Continuing on with the discussion regarding issues of physical modesty in the context of medical care, there continues to be debate throughout these Volumes as to who is responsible for the contested inequalities in attention to these issues and what is necessary for the resolution of these issues. Is there a conflict between the male and female gender, working apart, in attaining their own individual modesty goals or should both genders look to each other's physical modesty needs and desires and stand and work together to change the medical care system to meet all their goals? I suspect the latter is the wisest. Perhaps the best suggestion for both genders to become active to the same cause and to get together on a website to develop tools for advocacy. I would suggest checking in at Suzy's site where the goal is to do just that. Here is her description of the Mission Statement and Goals:
MISSION STATEMENT:
We believe that each patient is an individual and as such has specific preferences and needs including what accommodations they require to maximize comfort when their modesty must be compromised in the medical experience. Our mission it to act as a liaison between patients and providers in establishing, understanding, and executing the policies and procedures essential to that end. When appropriate we will act as advocates for patients to achieve that goal through interaction, education, and referrals to both patients and providers.
GOALS: Our goal is to help patients achieve dignified and respectful healthcare through education and information. Everyone has different needs and expectations of their healthcare providers, and we provide choices and options in obtaining those needs. We understand that modesty, privacy, and respect are primary needs when facing procedures and we promote educating providers in the sensitivity of those needs.
ADDENDUM (12-23-2011)
On 12-23-2011, Belinda wrote the following comment : Going back the the "Naked" article, it would seem that now is the time to write protocols for exams with dignity at the forefront with equal accessibility as needed for any kind of exam making draping practices uniform. It would give patients and idea of what to expect and do as much to relieve the awkwardness of such an exam. Any thoughts on this?
I responded with the following:
Belinda, an EXCELLENT suggestion! In fact, to make the suggestion even more productive.. how about the visitors here (even you PT) together create a final consensus list, a series of suggested protocols for attending to all the patient modesty issues experienced in medical care. The development of the list can written to this blog or Dr. Sherman/Doug Capra's or on Suzy's blog.But not just writing this protocol list to our blogs.. the final consensus list should be sent to Dr. Atui Gawande who wrote the article "Naked" in the New England Journal of Medicine and which was the basis for our entire series of Volumes on patient modesty. As some of you may know, Dr.Gawande is now a very well respected individual for his analysis and writings about a host of important medical issues that need fixing or change. By this project on our part, this may be the most direct way, through Dr.Gawande, to get something moving rather than repeated moaning and yearning on our blogs. How is that for an idea? Again, thanks Belinda for a suggestion to get us all "off our butts" (so to speak).
..Maurice.
Graphic: "Man and Woman Apart and Together"-Classic icons modified by me with ArtRage.
NOTICE: AS OF TODAY JANUARY 11, 2012 "PATIENT MODESTY: VOLUME 46" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 47
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Sign in nowsuzy -- The essence of what you state above is contained in the law. One problem is, most men aren't willing to fight it. It's considered unmanly, not macho, and most certainly, politically incorrect. I wonder how many men that Dr. Twana Sparks assaulted either pressed criminal or civil charges. Has anyone checked? I'll bet none of them did. In the case with the middle school boy who was stripped by middle school girls and exposed on the web -- they key is that his parents didn't pursue in court. No criminal charges? They certainly could have gone for civil charges, pain, suffering, etc. -- made the other parents "pay." But they didn't. I think we'd be surprised how the courts would stand behind men and boys if they would only use the courts.
Another point. The recent nurse, Terry, who showed up here and disappeared -- I have no way of knowing why she hasn't returned so I'm just making an educated guess. But my experience is that a significant number of medical professionals just don't what to "discuss" this issue. Like Terry, they have their opinion, and that's that. When confronted with valid questions that challenge their point of view, they just don't what to engage. I surmise they just don't find the subject worth debating. That's what may have happened. If not, and Terry is still reading these posts, I'd encourage her to really engage in this discussion civilly with us and be willing respond to civil challenges to her opinions.
Horrible that this is the typical HONEST response if you talk to guys in medicine today. Which just shows there will always be an element of sexuality present in any kind of a male/female female/male exam.
Also, I also still hear, from doctors and nurses, that they are "OK" with examining patients of either gender. My sister,who is an RN was musing about how she would feel examining men's penises in her new job for planned parenthood. I say what about how the poor guy feels?
Docs and nurses still don't get it; its not about them, it's about the patient.
Anne
Joel, you express that it's hard to imagine "a patient"- you don't say woman, being uncomfortable with ekg/heart procedures and Maurice, you say you can't imagine "any patient" - (you don't say woman which shows you are not thinking of patients as people) with a severe heart problem even thinking about modesty concerns. Well, neither of you have breasts! How would you feel about a female attaching electrodes to your penis or a female doctor dong a procedure there? Why are you forgetting that a women's breasts are sexual organs? Why does society not recognize this? I think it's because it's more comfortable for people in the medical profession not to. Anne
States. At that time there were about 2.3 million
registered nurses and 700,000 licensed practical nurses,
thus about 3 nurses for every physician.
There are very few physician associations in the
united states,yet thousands of nursing associations.
As an example, here are a few.
American association of colleges of nursing
American association of critical care nurses
American nurses association
The list goes on for another 387
Then the list starts again for another 256
Association for black nurses,one in every major city
Association for Hispanic nurses.
Association for Asian nurses
Association for native American nurses
Association for Indian nurses
Why are there so many nursing associations and
what are their functions. Interesting thing about these
associations are that not one of them mentions anything
about patients, it's all about nurses,it's all about them.
PT
I’m not an MD, but I’m a nursing student. In one of my classes, a lawyer from my university’s medical center spoke with us about legal issues that we may encounter in the future. I remember him speaking about assaults and warned us to never touch a patient if a patient tells us not to touch them. Any unwanted physical contact would be considered assault even if it’s just a harmless, light touch on the hand. I read a story on this blog about a woman who did not want residents touching her or examining her as she was going into labor, but felt that she had no choice or say in the matter. After reading this, I immediately thought that this would be considered an assault. There was no medical need for residents to examine her. It was just practice for the residents. She went on to write that no lawyer would take the case because it was considered standard procedure. No lawyer would take the case, because lawyers are after money and this would be difficult to get a sizeable settlement, but she could have gone to the police and speak to them about her concerns. The police can charge a person for assault and the DA’s office can prosecute. Large hospitals usually have the actual police on site.
On another note, nursing students must complete an L&D clinical. We’re paired with an L&D nurse and we shadow them during their shift. Nursing instructors know that some women are uncomfortable with a male nursing student especially when they are giving birth, but here’s the dilemma, male nursing students must also complete the L&D clinical. To solve this problem, nursing instructors just don’t ask women if they are okay with a male nursing student taking care of them, but the women can refuse and I hope women know they can refuse. They just have to speak up.
Please don’t assume that just because someone is well-educated and has a professional degree, that he or she will have the highest moral values. I worked for a female anesthesia attending at a large university teaching hospital and she experiences sexual harassment constantly from so-called peers. She is mostly in the OR and has described the OR as a male locker room. If surgical attendings don’t treat their peers with respect, why should patients expect anything different from attendings or maybe even residents?
In one of my nursing classes, we have to learn to give breast exams. I’m not sure when nurses will have to perform this exam, but I had to learn it and practiced on a prosthetic breast. We were placed into groups of four and there was a male nursing student in my group. He seemed to enjoy giving a breast exam too much and had a very perverted look on his face. We were all supposed to take turns giving the breast exam, but he wouldn’t let anyone else near the prosthetic breast. I was the only one who spoke up. I told him he looked like a pervert and the rest of the female nursing students need to practice as well. The other female nursing students thought I was too sensitive and quickly dismissed my concerns that this guy was being a pervert. After my outburst, this guy became the most considerate and reserved guy towards the female manekins.
SN
There appear to be a lot of things contributing to this paticular aspect of the issue. The view that men don't care or even like it is deffinately one, the view that female providers are gender nuetral and male providers are potential molesters, is another. I live in a small town, the only male nurse at our hospital not only quit the hospital, but the profession. I asked him why, he shrugged and said a lot of reasons, mainly I got tired of being treated different like I couldn't be allowed to do what they do, I wasn't one of the girls, after awhile I just gave up. I hate our letigonous society, but perhaps its time to do what women had to to gain ground, sue them and put the fear of a lawsuit in their mind, it seems to work. I hate that, but really, its what seems to get their attention.,,,alan
If Twana Sparks was a male doctor and the patient was female....the doctors license would have been revoked for good! (and that would imho be the appropriate response!!!
http://www.outpatientsurgery.net/resources/forms/2010/pdf/OutpatientSurgeryMagazine_1001_ent.pdf
I have a serious and practical suggestion for you to give you students based on my personal experience.
Please have the doctors ask the patients to lower their own underwear...there is a violating feeling and loss of control when it "is done" by the doctor. I am male, but I think this would be helpful for both genders. I've had doctors do it both ways....and I feel much more in control and respected when I am asked to do it.
Another two cents,
thanks,
Jim
It is similar to an abducted person being asked to strip themselves instead of others.
Nobody knows how they will feel because we are all different and so are our experiences.
Therefore, it is up to the MD to explain what is going to happen and who will be in the room when it happens. Then, ask the patient if they are in agreement and give them the choice of how things will be done.
belinda
Good point. We are all different and our personal experience colors our perspective. (As i explained above, I was traumatized by a doctor that undressed me when I was 12 years old.) However, asking if the patient is "in agreement" is a formality in most cases, because, as discussed above, the patient is "under duress" and most would never say "No" or disagree with a doctor.
I guess the bottom line is doctors need to treat patients with respect and include the patient by explaining "what" and "why".
I once went to a doctor that, while examining the genital area, kept saying "I'm sorry, I'm sorry...I know this isn't pleasant (he did not know my history)to me that was over the top...I was thinking...you shouldn't be "sorry" unless you doing something wrong or maybe, he was uncomfortable....Hmmmnn
Jim
This should be encouragement to everyone to speak up.
Mark
I had the very similar experience with my ultra sound. I was very encouraged not only by what the did, but the attitude toward me bringing the issue forward. The question now is how to get more men to step forward. Suzy and I are working on a website that we hope to lever to become more interactive with providers. If anyone wants to move from posting to becoming engaged in the process you are invited to join in at the link Dr. Bernstein has posted above....alan
Thank you for following up and pursuing change at that facility.
Your experience reminds me of when I had to have a lump check on my chest (read mammogram) I AM A MALE....but the only place to send me was a womans clinic that that did mammograms. It wasn't awkward in the exposure sense because I only had to take off my shirt.....BUT the staff was so awkward..they had no idea what to do with me...they didn't want me in the waiting room so they had me wait in an x-ray room that wasn't being used ...then the machine wasn't designed for a mans chest so the technician had some trouble getting a good image...then they needed to do a sonogram to double check the results....more awkward. the technician and the doctor seemed flustered....fortunately the results were negative. BUT I get my annual reminders (unnecessary in my case and a little humorous to me). And yes everyone there was female!
Jim
Each website has it's followers and serves a specific audience purpose, but I wonder if it might be a good idea to reference the other website and have people come to our blog and post how they would make it better. How it might serve more needs that we share here. It may help with the real change we are seeking. ?
Suzy
46% of the nurses in the military are male. (A small number considering the ratio of men in the military.) With the reduced overseas presence, many of these male nurses are returning to private life. I wrote to my congressman Frank Wolf to ask that these men be encouraged to use their medical background in the public medical system. As they leave the service they could receive counseling and job placement help. This is a near instant source of trained and experienced male nurses. No response yet from him. It would help if others wrote.
Mark
Great idea, now this is what we need to gravatate to. My congressmen is big into veterens affairs, the just opened a new VA clinic near me, I am going to fire off a letter suggesting he look into this immediately...alan
Washington (CNN) -- The Justice Department announced Friday that it is expanding its decades-old definition of rape to include attacks against men.
Now, any kind of nonconsensual penetration, no matter the gender of the attacker or victim, will constitute rape.
The crime of rape will now be defined as "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim," the Justice Department said.
Wouldn't you say that for the United States..this change in the definition of rape is about time! ..Maurice.
I will also be very interested to see if this changes anything in our prisons. I have seen some estimates that place the number of men raped in prison each year to be close to 140,000, a figure that exceeds the number of women raped each year. I will believe that society's attitude has changed when this is cause for prison reform, instead of jokes by late-night comedians. The definitional change for rape makes me cautiously optimistic, and is, at a minimum, a good first step.
However, I also noticed that the new definition of rape includes the following:
“It also says if a victim cannot give consent for any reason, the crime is a rape even if force is not used. That includes any victim who cannot consent due to alcohol or drug use.”
I have to wonder at the practical implications of this. For instance, if both parties have been drinking, could one of them still be accused of rape? Also, how much alcohol must someone consume before they are deemed unable to consent? Is everyone who ever had a couple of drinks at a bar and awoke to a bad case of the “oh no's” now considered a rape victim? The misapplication of this portion of the definition could harm men more than the other improvements would help them, and could reinforce the very same stereotypes that the recognition of men as rape victims might have helped to dispel.
This scenario happens all the time on college campuses and is responsible for the very high rape statistics that feminists talk of. But criminal convictions for rape on campuses are low because drunken recollections of assaults are very difficult to prove. Few of these cases are ever prosecuted.
Sexual assault crimes are defined by state law. Many have a crime called "unlawful sexual penetration". The caveat is that most of these laws have defined exceptions that clearly protect medical personnel in the course of an exam or treatment. My state, for example, lists the following exemptions:
(1) The penetration is part of a medically recognized treatment or diagnostic procedure; or
(2) The penetration is accomplished by a peace officer or a corrections officer acting in official capacity, or by medical personnel at the request of such an officer, in order to search for weapons, contraband or evidence of crime.
“It also says if a victim cannot give consent for any reason, the crime is a rape even if force is not used. That includes any victim who cannot consent due to alcohol or drug use.”
StayingFit wonders who would be charged with rape if a man and woman are both blotto when they have sex. Well, that is the purpose of defining rape as "penetration" alone, exempting "envelopment" as a crime. Under this definition, only the man has penetrated, so only the man gets charged. Radical feminists have been fighting for these changes...nuff said. For instance, a 40-yr.-old woman does not "rape" a 10-yr.-old boy since she didn't penetrate him.
--rsl
'The crime of rape will be defined as "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim" '
I think it has always been theoretically clear that a female can rape a male, but now with the words in place society will not be able to easily reject it. Without being too graphic and with the continual respect to Dr. Berstein's blog: "no matter how slight" gives us the clue that it is written to cover many biological intrusions. And although (what I read) may be vague, the term "oral penetration" does not imply automatatic guilt of inflictor (sp) or inflicted. One could read that as "She forced me to participate in oral penetration" just as easily as "He forced me to participate in oral penetration".
Suzy
http://toysoldier.wordpress.com/2011/10/20/fbi-expands-rape-definition-kind-of/
"Sexual assault of children by women is underreported because patriarchal, cultures don’t like admitting that women can be sexually motivated or use sex to wield power in aggressive and monstrous ways. That would mean admitting that some women are more “like men,” not the champions of a higher morality, not weaker, not all naturally more “nurturing.” That’s a lot of subversive information if you want to highlight how vulnerable and dependent women are. In addition, in the same environments, boys grow up knowing that to be weak or powerless in particularly when the aggressor is female is a big no-no."
I hope you can all see how this is intimately connected to male modesty. You'll find the article on this very interesting site:
http://goodmenproject.com/gender-sexuality/rape-culture-men-women-power/
Rape is any definition no matter who it happens to is a terrible thing.
However, it's not the only thing that causes severe issues with mental health.
Enclosed here is a pertinent article that deals with cruel and degrading treatment, loss of control and other such issues. I hope you will find the study both informative and interesting.
http://www.eurekalert.org/pub_releases/2007-03/jaaj-pap030107.php
belinda
When I wrote the article “Are Women Ready to Sexually "Come Out" Of The Medical Cultural Closet?” I was bombarded with hate e-mail. Half was from men who wanted to still believe that there are “women you take home to mother, and women you just take home”. Hmmm…Take all of those women and throw us in a room and you will find that each one of us is both. Ironic but true, and that tells us a lot about how society wants to see women no matter how they are faced with the facts.
By the way, the other half was from women who consider me a traitor to our gender.
Part of the rest of the male modesty issue depends on how men see gender-neutral and how women see gender-neutral.
Perhaps as an experiment, we could do a “He Said..She Said” and see where the disparity in perception lies.
Suzy
You may want to argue this point..but this is my opinion and the way I work. Show me statistics that confirm that virtually every patient will require provider gender selection to allow a comfortable but thorough examination and then my communication with that patient on the office or examination table will change. ..Maurice.
In all these volumes, I'm not sure anyone has suggested that "virtually every patient" will "require" this. I believe we're dealing with a minority of patients, but what could be a significant minority. Does this minority deserve patient-centered care to match their values? Most medical ethical guidelines suggested they do?
The problem is, and you give me the answer to this question: How do you know which ones require provider gender selection, which ones might want it, which ones don't need it -- unless you ask? How do you know? Is there some other method I'm unaware of? I suppose you can make an educated guess based upon patient behavior -- but that would still be a guess. This is epistemology. How do doctors "know" what they "know" about patient modesty? Indeed, what do they claim to "know?" Or, do some regard the whole topic as something not worth knowing? Does patient modesty not exist to some of them as a relevant concept? You ask to see the statistics. They're not out there. We don't have them. Why? Is it because there's not interest in "knowing" the statistics? If there is no interest, what does that say about the relevance of the issue in within the profession?
Of course, you can assume that, if patients require provider gender selection they'll ask for it. And when patients are empowered to make that gender selection, a significant number of them do. But as we've discussed, there a significant difference between the choice relationship a patient has with his or her personal physician, and what one encounters when one is sent to specialists and then to the hospital. I thought we've made a strong case that, under the circumstances, considering the contexts of alien environments and strange caregivers, and the power of a hospital's institutional culture, mosts patients won't "upset the apple cart," as the doctor said, whose article I quoted a few posts back.
No -- we can, at least you and I -- that all patients don't require this. No one to my knowledge is stating that. I'm certainly not.
But as I've said in the past, I don't think it's a question of a fixed stance for every patient under all circumstances. How many if not most patients feel about this issues is fluid and changes depending upon how respected and safe they feel, and that can change from context to context. My contention is that, someone who says they don't care about gender one way or other -- might quickly change that stance if they feel they're being disrespected and humiliated. And vice a versa -- someone who thinks they care about gender, may conclude it doesn't matter if they encounter empathetic, thoughtful, respectful care.
I don't think this issue is as simple as some people make it out to be. It's as complicated as human nature.
ago. Nurses stopped wearing skirts and started wearing
pants, scrub pants. I suppose that by wearing pants they
appear more male like, more gender neutral appearing
and they can say they put their pants on just like the
males do.
PT
We are all a sum of our parts. You are saying that you are gender neutral when it comes to who cares for you. Part of who you are was raised in this culture.
It is human nature based on society's norms and what we are taught for more people than not, to want same gender care for intimate exams or for a restroom attendant in a hotel.
You have been trained to be neutral and therefore, it is my strong opinion, that because you are a sum of your parts that you have this attitude (that I think is very healthy and wished we all could share).
It is also (and I have said this before) that you have no history of cruel and degrading treatment, sexual abuse or other issue with the healthcare system and that most of us have.
Think of the most humiliating thing that could happen to you, and then let it happen in a very public way. For some, it is to be publicly stripped naked (the things that nightmares make and commonly so) or...something else.
Whatever pushes your buttons you would to any length possible to avoid it from happening again.
You might remember in a former post, that I was just like you. The gender of the provider wasn't questioned, thought about and there was no embarrassment about anything medical until....
It would be interesting to know what you think about this.
belinda
It is preposterous that medical workers wear these things on the street (including the booties) and ten walk into the OR after lunch.
That's why when I go to the hospital I will never wear (and never have) a hospital gown and if I must, scrubs will do, thank you.
belinda
Maurice: In all these volumes, I don't think anyone has suggested that "virtually every patient" will "require" this. I believe we're dealing with a minority of patients, but what could be a significant minority. Does this minority deserve patient-centered care to match their values? Most medical ethical guidelines suggested they do?
The problem is, and you give me the answer to this question: How do you know which ones require provider gender selection, which ones may want it, which ones don't need it -- unless you ask? How do you know? Is there some other method I'm unaware of? I suppose you can make an educated guess based upon patient behavior -- but that would still be a guess. This is epistemology. How do doctors "know" what they "know" about patient modesty? Indeed, what do they claim to "know?" Or, do some regard the whole topic as something not worth knowing? Does patient modesty not exist to some of them as a relevant concept? You ask to see the statistics. They're not out there. We don't have them. Why? Is it because there's not interest in "knowing" the statistics? If there is no interest, what does that say about the relevance of the issue in within the profession?
Of course, you can assume that, if patients require provider gender selection they'll ask for it. And when patients are empowered to make that gender selection, a significant number of them do. But as we've discussed, there a significant difference between the choice relationship a patient has with his or her personal physician, and what one encounters when one is sent to specialists and then to the hospital. I thought we've made a strong case that, under the circumstances, considering the contexts of alien environments and strange caregivers, and the power of a hospital's institutional culture, mosts patients won't "upset the apple cart," as the doctor said, whose article I quoted a few posts back.
No -- we can, at least you and I -- that all patients don't require this. No one to my knowledge is stating that. I'm certainly not.
But as I've said in the past, I don't think it's a question of a fixed stance for every patient under all circumstances. How many if not most patients feel about this issues is fluid and changes depending upon how respected and safe they feel, and that can change from context to context. My contention is that, someone who says they don't care about gender one way or other -- might quickly change that stance if they feel they're being disrespected and humiliated. And vice a versa -- someone who thinks they care about gender, may conclude it doesn't matter if they encounter empathetic, thoughtful, respectful care.
I don't think this issue is as simple as some people make it out to be. It's as complicated as human nature.
And I don't have to tell them there are a bunch of females and an occasional male in the office environment--they can observe that on their own. Of course, what they might not know for sure is the gender of a provider who will do a nursing, assisting or testing procedure. Now, it is at that point, knowing by my description that the presence or management will not necessarily be by just me, for the patient to tell me about their gender desires if they had not said anything about that previously. Do I have to initiate specifically the issue of gender selection at this point. I think not. I have already provided the patient with a description of the participants in their care. Now is the time, if desired as part of their informed consent or dissent, for the patient to speak up about their concerns regarding what I described. If trust and confidence has already been developed in the earlier phases of the doctor-patient relationship and the patient shows to continue the relationship, I see no reason, based on inequality of power, not to expect the patient then to speak up to me their concerns. What I can do about them is another matter.
"Rocking the boat" is what I fear if the vast majority of my patients have an interest in diagnosis and treatment and no desire to engage into an issue of gender selection. If I bring up the issue personally at the onset, I am concerned it will be distracting to them with regard to the purpose of their visit ("doc, why are you bringing up this matter? I am worried about the blood in my stool")
Doug, I agree with the idea brought up earlier on this thread that, as long as we know now that there may be some population of patients with gender concerns, incorporating the gender concern question in the written admission paperwork would be a satisfactory alternate to the doctor directly and personally bringing up the topic. ..Maurice.
You write: "I have already provided the patient with a description of the participants in their care."
Here's where I think there's a disconnect. I don't know what you personally do, but my research and experience indicates that -- No -- doctors often don't go into detail relative to "participants" and who, gender-wise, will do specific kinds of "care," especially intimate care. It seems me that it's just assumed that because this is the way it is, the patient will either have no problem with it or that the patient will express his/her desires, or that it doesn't really matter how the patient feels.
You write: ""And I don't have to tell them there are a bunch of females and an occasional male in the office environment--they can observe that on their own."
True -- but we're not just talking about the "office" environment. We're talking about opposite gender chaperones, students, cna's, nurses. You say they can "observe" that on their own. No -- not unless they've experienced the ICU, or had a testicular ultrasound, or had an invasive prostate procedure, or otherwise experienced a hospital stay that involved the kind of care we're talking about. You'd be surprised how many patients go into the hospital with no idea as to what will happen to them and who will do what. And for some, that's just fine. For others it isn't. No -- they don't "know" what to expect -- and they are rarely told ahead of time who will do what, gender-wise.
This is where we seem to have a disconnect. As a patient, I would surmise many patients would feel comfortable enough to express themselves to their PCP. Some maybe wouldn't. But all that changes as the patients moves through the system and eventually finds him/herself in an alien environment where he/she knows nobody and doesn't really know what's happening. If patients say nothing, too often caregivers interpret that as "No problem." That isn't always the case.
On the other hand because of your position I believe the intimate "details" will be noticed. If they are discussed in the break room depends but more likely for you then me.
Just because "you don't have anything they haven't seen before" doesn't mean they are mentally neutered.
Mark
It seems that the healthcare system through it's training have some kind of brainwashing mechanism that destroys their sense of humanity and patient dignity, that it is a lost concept without boundaries.
The reason that I say this is from my research into the medical industry and the way it works, what sometimes happens to patients, and the egregious lack of dignity that would humiliate anyone.
Forced nudity is the first protocol in torture. It makes one submissive, humiliated, lose control and all that destroys the very soul of that person. For all intense purposes, a patient who doesn't know it's coming, or doesn't know that the room will be filled with people (and only consented to a procedure) can be traumatized. There is a difference between humiliation and trauma but so often they are linked together.
Let's pretend that we, on this blog are a minority. Doesn't the mental health and overall well being of that patient count? Isn't their outcome just as important as a good medical outcome. If one answers no to this question, then the entire medical foundation "to do no harm" no longer exists.
The medical community must recognize the dynamic of what's happening in order to make changes necessary to protect all. Every day someone else is either abused or feeling abused and that just creates more of us.
Because of this, it's just a matter of time that change will come probably through legislation rather than the medical system. For this, I have lost much respect for a flawed system, knowing the damage they cause and the unwillingness to protect their patients.
This is a problem that needs fixing.
Take away the unexpected and you take away trauma. The medical industry (yourself included) pretends that this gender issue doesn't exist. The only place it doesn't exist, is in the mindset of the medical community and the arrogance of that community not to recognize that human beings have feelings and deserve validation; just as the medical community enjoys for itself. In fact, more so because we're paying for your services.
So, I ask you these two question. What is happening in medical training that makes this community have a disconnect with humanity? Secondly, how do you propose to fix this.
belinda
In the environment in which I have control this is what is going on. There is no unexpected situations, loss of control or declared feelings of humiliation by our patients. I have no control over what happens elsewhere and since reading these Volumes, I have been educated that there is a group of patients of unknown numbers who find the medical system they experience leads to unexpected and perhaps unwelcome situations, a feeling of lack of control and humiliation. I have never said to my visitors to ignore doing something about these observations and feelings. I have said repeatedly for them to speak up, get together in an advocacy group and educate the rest of the medical system who haven't read my blog or Dr. Sherman's or other blogs where these concerns have been discussed.
I have written, the last with Doug, two articles to the AMA News on this very issue and I have recently been informing my students about the views expressed here. I continue to practice and teach attention, for all patients, to potential concerns for bodily modesty and the need to inform patients what they may experience nest. That's all I can do, myself. It is up to you Belinda and the others to go further. ..Maurice.
Mark
Mark brings up an interesting point when he writes: "because of your position, I don't think your personal experience with opposite gender intimate exams will be the same as most of ours."
There is some truth to that. Unless medical professionals go out of their way to make sure no one knows who they are, they may be treated differently, out of "professional courtesy." Recall the article a posted about the doctor whose wife was embarrassed and humiliated when she got a bed bath from a male nurse -- and how his eyes were opened as to this modesty issue. Note the article below, in KevinMD, by a doctor who talks about the unfairness of how a significant number of medical professionals are treated when they need medical services, as compared with the general public.
http://www.kevinmd.com/blog/2012/01/healthcare-system-unfair-unbalanced.html
This is not uncommon. When it doesn't happen the way described by this doctor, professionals get a real insight into how the system works -- the good, the bad and the ugly.
Patients are not taught or encouraged to speak up.
Since childhood how many of us are told that caregivers are the major exception to the privacy concerns about our body. We are told to ignore embarrassment (or humiliation) for the sake of health. We are told to get over it, go home, and move on. We are told as children (and later adults) to stop being silly, endure what you must, and let it go. So is it any wonder that, when patients act as they are conditioned to, that caregivers say that no one ever complains about these things? Of course they don't. The medical culture has tried to condition them into the gender nuetral mindset and expect them to act accordingly.
How many time have we heard that 'Health trumps humiliation"? That is not exactly an invitation to express concerns. That's a preconceived notion that we are abnormal or unusual if we can't or don't feel that way. If people are treated as small, they become small. And worse...they become silent.
Maybe we need to consider that if they do speak up, they are not a minority in beliefs: just a minority brave enough to talk about it.
Suzy
To whom this may concern,
I am the child of a urolgical surgeon. I love the human body and appreciate its capacity to adapt to numerous situations. I have both the aptitude, the finances, and the drive to go to medical school. However, given the horrendous abuse I suffered as a child, including physical , sexual, and emotional, I can say that I would never be able to go through that again. I have no doubt that a lot of it stemmed from my father's training as a resident surgeon. These abusive practices not only affect members of the medical community (doctors, nurses, etc) but their children as well. WHY WHY WHY is this necessary? Do you not realize how many lives you ruin? Not only one BUT SEVERAL? What is being accomplished with this inhumane process? NOTHING! Every individual should have the right to achieve their potential, the hazing and abuse that goes on makes that impossible. No human being can learn and excel under these conditions. The system needs to be fixed somehow and as a result, drives away the decent human beings who sincerely have a desire to help. IF THE MEDICAL PROFESSION WAS NOT THE ABUSIVE, CRUEL, DISGUSTING SYSTEM THAT IT IS: I WOULD HAVE GLADELY BEEN A DOCTOR.
THE MEDICAL SYSTEM IS STAGE FOUR, GLEASON 7 PROSTATE CANCER. IT is uncontrollable cellular growth with few chances of repair in sight. I don't think in my lifetime, the system that transformed my father into a horrendous sadistic MONSTER will ever change. It is my one hope, before I die (I am in my 20s now) that some miracle might happen. What a damn shame.
To the post on Saturday, April 19, 2008 1:49:00PM - I know from experience the abuse that you speak of. I know that no words I write can even begin to do justice towards the feelings of horrid pain and rage that you probably feel inside. The dehumanization process that strips you of every possible bit of soul, self esteem or will to live.I applaud your decision to be a human first and a doctor second. Please be assured my thoughts and prayers are with you. If you have any doubts about your decision, please go back and read my post. Without knowing it, the choice to refuse to be molded into that model of cruelty and evil, you have made the world a better place already. Thank You.
Sincerely,
DR
For instance, back in September, I went to a prostate cancer awareness clinic, which, to my surprise, included digital rectal exams for participants. When I was escorted to the examination room, the nurse informed me that my examiner would be a woman, and she wanted to be sure that this was OK. I told her that it was, but that I was grateful that she asked. And I truly was (I'm certain that another man was, too, since he asked for a different doctor).
Prior to being informed of my examiner's gender, I had wondered if my doctor would be a man or a woman. I was not concerned enough that I would insist on one or the other, but it was something that I had considered. So, when the nurse asked my preference, she certainly was not introducing a thought that had not already occurred to me, and I suspect that this is true for most patients. It is something that we have thought about. Therefore, far from “rocking the boat”, I think that most patients, even those who are gender-neutral (but not gender-unaware), would appreciate the respect that you show them by simply asking.
What do you believe you can accomplish with
another website,more than perhaps this blog and Dr.
Shermans? I am not doubting your desire to advocate
on this subject, but I believe this problem needs to be
taken to the institutions.
In other words they are not going to come to
us,we have to go to them. In essence this is a civil rights
issue whose time has not come. It is comparable to the
the black rights activists of the 60's whereby many know
of the problem, they just don't want a solution.
Additionally, you are working against long instilled
ideals, " nursing is the most trusted profession" and so
forth. You need many examples contrary to these ideals
and you need to have some medium to present to all the
institutions. How are you going to do that? What medium
are you going to use?
The very groups whose attention you want have
no desire to visit these blogs let alone appreciate this
subject matter. I'm not attempting to dash your hopes
but I believe there are other more fruitful and efficient
ways to achieve this. At some point I'll make these steps
known.
PT
The reasoning may be connected to whether the person had concerns BEFORE something happened or...if they had concerns AFTER something happens.
While modesty is something that is instilled, I, personally, never had these concerned and never asked question about who, when where, etc. While unaffected healthy individuals may or may not have these concerns, their level of that has to be considered minimal because unless they experienced the horrific, ridiculous things that sometimes do happen, they do not have the framework of experience to know exactly what to ask for or...the awareness that they have to ask for anything depending on their individual medical experiences of the past.
belinda
There is more than one way to service change. If you have a plan, does it need to be exclusive? Are we to say " Oh...he has it covered, so well...never mind. Let's just wait and see what he comes up with."
We've been waiting along time. Some of us feel it's time to move forward. If you have a scheme to "bust-out' the system from within, then great. I would believe it when I see it. In the meantime, (just as civil rights by the way) people need to know what they want, how to get it, and what to do if they don't. Do we remember the word 'empowerment'?
That never meant let's wait for the culture to change itself. It meant, instead, let's be strong enough to force the change.
You can't have too much support...or too much groundwork for change.
If you have a plan...let's hear it and get to it!
In the meantime...I'm not waiting Superman....I have my own champions of fate.
Suzy