcome are the same.
When patients have to wear gowns and no underwear for cataract surgery, you know it's psychological intimidation.
BJTNT
I don't disagree, Hexanchus, that it's consciously done for that reason at times by some caregivers. Most of the time, though, I think it's inertia -- habit. The gown has become a "uniform," a symbol of what it means to play the role of patient.
But, for those who do use the gown as a method, a strategy of control -- this is an example of what I've talked about before. Some medical professionals don't feel comfortable examining some patients, maybe opposite gender patients, maybe young, good-looking patients, maybe obese patients, maybe out-spoken or what are sometimes called "difficult" patients. Getting them in a gown puts the doctor or nurse in control.
Now, I'm not saying it's always done by all doctors or nurses. But it's done. This quote from a Reader's Digest article "41 Secrets Your Doctor Would Never Share" --
"I was told in school to put a patient in a gown when he isn’t listening or cooperating. It casts him in a position of subservience."
–Chiropractor, Atlanta
You can find the article here: "http://www.rd.com/health/41-secrets-for-your-next-doctor-visit/
As I've said in past posts, medical professionals use various strategies to deal with all kinds of issues, including personal problems. Some of these strategies are healthy for both caregiver and patient. Some help the doctor/nurse get through these problems but are very unhealthy for the patient. Getting the patient in a gown to control him/her may help the doctor get through the exam. Don't think patients are always unable to pick up on this kind of behavior. They may not be able to articulate what's happening, but they know they're being treated as a mere object.
Yes, the gown can be used as a weapon for some medical professionals. And as that I quoted above says, that's what he was taught. I don't think most caregivers use the gown consciously as a weapon, but it is done. It's probably a learned behavior passed on through tradition in the hidden curriculum.
With regard to BJTNT's comment, removal of underwear is totally unnecessary for cataract surgery and if it occurs it is, as Doug suggests, essentially a habit in the operating room for which the eye surgeon could request eliminated. I see no need for any weapons in the operating room beyond that of the often used scalpel blade. And if anyone is going to be attacked it will more likely be someone standing around the operating table. As I may have written before, as an intern I did witness an orthopedic surgeon throw a scalpel at a scrub nurse at the table in a moment of anger. Fortunately it didn't quite hit her and also did not hit me as I stood there but I was astounded by the behavior. ..Maurice.
My husband recently had a series of steroid injections in his back and it gave me an opportunity to observe the nurse and doctor behavior at the facility he visited. Since I have started reading this blog I have developed a rather keen interest in noticing how different things are handled from one hospital/doctor to another. At this out patient surgery center, which was located within an orthopedic hospital, the large majority of nurses were women. They did issue the dreaded gown but my husband was told to leave on his underwear. He was sedated for the procedure, laid on his stomach and the underwear merely had to be pulled back a little to do one of the injections. The nurses allowed the patients in pre op as well as post procedure to get dressed on their own with the help of their spouse. The hospital's patient rights statement specifically stated that patients were able to wear their own clothing as long as it did not interfere with treatment. But they have a wide range of services, from physical therapy (where it is quite reasonable to wear your own clothes) to surgeries where it most likely is not. But I thought it was at least encouraging that they did not require patients to remove underwear for a procedure that could be done with them on. I did, however, think that the setup was not that conducive to privacy. It was the typical large room with beds separated by curtains only and you could basically hear everything that was said to the patient in the bay next to you, as well as see patients rolled into recovery in various states of sedation. They did not close the curtains while the patient was coming out of the sedation and I did see some nurses adjusting and reaching under blankets and really not paying much attention to the fact that visitors were sitting within viewing distance of it all. That pary stuck me as a little insensitive. Just my opinion. Jean
I have stated this before but it fits this discussion. I think the ridiculous gown is the poster child of this issue. I had my throat scoped, same thing, the dreaded gown, nothing else. A woman in my office had the same thing done at a private clinic. They had her remove he shirt and put a gown over the rest of her clothes and that was it. Difference I am convinced mine was at a hospital that my doctor referred, she went to a clinic that relies on attracting people for revemue. Providers know we hate those gowns, sometimes there is absolutely no need to be naked under them, but it's just the way its always been done. Now if they know we hate them, know we are embarassed to be in them, and know there are options but don't take them...is this not the same issue with other areas of modesty. Does it not make sense that what we have been arguing here..providers know at some level but just don't want to make the effort to accomodate? It is hard to deny that everyone knows patients hate the gown, providers joke and comment, yet continue to use them. I am not talking when their use is justified, but when something more comfortable for the patient could be provided..lot of similarities with the issues we are discussing....alan
Why not just say no. Believe me, they are out to make a living and won't turn down someone for a procedure just because they don't wear a gown.
I've had all kinds of exams including colonoscopy and never wear one. The funny thing is, I never argument about it. Vocalize your needs. Unless there is some kind of medical reason, most requests are honored.
The medical profession may seem like they're "out to get us" but we're dealing with a number of factors.
belinda
The agency for healthcare research and quality has
a budget of 611 million dollars,imagine that. Their
mission is to improve the quality,safety,efficiency
and effectiveness of health for all americans.
The video,real men wear gowns, brainchild of
Dr Carolyn Clancy and her staff of 300, can be
viewed on YouTube. Was this the best they can
come up with. Some commentors on the YouTube
video suggest they don't understand the message.
The truth of the matter regarding hospital gowns,
few patients wear them. Visit any emergency room
and most patients put the gown on over their clothes,
it's a joke. Look at the inpatients, they bring their own
pajamas. Would someone please write and tell Dr
Clancy this,please. Furthermore,tell her to stop picking
on male patients with her Victorian ideals.
PT
PT I have to agree with you on this one, it seems to be a common theme in approaching men and health care to make light of it from Dr. Orange and her 10 things to the American Cancer Assoc. running the ad where a woman says what goes through a man's mind while he is getting a prostate exam..and starts with her spouting things like shopping lists, etc. The real men wear gown included one where the "Champ" is wearing a gown and bends over or something exposing his rear, "whoa that wasn't pretty"...I find it interesting that a lot of these programs were designed by women to encourage men to seek medical care....might be interesting to ask men....alan
Some of you may want to check out an interesting article on MSNBC's website (under the Health tab) titled "Why women avoid the gym? Getting naked." Especially interesting are the comments. Although this does not have to do with medical modesty, it is interesting to see that those commenting also seem to fall into groups when it comes to comfort level with nudity. I see a lot of correlation between those comments and the concerns on this blog. And, I might add, it seems the groups are pretty well divided between those with no concerns and those with avoiding exposure, both men and women. I think it proves that we are all individuals and, depending on our upbringing, life experiences, etc. we have different levels of comfort with this issue. And it seems to apply in many venues. Just a thought. Jean
These programs are degrading. It's not just men's programs either.
Look at the cancer society's breast cancer awareness bracelets that say "Boobies". It's enough that they've been on the DO NOT WEAR to school list.
It seems that the medical community wants to use their power to insult the intelligence of the populations who use their system. What they don't realize, is that the populace is too diverse and that it's impossible to make everyone happy.
Why not take the high road. Stop degrading people, body parts, men and women and start with a foundation of dignity. They can't go wrong with that. Then perhaps the people will get the exams they need. What do you think Maurice?
belinda
A main part of the problem in these cases, I think, is the lack of true patient representation on the committees that make these decisions. In many cases, doctors and nurses just consider themselves as representing patients because we are all patients. As we've discussed, and I've commented on, there are degrees of "being" a patient. And doctors and nurses are often treated differently in hospitals that know who they are. When the do get real patients, they most often get what they considered "enlightened" patients, or those who are activists but probably more open to opposite gender care and the gender neutral medical notion.
The committees who make these decisions don't see this is a controversial issue. They don't regard diversity regarding this position as a value to be endorsed. Add to this the fact that then this committee hires an advertising firm to make the video or ad -- and all there interested in is being cute and getting your attention. It all adds up to what we're seeing here.
We teach dignity to our medical students in terms of personal quality applied both the patient but also the physician. Both individuals deserve respect by the other. Now, some might say that only the patient, who is the one suffering, is the individual which should demand and obtain the greatest respect. I think that this is an important point to discuss as we are repeatedly stressing in this "Patient Modesty" thread about wrongs in behavior of the medical system. What responsibilities do patients bear when they interact with the medical system? ..Maurice.
Socially, the masses do not remove their clothing in publoic and for someone who is not used to the medical culture and has had the utmost dignified care in the doctor's office, does not expect the kind of treatment that are considered "standards of care". These would include disrobing patients completely in the OR while prepping for surgery while these patient are awake.
While patients do have a responsibility to communicate their needs, one cannot express themselves when they are so completely traumatized by behaviors that mimic sexual assault (i.e., what amounts to public stripping).
Just like any other consumer based service or product, it's up to the vender (in this case the medical providers) to explain the psycho social aspects of what to expect. They don't.
From the patient and legal perspective some of these behaviors are/were so egregious that laws were passed to protect patients.
I've mentioned it before, but it's the behavior of the medical community that caused the laws to protect patient dignity. These laws are still being ignored, as is the privacy clause in Title VII.
The medical community knows there is a problem and still has decided to just do what they do at everyone's detriment.
The population of traumatized people can only grow from the lack of proper social behavior in the medical arena. If it weren't improper and damaging to the public, they wouldn't have made laws.
Therefore, the burden falls on the medical community not the patient. If one doesn't know what to expect, they don't know what to ask for and are outraged afterwards. This is not mentally healthy so I aSk this?
Why does the medical profession continually put the blame on patients instead of taking responsibility, reporting deviance, signing consent forms before anethesia, etc.
There is so much impropriety going on and has been going on, that the responsibility falls to the medical profession, just as much as hiding medical mistakes falls on the profession to disclose.
belinda
We have published a new post concerning obtaining same gender maternity care from Misty Roberts of the patient modesty organization.
Take a look.
Wayne T James wrote the following today on my blog thread which also appears on Medpedia. ..Maurice.
Coming from a non medical side of caring for a client, I find myself at some odds with the prior comments and I have little comment to make about the hospital gowns except for my own experience. I have always had male doctors for my medical care, but I work in a field with MFT's and LCSW's which are mainly female. I have had problems with skin moles on my body which where pre-cancerous when removed. I was referred by my doctor to a dermatologist for further skin checks and evaluations Upon meeting the female doctor, I found her to be very thorough, caring and concerned about my modesty. She had me stripped down to my underwear in private and put on the paper gown. The gown did not fit very well and she had me removed the gown as she needed to check further on my body. Several basal carcinomas were found on my face and back, so I had several surgeries to remove those. As I went back to my dermatologist, I found that I felt very comfortable in her presence and since I am very concerned about getting rid of all of these skin cancers, I no longer put the gown on. In my last appointment with the dermatologist, I had an issue involving my genitals and she asked me to completely undressed. I cannot say if she left the room or not as I undressed because I was looking at the opposite wall from her location. She did a very thorough skin check and treated my medical issue which involved her touching my genitals and doing a biopsy. I was embarrassed as this was the first female in 36 years to see me undressed other than my wife. I was impressed by the way the doctor treated me and during the exam, I was not even concerned about being undressed in from of a female other than my wife. I feel that each person should be allowed to be dressed or undressed as they feel comfortable with as long as the clothes does not interfere with the medical exam that needs to be done. For some people, they prefer the same gender doctor as them while others accept opposite gender doctors. My male GP doctor just left the medical office I go to and I picked out a female doctor to be my main GP doctor based upon the experience I had with the dermatologist.
Interesting post. This is the key element of the post:
" I feel that each person should be allowed to be dressed or undressed as they feel comfortable with as long as the clothes does not interfere with the medical exam that needs to be done. For some people, they prefer the same gender doctor as them while others accept opposite gender doctors."
The "Real Men Wear Gowns" campaign is similar to a radio campaign that has been running in my area for several months. Although these “public service announcements” avoid using the ill advised gown metaphor their central theme is that “real men” take responsibility for their health by seeing a doctor regularly for physical exams and making timely appointments for colonoscopies, prostate exams, etc.
This message would be reasonable if in fact it were not so hypocritical. As many of us are aware, while we are encouraged to be “real men” who use the health care system frequently, once we arrive at the physician’s office or hospital the last thing the medical profession wants us to do is act like men. Men are assertive, insist on maintaining some control over their own bodies, and demand to be treated with courtesy and respect, especially considering we are paying for these medical services through the hefty premiums charged by our health care plans.
However, once we access the medical system we are expected to act like obedient little boys who do what they are told no matter how humiliating, embarrassing, or even unnecessary compliance may be. If we refuse opposite gender intimate care we are likely to be patronized, insulted, bullied, and labeled as difficult patients.
Unfortunately, we will be continued to be treated like children by the medical establishment as long as we let them do so. It will only be when enough of us truly begin acting like real men who firmly insist on dignified treatment that the current system will be forced to change.
MG
MG great observation, we are challenged to be real men, yet everything from the time we walk in to the time we leave has nothing resembling a male environment. I was sitting in my MD's office the other day, there were copies of officeMD magazines with Health pregnancy & better homes an garden. His office is a shade of pink or peach or something, he is the only male on staff, I am 6'1" tall and the gown is for a 5'4" person...great point, run all the ads you want, how about the push back if you want mean to really use your facility treat them like men...interesting observation...funny I had a dialouge with a male RN who left the field, said he could not handle the all female atmosphere but missed the patients and the work, I asked him if he would ever return, he said he was thinking about going back and getting certification to be a CRNA or some specialty as male RN's seemed to be better off there...same issue, differnt side of the gown...alan
That was very well said,MG. The truth of the matter is,
they don't like men being assertive as you have stated.
Any patient that is bullied,ridiculed and insulted should
not only complain to administration,but to the respective
state board of nursing. Most nurses believe the state
board of nursing is there to protect them,it is not. The
primary responsibility of state nursing boards is to
protect the public from nurses.
This is evident even with state medical boards for
physicians, the board's motto is, protecting the public.
My comments in no way suggest that physicians are
out to do you,the public harm. Rather, the point being
patients have avenues to pursue should they feel
intimidated or threatened. Most nurses are natural bullies,that it's their way or the highway. Somewhere
along the way the ideals of patient advocacy have been
lost. While they admit most nurses are bullies to each
other,they don't admit the fact they like to bully their
patients.
When the nurse is a bully by Theresa Brown Rn
well.blogs.nytimes.com/2010...
PT
I reject the expression "real men" as I would reject "real women". I think such classification of gender and/or behavior is mostly based on prejudice. I mean that an individual is prejudged with regard to arbitrary criteria regarding gender. Remarkably and for the betterment of us all, each person is an individual and should be considered as such. As physicians and other healthcare providers if we want to do the best for the patient, we should not lump them into arbitrary behavioral categories. We should look at each patient as an individual with their own capacities and their own personal issues and direct our advice and management to that individual and not to some meaningless category of "real". ..Maurice.
Dr. B.
I agree that patients should be accepted as individuals, but MDs are the first ones that don't.
The few times that I changed primary MDs, they could obviously see my gender, but always one of the first things asked was my age. When I objected one time "what did age have to do with anything", my comment was ignored with mild desdain. As I grow older, I see MDs treating me according to my age category and not as an individual. BJTNT
Great comment Dr. Bernstein,seems we recognize stereotyping is wrong in concept but not in application.
There was an interesting side thread on all nurses "since when did we start calling patients guests". The overwhelming discussion is they were patients not guests, that admin. was a pain for pushing the customer service, the dynamics were different, they were there to treat the illness/injury if they wanted to be guests go to a hotel. Now, if that is the prevelant mentality would it not help explain the reluctance to deal with our concerns on modesty? We are here to heal, not comfort...alan
I finally watched the 'real men' videos, and it made me wonder: If so much money is being put into a project to get men to go to the doctor then why not spend a little to find 'real solutions' for these 'real men'?
While I applaud the theory behind the effort of men's health awareness, it seems like the 'real point' is always to suck it up..be a man..and go do what you need to do. It's an old strategy that has never worked, yet is always resurrected every few years.
I agree with MG....if you're gonna pull the 'real men' card, don't treat them like silly little boys when they get there.
What's next? "Real Men ENJOY Female Intimate Care"?
I wonder how long that project would last.
Suzy
Would Dr Clancy and her staff entertain the thought of
having a video produced for real women. Would there
even be a need? What would be her goals and would
she produce such a video,even if her daughter needed
a mammogram and all mammographers were male.
Certainly, Dr Clancy and her staff must be aware of the
gender distribution in L&D as well as post op gyn floors.
For the year 2010, Dr Clancy and her staff of 300 were
given a budget of 300 million dollars. For the year 2011
that amount doubled to over 600 million dollars.
PT
Just a suggestion to perhaps help the "cause" for men especially: Why not start a petition on one of the web sites such as Change.org and get as many men as possible to sign up stating your reasons for avoiding medical care (the many reasons already established on this blog). Then when one of these campaigns surface you can send letters with copies of the petition to the organizers or sponsors so that they are aware that there are a lot more reasons than the same old tired ones they trot out. The more signatures you can get on the petition and the more letters you can send would be great. Perhaps (I know I'm going to get blasted for this one!) many of these campaign organizers just have no idea that the predominance of female care, especially in the secondary roles, is one that keeps men from the doctor. Maybe they have never had anyone state that concern or maybe they just have their heads in the sand. Who knows? But at least by letting them know it will, hopefully, open their eyes. It can't do any harm and maybe it can open a dialogue on a larger forum: get it more out in the open instead of it just seeming to stay confined to this blog. I, personally, would like to see a larger conversation of the modesty and same gender health care desire for BOTH men and women and would like to see it addressed on a wider forum. Jean
How is this for invasion of privacy as permitted by the U.S. Supreme Court (from the New York Times today's edition)?:
"The Supreme Court on Monday ruled by a 5-to-4 vote that officials may strip-search people arrested for any offense, however minor, before admitting them to jails even if the officials have no reason to suspect the presence of contraband." ..Maurice.
Thanks for this information. contacting several organization.
The good news are the magic words "before admitting them to jails).
It is highly unlikely that someone would be taken to jail for a minor infraction except if that individual is disrespectful to the officer and they want to punish.
The police are too busy to be bothered with extra work. The problem is that it promotes those who in any population may be abusive to exercise that mindset.
Whatever happened to no searching without probable cause. A traffic violation is hardly that.
Anonymous said: "It is highly unlikely that someone would be taken to jail for a minor infraction except if that individual is disrespectful to the officer and they want to punish.
The problem is that it promotes those who in any population may be abusive to exercise that mindset."
This is exactly what worries me about this decision. The police have very wide latitude, when deciding to use the power of arrest. This can already be used to intimidate, coerce, or punish. How much more powerful a weapon is it, if the person arrested is almost guaranteed to endure a humiliating strip search?
Also, let's keep in mind that the plaintive in this case had been arrested due to a computer error. He had done absolutely nothing to deserve arrest, and that includes his attitude toward the arresting officer. This was a completely innocent man who was strip searched, twice, and held for seven days, because someone had neglected to remove an outstanding warrant, over a matter that had been settled years earlier.
What happened in this case could happen to any of us. It troubles me greatly to think that we can be detained and humiliated for no better reason than some clerk made a keying error, or some officer didn't like the color of our hoodies.
"I am not sure that the 2nd year medical student of either gender really are representative of the general patient population. First, they are not sick..they have no symptoms that are causing them distress and need physical examination to diagnose. Second, and most importantly, I think, is the fact that they are living the medical school year together in a group of the same 6 and this daily purely academic collegial relationship makes them shy regarding degrees of intimacy."
That situation isn't really that different than other common situations. One example, a high school athlete would most often know that he doesn't have a hernia before an athletic physical, but he is forced to have it checked anyway. A school nurse is often used as an assistant or chaparone. So for four years this student may walk the same hallways as the school nurse, run into her in the school offices, possibly even work closely with her as an office aide of some kind (as I did in high school).
I know in my own experience that if she had been present during my hernia exam (though I didn't play school sports for this very reason) I wouldn't have been able to look her in the eye ever again. But it happens, and if med students can't understand that their modesty isn't unique, they shouldn't be prepared to ignore other people with the same modesty concerns.
GR
I really don't care who sees me naked when I am in surgery. I'm there to be made "whole" again and to feel better and as long as that is done to the best of the surgeon's ability I can't be bothered with the who's and what's of being prepped and draped.
I have had 5 surgeries in the last 2 years. My endometrial ablation was performed by a male ob/gyn from the Woman's Clinic at the Commuunity Health Care Center I am a patient of. I had a period that lasted 7 weeks and he was more compassionate about my situation than my female providers-one even told me that if it made me feel any better my period would eventually stop. When I told the gyno what she said his comment was "but why suffer if you don't have to?" That's the kind of attitude I want to have from someone who is operating on me-I don't care what gender they are. It's more important to me that a person has compassion and is skilled in their profession.
I think too many people are hung up on this issue. I'm sure that the person who sees you naked in the OR is going to recognize you on the street and point out to their friends that you have a small or big penis or that your breasts are small or large. After all the naked bodies these people see they can't tell you apart from one patient to another when you have your clothes on. Same goes for people doing imaging studies or the person in the ER that treats you.
Blue Fairy, I am so pleased that you came to this thread and wrote your opinion with regard to the trend of thought and feelings of others writing here. Before starting this thread, I was under the general assumption that my patients were of the same mindset as you since no patient ever told me otherwise (nor,to be honest did I ask.)
Obviously, others writing to your comment may present their opposing views if they have them, as they should, but I hope you stick around to defend your own views. ..Maurice.
But Blue Fairy,what if someone was unprofessional
to you. Bet your attitude would change then.
PT
I would be interested to know why Blue Fairy visited this site if she did not have a problem with this issue? Her comments are, again, what I believe is the attitude of a lot of people: they have no problem with modesty in a medical situation so they think no one else should. And what PT said is true, also. Once you have a disrespectful experience you are leary of any future medical encounters.
I kind of look at it like all other things in life. So many people think that everyone should share their feelings/beliefs, whether they be political, religious, etc. They just cannot understand how someone may feel differently. And this issue is no different. We all have our own sensitivities, beliefs, comfort zones, etc. I respect those who have no problem with modesty in a medical setting so I cannot understand why those individuals cannot respect that I may feel differently.
I never considered myself particularly modest until I was absolutely humiliated by female nurses on two separate occasions for outpatient procedures. My first experiences with opposite gender care that required nudity on my part. I've cited my cardiac catheterization procedure on this blog previously. The other incident was a retrograde urethrogram; I'm instructed to strip below my waist, positioned on the table, and while the nurse preps me, three other nurses enter the radiology lab and watch the entire procedure. No one asked permission to observe and I did like most guys and laid there silently enduring the humiliation. Never again; my medical care is not a spectator sport. I'm certain if Blue Fairy was subject to a similar experience with all male nurses, she might have a little more empathy for those of us who have been subject to degrading experiences at the hands of these "professionals." A true emergency in the ER or heavily sedated or asleep, I could care less.
F1114ever
“Blue Fairy”:
You almost had me at a ‘live and let live’ attitude, until the final paragraph. It seems needlessly berating, a bit naïve, and rather confrontational.
However: if you believe that “too many people are hung up on this issue” then maybe we have served our purpose in proving perhaps we are not such a minority after all.
Suzy
Blue Fairy represents that attitude that if I feel a certain way, that's the norm -- which may be correct. If her attitude is the norm, it's not the norm because she feels that way, though. We get that on this blog, the "how I feel" must be normal because I'm normal and how you feel must not be normal because that's not how I feel.
Having said that, I do believe that Blue Fairy does represent the norm, i.e. most people don't care about gender with all the other risks involved in surgery. That's basically how i feel. But, if I had a bad experience while conscious involving modesty or anything else, you can be sure I'd let them know and make sure it wouldn't happen again. Thus...
...Someone wrote: "Once you have a disrespectful experience you are leary of any future medical encounters."
No -- once you have a disrespectful experience go into your next experience with your eyes wide open, have high expectations, let the staff know what your expectations are, and don't settle for anything less. Make it clear. You might even mention to them the horrible experience you had last time so they know where you're coming from.
That's what needs to happen. Not avoiding medical care because you ahd a bad experience.
I agree with Suzy, Blue Fairy certainly has the right to express what is right for her, what I don't understand is why she or people like her have the right to decide what is right for me. Have you walked in my shoes, have you lived my life experiences, do you practice my religion or interpet it as I do, then you have no right to say I am "hung up" anymore than I have the right to say you must get off on it or are immoral or perverted for the way you feel.....we are all individuals, you have your views and rightly so, but don't judge me if mine are not yours....alan
It would be recommended that "Blue Fairy" read this blog from the beginning.
We are all a sum of our experiences and I'm pleased that Blue Fairy has had the kind of experiences that we all strive to have.
Unfortunately, you normally do not find someone like Blue Fairy on this blog.
The reason is that Blue Fairy has not had a negative hospital experience. She doesn't know or have any idea of the kinds of things that can and do happen. This is not her fault; just her experience.
It would be interesting to interview patients as they exit the hospital to find out about their experience and if they felt humiliated and why. I would guess that because negative experiences are so common for a variety of reasons that Blue Fairy would be in the minority.
belinda
I agree with Doug's "middle ground" approach to the dealing with the contrasting views which can be expressed regarding the patient modesty issues as handled by the medical system. I also feel that those who hold one view should not be "fighting" the other but should work together to find ways to make all patients comfortable with their medical system experience. Yes, there should be advocacy to stimulate finding those ways and make the necessary changes but the advocacy should be mutual. What is missing in this whole issue is education. Those who find emotional pain with the behavior of the system should be educated that there are patients who haven't had their experiences. And those who haven't had such experiences should be educated to the fact that such emotional distress can be faced by others. And, finally, physician's like me should be educated that not all patients are satisfied as is Blue Fairy with how we are behaving. ..Maurice.
Blue Fairy
I have decided that you are correct when you said,
"too many people are hung up on this issue. Whether
it be in the operating room,emergency room or where
ever, it shouldn't matter.
So, perhaps you could write and publish your opinions in some select womens and teens magazines. Let them know that there are no male mammographers, but that men are fully capable of performing this job,professionally.
That there are no male nurses working in L&D, nor in
post-op gyn floors. Now I believe all women would
certainly agree to these sweeping changes if you
would speak up on these matters.
PT
I would like your professional opinion about what seemed to me a poorly handled nursing experience I just had, and suggestions about how the nurses and I as a patient could have handled this better.*After surgery I was unable to urinate. The floor nurse did a bladder ultrasound and it was decided to insert a Foley catheter to relieve my urinary retention. The floor nurse arrived seeming rattled, perhaps because she had too much to do. She pulled up my hospital gown, put on sterile gloves and proceeded to cleanse the head of my penis. This was being watched by my private duty night nurse. She then injected some lubricant into my urethra and started to insert the catheter. Then she hit my enlarged prostate and it stopped. *She pushed and pushed but was unable to advance the catheter. As you can imagine I was quite uncomfortable and alarmed at this, not to mention embarrassed. Both gloved hands were quite covered with lubricant by this point, so the hand grasping my penis kept sliding down the shaft. *This went on for some time, as she kept telling me she was sorry. Perhaps you can imagine the effect this tightly squeezing hand had on my penis as it repeatedly slid down the shaft.*At this point my private duty nurse said "let me hold his penis, you push" and putting on a pair of gloves grasped my penis, which was by this point nearly erect in spite of the discomfort.*The floor nurse said she would do it and took my penis back, but still her fingers kept sliding down the shaft. I was trying hard not to ejaculate.The private duty nurse said she would get help from the nurse practitioner as the floor nurse kept working. * After a few minutes of this the nurse practitioner arrived, donned gloves and proceeded to urge the catheter past my reluctant prostate gland. *At his moment a young respiration technologist walked in to install a cpap machine and we all five hung there for a moment in time: me, a triumphant looking nurse practitioner, two deflated looking nurses and a horrified looking lab tech, all staring at my newly catheterized mostly erect penis. *I was mortified, uncomfortable and quite aroused. *How could this embarrassing situation been better handled?
It seems to me that the combination of being exposed and medical procedures actually increase the level of humiliation to the patient.
Medical science has never considered the psychological aspects of care nor do they really want to.
It could be so easily handled by limiting who is in the room and for such an intimate male procedure, it would seem that there might be first a device rather than a human hand to place the sexual organs and secondly, drape the patient in such a way that he can't see what's happening.
This false sense of privacy goes a long way to limiting feelings of vulnerability and humiliation and is used in every gynecological office during sensitive exams. They use it during all kinds of ultra sound exams as well.
This patient's feelings weren't considered and while the medical community feel that this is unimportant or errevelent better guess again because they are the resounding factor why patients do not go to the doctor or have intimate procedures performed.
The medical community is so arrogant that they don't even want to do the research in how their own protocols hurt people. What does that say for morals and ethics?
belinda
In response to David’s question concerning how his embarrassing situation could have been better handled, I do have a few suggestions and I do have great sympathy for the situation he found himself in.
First, he could have requested that a male nurse insert the catheter. However, given the urgency of the situation and depending on the availability of a male this might not have been a realistic option. However, even if he had to endure characterization by the floor nurse there seems to be no logical reason for the night nurse to be observing this, so he could have insisted she leave the room during the procedure.
When the floor nurse ran into difficulty, he might have requested that a male urologist be called to complete the procedure properly. Once again, this may not have been possible but it couldn’t have hurt to ask.
The most inexcusable offense was committed by the respiration technologist who “walked in” during the procedure. If he was in a private room, the door should have been closed and the technologist should have knocked before entering. If he was in a semi-private room the curtain should have drawn around his bedside during the procedure and the technologist should not have parted the curtain without first asking permission. When she did enter, he could have demanded that she leave immediately.
David writes that this “horrified looking lab tech” was staring at his newly characterized penis. I believe he is mistaken about her feelings at the time, because a truly “horrified” individual would have excused herself and left immediately once she realized the situation.
I do want David to realize that I am in no way being critical of him for not taking any of the steps suggested above. He was in an extremely stressful and difficult situation and I know that I might not have voiced any of these responses had I been in his place.
What he can do is file a formal complaint with the hospital administration regarding this episode, particularly the intrusion of unnecessary personnel during such an intimate procedure. And he should not give up until he is at least given a serious response to his concerns. Perhaps such a complaint could this could help result in more consideration for patient modesty in the future.
MG
I don't mean to sound defensive and you have emphasized that you were not criticizing me personally, but I too have been thinking about what I could have done differently.
I did not even know that the nurse was planning to insert a catheter. After doing an ultrasound of my bladder, when I asked what they would do she simply replied "we'll see.". When she returned with the catheter kit she did not tell me what she was doing until I asked and she was starting to clean my penis and I guess I was too taken aback to object.
As for the presence of the private duty nurse, i just assumed that she was trying to help, thus the offer to hold my penis. It didn't occur to me to ask her to leave.
I was in a private room but I guess there was such a hubbub in the tiny room that they neglected to close the door or even pull the curtain, and I was acutely aware of being visible to hospital personnel passing in the corridor.
I guess "horrified" is not accurate for the young woman with the cpap machine, maybe surprised, but I am now struck by the fact that she kept on setting up the machine while staring at my penis.
At the time I was particularly mortified that my penis became erect and was worried about what they would think of me, but in retrospect I realized that my penis was reacting to the considerable stimulation it was receiving, not sexual thoughts.
I am reluctant to file a complaint with the hospital as I feel dependent on them for future care and I'm reluctant to invoke their and my various doctor's ire.
MG, When someone is being humiliated and traumatized people implode and focus on their plight. Things happen so quickly that there is either no time to react or the level of upset feelings is so profound that logical thinking is not possible.
Once something has happened, one can prepare, however, in the throws of psychological trauma logical thought, solutions are not possible.
Furthermore, once someone has already been exposed they are so completely deflated that the damage is already done, thus, removing personnel later, doesn't matter.
The horrified tech might have been traumatized in their feelings as well. Fight, flight or flee does not work on traumatized individuals. Sometimes they freeze and that is what preempts dissociation in patients who later develop post traumatic stress disorder.
Cruel and degrading treatment can and does do that. This topic makes for some interesting reading.
belinda
researcher psycho social dynamics of healthcare
David, you must do what you feel is best. However, realize that by talking about your feelings in a positive way with the staff puts you in the role of educator. Some medical personnel are so focused on their duties that they neglect this very important of healthcare.
It's important for those of us who are treated in a way that is personally degrading, to speak about what can be done in the future.
You don't have to whine, but enlighten. They might even appreciate your input if you do it without malice. It's difficult because you may have feelings of anger but working through them in a positive way is healthy for you, the staff, your relationship with your doctor, tailoring your future needs based on your experience.
Counseling works well for some to help sort out the various feelings that are internalized and sometimes take years to come to the forefront.
Whatever you do, I wish you the best and to search your own soul for decisions that are right for you.
I just wanted you to know that expressing yourself over something that was traumatic, is a healthy way to protect yourself in the future and to be part of the patient population who wants to educate, enlighten and get what they need in the future.
belinda
To be honest about this, although I may not be dealing with some deeper feelings, I do not think the embarrassment of having my genitals exposed to a group of people of the opposite gender rose to the level of "trauma". Uncomfortable, sure. Did I continue to think about it afterwards and would I have preferred it hadn't happened, yes.
I do think that the whole episode should not have happened, that personnel in hospitals should be sensitive to people's discomfort at being exposed to even one person, but unnecessarily to four strangers was very unfair. This was exacerbated by the circumstance in which I had become physically aroused because of the stimulation of the procedure, but in any case it would have made me very uncomfortable. However for me this was not really traumatic.
To me the worst part was that it was mostly avoidable. It underscored to me how difficult it is to look out for your own interests when you don't know what is happening. I don't know anything about catheterization, but someone else mentioned to me that they should not have been applying so much pressure. The night nurse should not have stayed to watch, which in retrospect I really don't understand, and the technician should not have come in or been staring at my erect penis.
I do agree that there was a high level of insensitivity shown, and for that , on thinking about it, I will make a formal complaint to the hospital.
Please, please read the article in today's New York Times about proposed changes in the Medical College Admission Test given as a requirement by the American Association of Medical Colleges to undergrads who want to go to medical school.
The Medical College Admission Test is, of course, much more than a test. A good score is crucial for entry into a profession that is perennially oversubscribed. Last year, nearly 44,000 people applied for about 19,000 places at medical schools in the United States. So the overhaul of the test, which was announced last year and approved in February, could fundamentally change the kind of student who will succeed in that process. It alters the raw material that medical schools receive to mold into the nation’s future doctors.
Which is exactly what the A.A.M.C. has in mind. In surveys, “the public had great confidence in doctors’ knowledge but much less in their bedside manner,” said Darrell G. Kirch, president of the association, in announcing the change. “The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.”
A readers thoughts about this change for admitting medical students actually fits with was has been described on my blog thread by my visitors here:
"We should test everyone who has his or her hands in medicine, not just docs, but admin, insurance brokers, politicians, nurses, lawyers, hospital CEO's, technicians, medical assistants, radiologists, pathologists, investors for good bed side manners. In the age of quasi-patient dictated healthcare, have the patients themselves tested for good bed side manners as well.
The art of medicine is easier said than done. Putting on a white coat will make you feel like one but does nothing for the services being delivered. That's something deeper, and not everyone who is in medicine may have it."
So you see.. the medical care system may be doing some "catching up" on what you, the patients, are thinking and speaking about. ..Maurice.
We have posted a new article on our blog about the differences how modesty is treated in medicine and in society in general.
Take a look.
O.K. here goes:
Either Davidd32 is THE unluckiest man in the world to encounter the coincidence of so many uncaring and disrespectful employees in one building/area/ (floor?) or at some point mathematically we have to admit the culture is greater than the 'outlier' theory.
If the story is true..not one, but several nurses couldn't see what a circus this was? Not one, but many could not remember to close a curtain and shut a door? Not one, but many could not tell a tech to come back at a more appropriate time? Not one, but many could not say "Let's all leave except for the one who knows what they are doing because the client is obviously stressed and embarrassed."?
Really. So many participants in one place and we are to believe that this blatant disrespect is rare.
To the anonymous poster
With OK, here goes:
You have expressed the facts exactly. This
blatant disrespect is not rare, it is the norm. I suspect
many on this blog either are afraid or simply cannot
handle the facts. This incident regarding Davidd32
reminds me of an incident many years ago at a large
teaching hospital in the Midwest.
I saw two female nurses catherize a young
comatose male patient in full view of a female patient
without pulling the curtain. This is the norm for male
patients within our health care system. So much for
the most trusted so called nursing "profession".
PT
To be fair I and my family have been patients in this same major New York hospital many times and have always found the nursing care to be adequate (I'm sure more hurried than in other parts of the country but OK) so I guess it was a confluence of factors or else I AM the unluckiest man alive.
I mentioned the incident to a nursing professor friend last night (without all the embarrassing details) and she too urged me to file a complaint with the hospital.
I was thinking about one of the comments posted about my cathaterization We all have mixed reasons for doing things and I was wondering if something not completely conscious could have been going on here. I now realize that I did not yell at some of the people in my room to get out. I could have told them to close the door and pull the curtain . Certainly I could have told the cpap woman to leave, the night nurse was not doing anything and I could have asked her to leave. I was very embarrassed, but if I think about it I was also aroused. While the situation was uncomfortable, it was also erotic. We know of the popularity of 50 shades of Grey with its kinky erotic appeal . Do I too have some role in the staff's failure to guard my privacy. And how about the night nurse and the cpap woman? Did they stay to look at my erect penis? Why did the night nurse insist on holding my penis anyway? She was absolutely no help and the floor nurse quickly pulled my penis back from her and then she only watched after she went to get the nurse practitioner. Why was she watching? Was it only professional curiosity? Was there something prurient on their side as well? The floor nurse and the nurse practitioner were professional. The unconscious can be powerful.
Davidd32
There are a number of concerns I have that
are emerging from your posts. First, nurse practitioners
DON'T do floor nursing,PERIOD! A cpap breathing
machine stands for continuous positive airway pressure.
Hospitals don't use them, however, hospitals
do use bipap breathing machines, stands for positive
airway pressure. It would take me pages and pages of
technical jargon to explain the difference between the
two. I know the types of patients that require these
machines and the medical history each that would
present to require such a breathing apparatus.
Furthermore, you post is beginning to sound
as if you were titillated by this experience and or
fantasy based. I am not here for that, nor will I ever,
ever be an advocate for that. Any patient that requires
a bipap machine has often serious medical problems
and therefore I believe attaining an erection would be
improbable. Please do not insult our intelligence on
this blog.
PT
I have used a cpap machine for many years. The machine was provided by the hospital for my overnight stay for my sleep apnea. Obviously you are wrong about hospitals not using them since a major new York teaching hospital provided it to me three weeks ago. I also know the difference between the cpap and the bipap machine. I know other people with sleep apnea who use a bipap machine and are definitely not so Ill that they cannot have an erection, so you are clearly misinformed, but seemingly very self confident in your ignorance. As for the nurse practitioner not doing nursing, obviously you are again wrong. The same new york major teaching hospital in which I was a patient had a chalk board in my room with the name of the floor nurse and the nurse practitioner. When the floor nurse had a problem the nurse practitioner was called. This happened so you must be misinformed. As for the titillation you find in my discussion, I am only trying to be introspective about an actual experience. If you find it titillating you should look inward. your discussion of sleep apnea is ill-informed and your attitude is arrogant and condescending.
Both Davidd32 and PT have contributed their personal views based on their experiences and knowledge both of which are worthy for contemplation by the visitors here. However, I would discourage any near ad hominem responses by any of our contributors. What we are interested is the individual's experience and knowledge and not a dissections of another contributor's personality. ..Maurice.
Davidd32
1) In over 35 years of health care experience
I have never seen a nurse practitioner employed
at any hospital.
If there are, they certainly don't do floor nursing
and they wouldn't bother with a foley catheter.
There are such things as Hospitalists and
attendings, residents and med students as
well as interns. Nurse quacktitioners, excuse me
nurse practitioners virtually always work with a
physicians group, outside of the hospital.
The respiratory departments at hospitals don't
keep cpap machines,why, they are not useful,nor
applicable to hospital patients.
Cpap machines are often purchased for patients
at home with sleep apnea, and the hospital will
Not let you bring it with you. No matter what your
excuse,the bio-med department will say NO.
There are sleep centers that have them. Those
patients are kept overnight. But the big one is this,
those patients don't require a foley, they don't even
keep foley catheters at those facilities. Why would
they place an indwelling catheter in the am, when
you go home that day! Busted.
PT
PT,
This is off topic, but I assure you that lots of nurse practitioners are employed by hospitals. You're right on one point, I've never seen them do floor nursing; they usually work in departments doing specialized tasks. For instance both hospitals I go to employ NPs to do the stress tests in Cardiology. There are also others in the hospitals.
Of course most patients wouldn't know the formal status of the non physician providers seeing them.
I took one minute to google it and came up with several expired ads for nurse practitioner surgical short stay new york Presbyterian hospital. I am surprised that people with particular experience would presume to be experts on the staffing patterns of hospitals nationally. If you are really that curious take one minute to google these nurse practitioner jobs or three minutes and call the hospital and ask them if a nurse practitioner might have such a job. If you are really that curious call the nurse practitioner working there and ask them to describe their job, or perhaps quote the story, they may remember. But is that the topic of this discussion?
As for the previous post it was so replete with statements and presumptions that are at variance with the practice at the hospital I was in that there is no point in refuting each item and I don't think I should. If you would like to email me personally I would be happy to give you the specifics, but again I don't think this is what the followers of this discussion are interested in.
I agree with Davidd32 that we are now off topic for this blog thread even though the clinical roles of those providing care in hospitals may be of interest to clarify. With that, I am willing to facilitate the communication between Davidd32 and PT simply by writing me e-mail (DoktorMo@aol.com) thus providing e-mail addresses which I can privately provide the two visitors. ..Maurice.
I've been following these discussion, though I haven't posted for quite a while. I'm not sure what more I have say about this topic that I haven't already said. But I will post what I believe is the most powerful way we can change the medical culture surround patient modesty issues.
Patients, and/or their advocates, need to speak up. Our efforts, I'm convinced, should be focused on empowering patients and empower advocates who can speak up for those who can't or won't.
1. Patients or their advocates need to speak up from the beginning about their modesty concerns and needs, to their primary care physicians, to specialists they go to, to nurses, and cna's and techs. Make your needs know. Be clear. Be civil. But be firm about your expectations.
2. Patients or their advocates need to speak up immediately when a modesty violation happens. The magic word is "Stop." Withdraw your consent -- not to the treatment itself, but to the way your being treated or to the gender of the caregiver if that concerns you. In my opinion, the most effective time to do this is at the moment it happens. That moment has more power than any meeting or letter.
3. Number 2 above may satisfy you and solve your problem. If not, write letters and demand meetings. Put your concerns in writing, and make sure you send copies to several people. Make sure you send the letters to the right people, not just anyone. Send it to those in power who can make the decisions. The odds of your letter being ignored are slim of you copy it to several people.
Patients must realize that by not speaking up when modesty violations happen, the message communicated is that these kinds of behaviors are okay, or at least acceptable. By not speaking up, patients are helping to create and strengthen the precise kind of medical culture we're fighting against. Patients become part of the problem rather than part of the solution.
Now -- we can talk again and again how it's the medical profession's responsibility to take the first step -- to ask about patient modesty, etc.
It's not going to happen. It's not going to happen until it becomes an issue, and it's not going to become a real issue until patients start speaking up.
I've been on this modesty thread almost from the beginning. Everything I've written comes down to what I've just stated above. I really don't know what else to add to this discussion.
Good advice. I have in fact just composed a letter of complaint which I am sending to the Patient Services Administration at the hospital where I had my surgery making them aware of the incident I experienced which was a breach of my privacy.
Doug,
I agree completely. Nothing is going to change unless/until patients start standing up for themselves, and the best time is either before the fact to establish the ground rules, or immediately when a privacy/modesty violation occurs.
As you stated, calmly but firmly let them know what you expect, then hold their feet to the fire to make sure they follow through.
A blogger.com error prevented the usual publishing of belinda's posting from today, so I have copied the posting here. ..Maurice.
What patients don't realize it is they that hold all the power. You can express your needs ahead for a scheduled procedure (so that there are no staffing surprises) and when your needs are not not met, refuse to follow through on your procedure or test. You also have a person named who you expressed your needs and you was responsible for accommodating you or advising otherwise that this couldn't be done. This way they know they are ones who didn't prepare properly, and if you stick to your expectations they will turn the world upside to accommodate.
If you wait and surprise them at the last minute, then there is an excuse and possible inconvenience to the patient.
Once their schedule gets totally upset by your refusal, especially if this creates liability if they don't proceed as scheduled, and they knew ahead of time about your needs they have 100% liability.
belinda
Dr B, would you be so kind as to provide a link to this
blog. I know some of our readers may no longer be
infatuated with nurse practitioners after they read this one.
newfnp.blogspot.com/2007/05/is-that-twinkle-in-your-pocket.html
PT
PT,your URL no longer goes to a page and the blog itself hasn't been active for a year but if you simply go to http://newfnp.blogspot.com and you scour around the blog postings over the years you will find that this "new" family nurse practitioner's view of patients and her colleagues might give the reader insight into what PT is writing about. Though, really PT, I wouldn't paint the behavior of all NPs with the same brush and the paint of "new FNP".
Yes, of course, I wouldn't be infatuated with "new FNP" but really in the discussion we are having here, is it really appropriate to generalize the whole population of NPs based on this nurse's appearance? ..Maurice.
Maurice
To answer your question,absolutely. For me, I feel
it is appropriate to generalize the entire female nursing
population. Yes, I paint them all with the same brush.
The paint I choose is hate,distrust and dissatisfaction
all mixed together. I chose this color of paint based on
my set of life experiences,my criteria,my appraisal. Until
you or anyone can walk in my shoes, who can make a
decision for me as to what generalizations are
appropriate or not.
PT
PT has provided the correct link to the nFNP posting on her blog. ..Maurice.
Interesting article in Family Practice News about "Prostate Cancer Survivors Avoid Therapy for Sexual Side Effects" conducted by Memorial Sloan-Kettering Cancer Center; FPN link. Link to the MSKCC presentation: MSKCC link. I bet the 95% probability of diagnosis/treatment involving female providers (assistant or nurse) might have influenced a significant percentage to avoid/delay treatment. I emailed narusj@mskcc.org and asked if this specific question was asked of the participants.
My husband went to his surgeon for an umbilical hernia exam. I stayed in the exam room with him. A nurse was present for some of the exam just to hold a light for the doctor. She did not stay for the entire exam, thankfully. My husband was sitting in a chair with his shirt still rolled up. As the nurse was leaving the room, she leaned over and touched my husband's belly button and giggled. What was this about? I did not say anything to her or the doctor as I should have, because I did not want to upset the doctor and jeopardize my husband's upcoming surgery. I don't know if she was just being funny or trying to flirt with my husband. I wish some of these nurses would understand what professionalism is.
This experience was written today by Anonymous to my blog thread "Patient Modesty: A More Significant Issue?", which between May 2006 and February 2007 accumulated over 900 comments at which point the Blogger.com system broke down and refused to publish more and so I then started this series of Volumes.
It is interesting to go back the 5- 6 years and read the comments written then. Has the views now changed? Has anything changed? ..Maurice.
Maurice:
It would be valuable and interesting for someone to go back through past threads to find patterns and motifs. Perhaps we could get a graduate student to do a thesis on this subject, or perhaps we could get a grant.
The example you selected above is interesting. I don't attach to much significance to the nurse's behavior. It was simply unprofessional and inappropriate, perhaps obtuse -- but I doubt there was any intentional harm or intimidation intended. It does show immaturity and a kind of cluelessness.
What I find most significant about the story is this statement: "I did not say anything to her or the doctor as I should have, because I did not want to upset the doctor and jeopardize my husband's upcoming surgery."
This is a pattern I believe we will find in many stories -- the fear of reprisal from the system if a patient complains. This is a real concern. As evidence, I could show you a number of patient rights documents that specifically refer to this possibility, assuring the patient that this will not happen. If this fear were not a problem, there would be no need to include it in patient rights documents. And patients are not crazy to have this concern. There is such a stereotype as the "bad" or "difficult" patient. Some of these patients deserve the title. Some do not, but get the designation because they had the gumption to challenge the system. But the fact probably is that, although their medical treatment would not be compromised, their psychological and social treatment would be. They might be treated coldly, and staff would appear less friendly toward them.
Some patients may even fear complaining about safety issues. They may even convince themselves that things are really okay, that they really didn't see what they saw or interpreted it incorrectly. After all, "I'm not a medical professional," they think. For their psychological comfort, they put full trust in the system, even if their senses and instincts tells them something else.
Over the years, I've run in to dozens of patients who told me they didn't and will not complain because they feel their future care will be affected. Whether that's true or not is debatable. What is not debatable is how firmly some patients believe this.
These are the kinds of motifs we may find by analyzing past threads.
Doug, I agree. Anonymous has shown us an example of where the "power" in the doctor-patient relationship lies. It is relatively easy for the doctor to get another patient but not so easy for the wife to get another husband when the wife believes that "speaking up" might "jeopardize the upcoming surgery", perhaps seriously.
No matter how much I continue to preach the necessity of equality of the two parties in meeting the goals of the doctor-patient relationship, perhaps the dependence on the physician's skills will always make such a equality impossible to attain. Too bad!
So this inequality should put a responsibility, though perhaps a heavier burden on the physician, to anticipate and accept a patient to "speaking up" and be ready to listen and attempt to mitigate the concerns of the patient. The patient or family should then be able to walk away with the feeling "he (or she) listened and cares".
..Maurice.
I received the following e-mail from a visitor today:
I was wondering if you have any suggestion on how one can start contributing to the area of patient modesty? (i.e., help advocate for patients' right and importance of their mental health through the procedures and when patient's modesty has to be compromised; how to prepare them for it, so that the blow is not as harsh as many people have experienced it to be --felt shocked, violated, and mortified.. feeling that lasted way beyond the time of the experience & changed their view of and trust in medical providers..)
I know you suggested in your blog to go to "Suzy's blog" but that does not seem to be active and was wondering if you have any other ideas on how to help prepare patients for such an important thing and avoid any future negative feelings about the medical field.
Any answer will be greatly appreciated!
I wrote back (but I hope those interested here will also follow through):
as was mentioned on my thread a while ago, a group here should organize a petition drive (to get the input of folks at least throughout America using a free service such as Care2 Petition Site http://www.thepetitionsite.com/ ) If you all can get the word out and document support, then this information can be delivered to appropriate institutions of the medical system and may have some clout. That could,at least, be a beginning beyond individual patients "spreading the word" to their doctors and hospitals ..Maurice.
Maurice:
It would help to know who is asking the question. It reads to me like a medical professional, perhaps a doctor or a nurse. The last sentence indicates that, especially.
If it is a medical professional, here are some suggestions:
-- Bring the topic up at staff meetings, insist that it is important, and insist that it be discussed.
-- Be prepared for some negative responses. Most probably accept this as an issue, but in the hierarchy of the system, the position of those who think it isn't an issue and speak up may inhibit others from responding. Be willing to buck the system and insist that this issue be discussed.
-- This comment disturbs me: "how to prepare them for it, so that the blow is not as harsh as many people have experienced it to be --felt shocked, violated, and mortified.. feeling that lasted way beyond the time of the experience & changed their view of and trust in medical providers."
Perhaps I misread, but the intent seems to be to prepare patients to just accept the worst, to accept modesty violations as the status quo. The position seems to be that this is just the way it is so -- if we can at least let people know this is how it is, perhaps it won't be so bad for them. If I'm interpreting this correctly, than I must say that this poster is completely off track, even clueless.
-- The key is COMMUNICATION. Let patients know how the procedure is typically done and the gender of those involved. Be honest and specific. Ask how the patient feels about that. Outline how the patients's modesty will be protected as much as possible and, if that isn't good enough for the patient, ask what they would like to see done.
This is not brain surgery. It's not rocket science. It's honest, clear, empathetic communication. If you can not or will not meet the patient's needs, then at least be have the professional integrity and ethics to say so and let the patient find another provider. Dare I even suggest that you help the patient find a provider that will meet their needs? Or would that be too much? For medical professions, this really isn't a difficult issue to solve. It's more a matter of first recognizing and accepting the issue of patient modesty, and then having the will to deal with it.
I'd be curious as to how others read that post.
I don't know the writer's occupation, Doug. Maybe she will write directly to the thread and explain your uncertainties.
What is happening to the advocacy activity of those interested here? Has anyone developed a petition to enter for "signatures" on any of the petition/advocacy websites? ..Maurice.
I suggest we move in a different direction to solve
this long standing discrimination against male patients by training men as male mammographers. Hire male nurses to work in L&D and post-op gyn floors. Male receptionists at gynecology offices. Hire only big young burley guys working at the mammo clinics.
Tell the women if they don't like it, go elsewhere. This includes posting porn from playboy magazine on the walls of all the restrooms at these clinics. The male nurses on the post-op gyn floors need to wear sexually suggestive scrubs. Tell all the female patients you have nothing I haven't seen before.
When you learn that your female patient is a nurse
don't give her any privacy whatsoever. Leave the door
or curtains open and by all means cath them while other staff can notice as they walk by. Create websites
making fun of female patients breasts and genitals.
Male receptionists at gyn clinics should interrupt the
physician frequently while performing exams on female
patients. Invite the public to enter military installations
and gawk at female inductees nude receiving a medical
physical. Strike the breasts and genitals of all female
patients if they even look aroused. Male nurse " family"
practitioners examine all women who want to play sports. Insure that every orifice is checked, even if
these young women are just handing out volleyballs.
Can anyone tell me why we can't make this
happen, after all ,if you reverse the roles, these instances are common day occurrences everyday in
the life of male patients.
PT
Dr. Berstein:
I don't mind updating everyone on where our advocacy is at the moment...
The website is planned and written. We did run into funding issues, (as these projects ususally do at times) but when that hurdle is overcome then the site will go live. I do apologise to everyone, but these things do happen.
Now, while my blog is still active, it takes conversation to make conversation. If anyone has any thoughts on what they would like to see included, or even what the website will contain so we can flesh it out together, I more than welcome any comments. To date there has been many visits but very little comments.
Suzy
PT:
While I understand the frustration behind your post, turning the tables on abuse and discrimination does not solve the problem. Only solving the problem solves the problem. Re-directing abuse will never and should not ever be the answer.
A pelvic exam feels like rape. I have never gone to a physician for the purpose of a pelvic exam. Rather, I am pressured into having one. So, against my wishes I am made to strip, spread my legs, endure a light shining on my most intimate parts, submit to digital penetration followed by cold metal that spreads my vagina open, and then hold still for scraping, poking and prodding.
If this is not abusive enough, I have had one physician who did not provide a gown or any type of covering but left me completely naked during the exam. A different physician years later inserted a finger and asked me to "squeeze his finger". Then when the speculum was inserted and dilated I felt something repeatedly touching the walls of my vagina and I suspected he was inserting his penis.
In addition to putting women at risk of further sexual abuse and humiliation, the rush to get our vaginas is taking away any kind of holistic health care. Every physician I have gone to does not seem at all concerned with my general health. It's all about laying back, spreading my legs, and closing my mouth.
Anonymous from 5/9 - 12:28am
To borrow a slogan, Just say NO!
If you're not comfortable with either the provider or any part of the exam, ask for a different provider or refuse any parts of an exam you are not comfortable with. That is your right, and they can't force you to do otherwise.
FYI, there is a consensus that pelvic exams in asymptomatic women have little or no clinical value. So unless you are having a problem, there's no real reason to have the exam.
Suzy
I have probably reviewed hundreds of physician,
nursing and other related texts that pertain to medical
procedures and exams. Not once in any literature have
I read any differences in procedures as they regard
gender. It dosen't say anywhere that male privacy is
any less than female privacy. It is the female nursing staff that takes it upon themselves to insure male patient privacy is disregarded,this is their agenda.
At this point I am for the sake of this argument
excluding abuse and discrimination,rather make the
standards the same for both parties. Female patients
on a daily basis endure what male patients endure,
then maybe people will wake up and the system as a
whole will change.
PT
Just to let you all know that I have started a new thread on changing the medical system in all of its various methods of "doing medicine" to one of very clearly and emphatically focusing on changes based upon patient-centered consumerism. Go there, go to the link to the article on the subject, read and return there and input your further suggestions and criticisms. The title and link to my new thread is:
A Change of the Medical System to Patient-Centered Consumerism: Is that What You Want?
..Maurice.
I have posted a new article on our blog on the mass media and men's health.
Take a look.
PT:
I see your point, but when the standards are not the same for all parties: that is discrimination. And when people are casually humiliated with no attempt at privacy and dignity (when others are afforded it) that can be deemed abusive. The stakes are not high if the terms are not strong. As far as I can tell, when there is no equity, there is discrimination.
But for a few terms, are we not saying the same thing?
Suzy
Suzy
Turning the tables on abuse and discrimination
would solve the problem. That all women would have
to choose male providers for every procedure.
Consider racial discrimination and resulting
affirmative action: policies that take factors such as
race,color,religion,gender,sexual orientation or national
origin into consideration in order to benefit an under
represented group,justified as counting the effect of
discrimination.
In fact, I am writing my legislators to initiate such
a policy to counter the effect of discrimination towards
men by the female dominated health industry. In the end maybe you and other women will hate the nursing
industry as much as I do!
PT
PT, Your comments make me wonder what exactly is it that you would wish others harm and why you feel that it would change the system to inflict harm on innocent patients of both genders.
Your positions has no merit and is destructive as well as mean spirited
But anonymous, isn't that what our government and our
society did regarding discrimination and affirmative action.
Suppose you are a white woman applying to medical
school with a 3.85 gpa, medical experience and high mcat score but were denied acceptance. Only to learn a black woman with a 3.25 gpa and lesser qualifications was accepted over you. Got news for you,it happens all the time. Tell society that they are mean spirited and harmful for discriminating against you. If society would stop discriminating against blacks this wouldn't happen.
Perhaps the entire female dominated healthcare
industry should take a clue from affirmative action and
it's lessons and stop discriminating against male patients.
PT
The latest allnurses mockery of males and their anatomy. They obviously think this is funny.
http://allnurses.com/cna-ma-nursing/things-we-think-702874.html
From the allnurses link:
" one of us is bound to be marked as 'without compassion' shortly!"
Read all the comments. They are not at all uniformly directed to the male gender nor all to patients themselves.
Every healthcare provider is human and, if conscious, has thoughts which come and go with the situation. These fleeting thoughts, to me, as being a behavior of the human family, are less important to me than what the healthcare provider actually does in attention and care for the patient.
I say: let these be unspoken thoughts. It is what you finally do which is more important.
Anyone disagree? ..Maurice.
"I say: let these be unspoken thoughts. It is what you finally do which is more important."
The problem is, Maurice, that these are not "unspoken" thoughts. There out there on the web for everybody to read. If these kinds of statements circulated in the nurse break rooms or just among nurses, I could agree with you. But these thoughts are public.
Patients use the web to do all kinds of medical searches to learn more about their condition or the condition friends and family. As they search the web, they come into contact with threads like this on allnurses and other medical blogs. It's not as if the patients are looking for this stuff. It just turns up.
Threads like this diminish the profession of nursing. Sure, we can all agree that they're human like everyone else and subject to human foibles like the rest of us. But by broadcasting it over the web, these nurses compromise their maturity and professionalism, and also make patients wonder how well they are able to honor HIPAA in reality if they do things like this. What else are they sharing in public, patients might wonder? This all said -- we're assuming they are indeed nurses writing these posts -- we don't know for sure they are.
But the management of allnurses, by allowing unprofessional content like this on their site, are doing no favors to their profession.
I do agree with you that -- "It is what you finally do which is more important." But...when patients read threads like this, they may begin to wonder about what's really behind the surface compassion, caring and professional treatment. What will they later write about patients on the blogs or laugh about in the break room?
OK Doug, would you then say that I failed in my duty as a moderator for this ethics blog by not deleting the comment with the link? There has been many links to allnurses website on this thread in the past many referring to poor nursing behaviors. Should I have rejected those visitor written comments?
"Unspoken thoughts" I was referring to was "unspoken" to the patient or family with the healthcare provider's actions speaking louder than thoughts. "Spoken" to the public via a website: I wonder if that is another matter. I might say, let the public decide the neutrality, beneficence or maleficence of those thoughts related to the goals of the medical profession. Perhaps that is the reason I permitted those links to be published here.
By the way, this allowance is much different than allowing ad hominem and non-constructive remarks about individuals or other derogatory comments about specific persons without without reliable documentation and that person's chance to respond. I will reject such postings. In the case of the nurses on allnurses.. they "speak for themselves" and should face any consequences for their expressions. ..Maurice.
Regarding the comments on all nurses,"things we think"
This is a female cna who went from things we think to
things we do. She was arrested.
www.theindychannel.com/news/28624661/detail.html
Maurice,sometimes I think you are in denial. Does it
bother you that these things happen in healthcare.The
problem, these are not isolated incidents. They happen
every day,they very well could happen to you. There is a
tremendous potential for this blog that through these
discussions, perhaps no patient would ever have to
experience any of this.
PT
"OK Doug, would you then say that I failed in my duty as a moderator for this ethics blog by not deleting the comment with the link?"
One can't discuss whether a behavior is ethical or unethical out of context. There must be something specific to discuss. You provided the context for this discussion by publishing the link. So -- no, you didn't fail in your duty. You provided a link to material that was already out there -- you didn't solicit that material. And by the way, I find absolute no value in threads like that one on allnurses. What's its purpose -- besides, using patients stories as form of ranting, and entertainment, and laughter.
Let me ask you a question, Maurice -- Would you start a thread on this blog that had no purpose other than to provide a place for people ridicule others merely for the sake of "venting," and "ranting" and entertainment?
Doug, what has been been, in part, written to this Patient Modesty thread has been "ranting" (m-w definition: "Speak or shout at length in a wild, impassioned way") and venting (m-w definition: "Give free expression to (a strong emotion)". As one can note, my bioethics blog permitted the above but with attention to excluding ad hominem or other criticisms of specific individuals without documentation or opportunity to respond. However, it is not for entertainment but for education and discussion. So go ahead and rant and vent but also provide documentation to support the view presented.
PT, thanks for the compliment but I doubt this one blog has that much clout to prevent the incident that you documented. ..Maurice.
These are not "unspoken thoughts". These are now verbalized for all to see. This is the same as having been spoken. This is a passive/aggressive way to communicate.
I think allnurses functions as one giant break room. They know they can’t say to the patient what they are really thinking, most patients would file a complaint. So they do the next best thing and that is to wait until they get into the nurses station or break room (allnurses) and have a great time at the patient’s expense. The patient doesn’t know what’s being said so they aren’t really harmed right? I think even thinking these thoughts indicate disrespect for the dignity of the patient. It is unprofessional behavior. We've all heard the phrase, “You are what you eat.” The same principle applies to your thoughts. You are what you think. I have seen allnurses posts that make fun of obese women but never their reproductive anatomy the way male reproductive anatomy is made fun of. Female nurses seem to be able to get away with this, and Maurice you give them a pass too, hey they're human. And I agree with PT, Maurice you are in denial.
"However, it is not for entertainment but for education and discussion."
You can make a good case for you blog, Maurice, but I see absolutely no educational purpose for threads like the one shown on allnurses. It's merely for the personal and emotional venting of the posters. They feel better by making fun of the patients the work with. Recall in past posts I talked about strategies that medical professionals can use to deal with these issues of stress and nudity. Some strategies protect the health care worker and can actually harm the patient. Threads like this on allnurses perhaps act as vent for nurses, but they also harden them and gives them the illusion that these kinds of thoughts are harmless, even when posted on the web. Thoughts like this are not harmless. They enter into the psyche and influence not only attitudes but potentially even behavior.
The link I provided above was of a female cna who
thought it was funny by the manner in which a male
paraplegic defacated into a bedpan. In fact, she thought
it was so funny that she took a picture and posted it
on facebook. She was arrested.
The correlation with this incident and the thread on
all nurses, things-we-think, demonstrate just how
disturbing thoughts to actions are closely linked.
Not just was this on a cna,ma thread, rather registered nurses were in on the laughter as well. Even more
remarkable is the fact that one poster has the
audacity to put her picture on her posts,while making
derogatory comments about male genatalia.
Can one with a medical certificate such as a cna,ma,
rn or lpn be held accountable for unprofessional comments while off the job. Certainly, posting your
picture along with these comments is comparable
to posting derogatory comments on facebook in the
eyes of most employers.
Most of these posters on all nurses somehow feel
they are immune only because it's a nurses site, I
beg to differ, and I believe they can be held accountable.
Maurice,please don't take our comments personally,
we want solutions and the medical community needs
to take a real closer look at this.
PT
I want to clarify my postion on the topic under discussion. This thread on alllnurses isn't an allnurses problem. It's a societal, a cultural problem brought about by the new technology of the web. Allnurses is one place where it shows up, there and on other medical blogs. The whole notion of "privacy" is changing in our culture, and a new generation views it differently. Young professionals in all kinds of fields see the web as place to post almost anything they're thinking. It's so easy to put out there, and so difficult or impossible to take back.
Also, as I've said before, I don't think threads like the one presented represent the majority of nurses. A significant minority, yes, but not a majority. But here's the danger as I see it: The new generation of nurses represents to a large extent the new attitude toward privacy. They may view it differently and in a less restrictive way. Also, I'm quite concerned with the student who graduates high school, takes an 8-week CNA class in the summer, and then goes to work in a hospital or nursing home. They also carry with them this new world view about privacy - and I see little ethical training in their education, which is mostly task oriented.
So -- my point is that this is a cultural problem. But, as I've said before, when it infiltrates the medical profession, the stakes are so high, that it represents a special danger that needs to be addressed by those in charge in a more direct and serious way.
To both Doug and PT: You both see now why I permitted my visitors' commentaries and the url of allnurses to be published here. It was for the education for those who visited our thread. The providing of the url meets my requirement for the resource documentation which I hope everyone who makes bold statements here will provide. I won't make a comment about what I think about allnurses website. I haven't followed all their topics and I am not aware of their policies. But I leave it up to my visitors to find the good or bad stuff and provide the documentation. I would say, however, that it is allnurses decision and the anonymous nurses who write there to decide on their own whether such revelations and "education" presented to the public improve or harm the profession of nursing despite possibly being somewhat self-therapeutic to those nurses. ..Maurice.
"To both Doug and PT: You both see now why I permitted my visitors' commentaries and the url of allnurses to be published here."
You've lost me. The comment above doesn't make sense to me. I'm not sure of what happened that all of a sudden caused me to finally now "see" why you permitted the URL on your site. I never disagreed with you putting the URL on this site. Your site represents an informed discussion about an ethical issue represented by that URL. My comments are completely relative to the allnurses site. Not to yours.
Doug, I guess I got lost too. Therefore, let's continue a discussion regarding what we all would consider the best behavior of the medical system and the best way to achieve such a goal since there now appears to be behavior which is considered far from the best. ..Maurice.
Maurice said
"decision of those nurses who write such revelations
and education presented to the public improve or harm
the profession of nursing despite possibly being some
what self-therapeutic to those nurses."
Absolutely, I feel so sorry for the one female cna
who said " my sex drive is ruined for life cause this old
male resident with dementia walks around partially nude."
Its sad Maurice, this little cna, to go through all of
that. You would think she would have been warned
before she became a cna,that something like this
could happen. Now you know Maurice, this kid could
have done something else, studied particle physics,
plant morphology, linguistic anthropology.
Yet she chose to work as a cna and now look, she
needs an out, therapy. Something that's self-therapeutic, something that let's out some steam. An
outlet that belittles her work and the values of others.
Making fun of male anatomy and her patients,but
Is it self-therapeutic,really or just frustration for the
limit of her intellectual ability.
PT
Hooray! Today's New York Times tells us that more men are going into nursing. How about that?? ..Maurice.
Maurice: The comments following the article are more interesting than the article itself. They give tremendous insight into gender attitudes in this country. Although in the minority, I'm surprised at the sexist stereotyping and general sexism that shows up on both sides. Some women resent men entering into female dominated professions, some women don't, some women are happy. Some men see this as the feminization of men and a few see men in nursing as all gay. Very interesting comments that shed some light on the big picture of this topic of patient modesty -- although not one comment mentions that more male nurses will give some men the opportunity for same gender care -- not one comment about that - which is a clear indicator of how off the radar this topic is.
May I suggest that the visitors to our thread here quickly (before it closes down) write, write directly to the New York Times article and present your views. Times distribution and readership, I am sure, is far,far greater than my blog. Use this as an appropriate opportunity for advocacy! ..Maurice.
I received the following comments today written to the now closed to posting "Naked". ..Maurice.
I recently had an open partial nephrectomy, while in pre-op I got the usual IV set up put in place, the usual questions ask and lay there with a gown on. My head was to the wall and my feet to the open area where everyone could see right up the gown to the forbidden zone. This area was for patients and medical staff or so I thought. However many family members were sitting with their patient. I was there for 3 hours, in holding because the OR was being used. When my turn came the Doctors and OR nurses came and said you up it is your turn now. they wanted to give me a shot to make me more relaxed and I refused it saying lets get it done. I was covered more modestly all the time in OR than I was in pre op or recovery. Same gender care was not available for me so I had to allow what nurse was available to care for me. I was even rediculed for asking for it. I was checked by both male and female, interns or residents I do not know which, with doors open to halls, so when it came to walks I sang songs about the Moon, it got chuckles and was the subject of more than a few conservations. they even ask my doctor to tell me to stop that. J
The nursing industry calls themselves the most
trusted profession. Yet, I cannot think of any industry,
profession, who makes fun of the genitals of their
clients,buyers,purchasers,patrons like nursing does
of their patients. Re: allnurses thread.
Recently, I visited a diagnostic imaging site,physical
therapy site and a respiratory site.Unlike allnurses, I had to create a user name and password to gain access. I did not find one single derogatory comment among these sites that referenced a patients genitals.
Doug, these kinds of behaviors existed long before
the Internet came along. The Internet is just a new
medium that exploits patient privacy, promotes patient
identity theft and lowers patient standards of care.
PT
A visitor to this thread wrote the following e-mail to me this morning. Though the issue was not modesty, it was about the need for a proper professional response to the request of a patient and I thought it was appropriate to post here. ..Maurice.
doktor mo: i love your blog on patient modesty and find it very interesting and informative. i would like information on the procedure of catheterization of the male urinary bladder. i preface this by stating i am not in the medical profession and certainly am not suggesting that medical providers knuckle to my will, or that i am doubting their treatment regimen. i am simply one person with extenuating circumstances concerning delivery of healthcare to me, which is why i write this letter. when it comes to urinary catheterization the gender of the nurse performing the procedure has never mattered to me. it is the pain involved that concerns me. when i am a patient in a hospital or emergency room, i have no desire to refuse whatever intervention is recommended by examining staff. i just do not want to hurt. i am so very squeamish about being catheterized and expect it to hurt soooooooooo much that lying in bed calmly cooperating is not remotely possible. i have seen an instructional video on you tube in which a live male patient is catheterized by a female nurse who informs him that "this is going to be uncomfortable and i need you to relax as much as possible". i have yet to meet the man who, when being approached by a nurse carrying a footlong tube the approximate circumference of a pencil, and knowing where she intends to insert it, who would be induced to relax. as she begins the insertion and he commences to squirming and moaning, she tells him "i'm sorry. i know this hurts. i know this hurts. try to relax" i have questioned, with both my anxieties concerning this and the knowledge of the inserting nurse that it does indeed hurt, why i could not be sedated prior to having this done? the typical response was from an emergency room nurse who stated that the risks of sedation were too great and that no ER physician would order sedation for such a minor procedure. minor to whom i wondered? i welcome the nurses' input and agree sedation is never a good thing, but it boils down to a question of how much pain i can tolerate without being sedated. this should be a group decision, but with me having the final say. in my quest for information concerning the actual reality of catheterization, i have been asked why i wanted to know, why i question the system, etc.. the biggest problem to me is no response at all, simply ignoring the question alltogether. this is what fuels my greatest concern-------------which is in order to obtain the best healthcare possible, i must become a meek, unquestioning patient with no say, blindly accepting whatever the staff dictates. sometimes i think complete avoidance of the whole healthcare system is preferable than just blind submission. surely there be a better method of distributing healthcare incorporating the true and best interests of both provider and patient, and acceptable to both. thank you very much for listening and request that you please respond, even it is only with directions to the nearest mental hospital!!
Remember, it's all about them.
BJTNT
The business model of medical operations{MO}is a bureaucracy. That's why we are called patients and not customers or clients. The government and insurance companies are the customers of medical operations, so why should the MO administrators listen to us other than as an element of public relations which seems to be ingrained in our society.
We need to team with the MO administrators and lobby the government and insurance companies. One tactic may be to propose a Patient Modesty Officer {PMO}. The administrators would be an easy sell because it would be another expense plus a per cent profit for their MO. Even a PMO would accomplish little, if anything, but just the title in MO would bring awareness of patient modesty. Yes, this is easy to say, but it's tough to do.
BJTNT
My recent article on how the mass media covers issues of men's health has been reposted on the widely read blog KevinMD. Please take a look and contribute to any comments.
Read all about Planetree since it seems such a patient-centered organization and institutions would be just the appropriate place to participate for those on this blog advocating change in the medical system and attention to patient modesty. Here is "About Us" from the website. ..Maurice.
About Us
Since our founding by a patient in 1978, Planetree has defined what it means to be patient-centered. Planetree’s philosophy is based on a simple premise: care should be organized first and foremost around the needs of patients. To understand those needs Planetree turned to the source. Thousands of focus groups—from bedside to boardroom—with patients, long-term care residents, families and professional caregivers across the globe have borne out their needs and desires for a more personalized, humanized and demystified health care experience.
Bringing these concepts to life requires a shift not merely in operations but fundamentally in culture. Planetree guides providers through a structured process that enables caregivers to transform the health care experience they provide.
Planetree has a 30-year history of partnering with providers across the continuum of care to transform organizational cultures. It’s about creating culture change and delivering health care that is putting the needs of individuals first. By partnering with Planetree, providers across the continuum—from large, urban systems to small, critical access hospitals and long-term care communities–attain the expertise, tools and support needed to transform their health care experiences for patients, residents and caregivers alike. Presently, Planetree’s international membership is comprised of more than 500 organizations from five countries. Additionally, Planetree was selected by The Department of Veterans Affairs (VA) to collaborate with the new VA Office of Patient Centered Care and Cultural Transformation in the development of the VA’s own patient-centered care model for Veterans who receive health care services at VA’s more than 1,000 points of care across the nation.
Maurice
Not to sound as if your contributions are
diminished, but patient centered care means nothing
to me. As I've mentioned on another discussion it's
a redundant idea,an illusion and probably a marketing
idea at best. As you mentioned, there were no provisions
for same gender care by Berwick, when are people going
to get it.
PT
As a woman, I've appalled with the way the general medical profession handles (or doesn't handle) patient modesty, and their seeming obsession with having access to the genital area. In the past I have been denied everything from allergy tests to antibiotics for ear infections due to my refusal to submit to a PAP smear. So be it, I now turn to alternative medicine for what I can, and suffer through the rest.
My 60-year-old husband never quite understood my views since he'd only gone for random physicals and never experienced anything untoward. However, he rcently underwent an outpatient surgery to have an ICD device placed in his shoulder, and now he understands.
He was required to check in to the hospital 2 hours before his scheduled surgery time. A nurse came in and gave him a gown and told him to remove everything including his underwear. She wrote something on a chart and repeated "Now don't forget your underwear." Then she adjusted the bed and a third time said "Remember to take off your underwear." I could tell she was making him very uncomfortable with her repeated focus on his underwear, so I firmly told her to Back Off. I told her he was neither deaf nor mentally impared so I was certain that he understood her directions, and I asked her to leave. She left, but he was visibly shaking as he got changed. And then we sat there in that room for 2 hours, with literally nothing else happening beside a nurse coming in 1 time to take his blood pressure (which was higher than usual). Finally nerves got the better of him, and he slipped his pants back on so he could walk around the room a bit. Like she had radar, a nurse came in shortly after and berated him for not having all his clothes off. So he took off his pants again and laid in the bed for 2 more hours while nothing happened.
Finally a man came in to take him down to the pre-op room. My husband was allowed to go to the bathroom before being wheeled downstairs. And as he asked me, WHY did they insist on him being nude under a butt-revealing short gown for all that time? Could he not have just been told to change when he went to the bathroom? It seemed like nothing more than a tactic to upset him and make him submissive.
Once in the staging area, a nurse cleaned the shoulder area, inserted an antibiotic IV, and jokingly told him not to go anywhere. The she flipped up his sheet a little and joked "Not that you're dressed to make an escape anyway, right?" before she left the room. Wow, what a way to humiliate a frightened man and emphasize his vulnerability. My husband went a little nutters at that point, asking me to remove his IV and bring him his clothes so he could leave. I had to beg him to go ahead with the potentially lifesaving procedure.
Afterwards he was supposed to stay in recovery for an hour (where I wasnt allowed to be)before being returned to his room, but it didn't work out that way. I don't know what happened in recovery, but he came walking up to me in his gown and asked for his clothes. I gave them to him, he changed in a bathroom, and we left.
Now he says that when the battery on the ICD wears out, he won't go back to have it replaced. He says the thing can just "Sit in his chest doing nothing" because it "isn't worth it" to have to go through all that.
Nornally my husband is the apitome of a rational thinker, so obviously their techniques really upset him. I'm sure he wouldn't have made such a rash end decision if they hadn't insisted on making him lay around for 4 hours feeling humiliated with those 2 nurses making an issue of it, when there was no need for it. And they wonder why people don't go in for needed tests and procedures? What's wrong with our medical society?
When you work for the demi-god, you are an angel and patients are mere mortals. This culture has evolved into the PCC syndrome - Power, Control, and Convenience for the medical operations employees. Assume this premise and see how much this describes what you observe in medical operations.
The unfortunate element of the PCC syndrome is that the employees can practive it with impunity. There is no management to crack down on them. The MO administrators are only concerned with implementing the medical committees and ownership policies. The supervisors are promoted employees with the PCC mindset. And MDs only want to "see patients". So, the kids get to run the candy store.
On the other hand, as POGO stated in the Walt Kelley cartoon of the same name "We have found the enemy and he is us." We expect [and I think rightly so] high standards from medical operations{MO} because our health and even our life can be at stake. But, to the MO employees it's just a job. It's just a job with some nice perks {PCC}.
BJTNT
NOTICE: AS OF TODAY MAY 30, 2012 "PATIENT MODESTY: VOLUME 48" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 49
Post a Comment
<< Home