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Friday, November 16, 2007

Add Your Personal Story of Privacy Violations

These can be violations of confidential information such as providers or employees talking to others about your medical findings or violations of procedures or examinations, such as examining room doors left open. Violations specifically covered under HIPAA of information transfers can be listed below or see link under HIPAA.
Stories which in my estimation are likely to be fictional will not be posted.
An article outlining steps to take to complain about violations is here.

198 comments:

Joel Sherman said...

The hope is that these incidents can help us figure out what problems need to be corrected. Please post violations here and possible solutions under the section below on what we can do to improve privacy rights.

Anonymous said...

An institutionalized practice in hospitals and ambulatory care facilities is the unnecessary denudation of patients. I use the term denudation to refer not only to stripping patients of their clothing and other coverings (e.g., sheets or blankets) but also to the exposure or partial exposure of patients due to unsolicited and unwanted actions by healthcare providers. Requiring patients to wear gossamer-like gowns when more substantial garments are available and equally practical is just one example. Healthcare providers also regularly enter patients' hospital rooms or examination rooms without being invited while patients are involved in some private or intimate activity. The provider may simply enter the room without knocking, make a cursory knock and enter without invitation, or knocks and is invited in by a physician or another individual who is conducting an examination. I have intermittently experienced all of these things from the time I was a child until just two months ago.

Here are a couple of recent examples. When I was getting dressed in an examination room after the physician had left, an LPN opened the door, which struck my head and shoulder, and walked in. She apologized, not for compromising my rights to privacy and dignity, but for hitting me with the door. On another occasion, a nurse walked into the examinaiton room without knocking while the physician was checking me for a hernia. She left the door open and I could see people in the waiting room straining to see what was going on. I suppose their attention was drawn to my pointed demand that the invader leave and close the door behind her.

I sometimes lock the door before the physician begins his examination. On one occasion during an examination, a nurse tried to enter but could not because I had locked the door. When finally she was allowed in, she responded with umbrage saying, "This is the first time I've ever been locked out."

Another frequently occurring event which denudes patients is the unnecessary removal of items that cover them, thus exposing them to the uninvited scrutiny of others. When I was 17-years-old, three nurses did this to me when I was laid up in a hospital with a broken leg. When I was in ICU, I saw a fourth nurse do this to another patient at the urging of one of her colleagues. During my stay at the hospital, eight nurses cared for me, four of whom engaged in what I know now to be undeniably unethical behavior.

I naively believed that such actions were probably rare any more until age-associated chronic problems forced me into seeking care. The following represent a small sampling of denudations involving the unnecessary removal of coverings.

Item #1: I asked students to describe in writing their most humiliating experience. Several students wrote of their experiences in the healthcare system. An 18-year-old student wrote that "I was strip-searched at the time of my admission into the [psychiatric] hospital. I was shocked that I would be treated like a criminal . . . The other patients and I were frequently watched while we showered and went to the bathroom." One of those who participated was a male nurse. When the patient objected, his response was, "Im a nurse; this is my job." "These were some of the most humiliating experiences of my life," the student wrote.

Item #2: A 23-year-old college student reported that she was in a hospital to receive surgery for complications caused by Chron's disease. She was wheeled in a hospital bed to a room in which there were several male patients who were also in hospital beds. "As I lay there, these nurses came and took the sheets off two men and began to shave them. You know, their pubic hair. They didn't say anything, just took the sheets off them. . . Right in front of me, they shaved them. I couldn't believe it. I was real embarrassed. . . I was right next to this young guy [ who was also waiting to be prepared for surgery]. We just looked at each other and he shrugged. . . I asked the doctor if they were going to do that to me in that room. He laughed and said "no," that I'd have privacy."

Item #3: A college professor reported to me that he went to the hospital to get a procedure related to his cancer. He was given a shot to relax him. "The nurses thought I was asleep. They lifted my sheet and commented on how hairy my ass was."

Item #4: A young man, comatosed due to an automobile accident, was lying naked and catheterized in an intensive care unit. Without the permission of family, the man's girlfriend invited her sister in to see him in violation of hospital policy and without objection from hospital personnel (This was reported to me dispassionately by the sister.) I later saw the sister in an open VA ward, which any passerby could view, rubbing the exposed leg of and talking to the comatosed patient as his penis went up and down with different levels of tumescence. When I complained to a nurse about what I saw, she informed me that it really didn't matter because the patient didn't know what was happening to him.

Item #5: I went to the local hospital to visit a friend. As I walked to his room, I had to pass several other rooms that, unless one had blinders on, were in plain view. In one, a nurse was helping an elderly gentleman, who I later discovered had dementia, use a urinal. In another room an elderly woman lay exposed for anyone to see. I informed the nurse at the desk about the latter and suggested that the woman be covered. She took abouty ten minutes to complete her paper work before taking care of the task. Within minutes, I saw members of the elderly woman's family enter the her room. I wondered how they would have reacted had they seen what I saw.

Item #6: A graduate of the nursing program at the local university who was working at a local hospital reported to me that on one occasion, when she came into work, she was told by a number of her colleagues from the earlier shift about an elderly male patient who was being "uncooperative." It seems that he would not let them change or clean his femoral line. "He wouldn't let them touch him," she reported. When she asked them why, the response was, "He's just being difficult." The patient's chart indicated that he had refused care but no explanation for his doing so was given. When the nurse went into the man's room, "he pulled the sheet up to his neck and just glared at me." After speaking with him for a few minutes, she found out that the other nurses had approached the task of changing or cleaning his catheter by walking into his room and, without a word, "whipping off his sheet" thus exposing him. "I told him it wasn't at all necessary to remove the sheet, that all I had to do was move the sheet just enough to get to the arterial line. As I spoke to him, I could see that he was becoming more relaxed. . . I had no trouble at all."

Item #7: An employee at the school at which I teach reported that her husband went to the hospital to receive surgery for carpal-tunnel syndrome. He was told to remove all his clothing and don the ubiquitous hospital gown. He asked why he had to remove his underwear if the surgery was going to be on his wrist. He was told, "It's policy." He did not accept this explanation as legitimate and kept his underpants on. After he was anesthesized, his underpants were removed. A nurse brought them to the waiting room and in front of other people handed them over to his wife laughing as she proclaimed, "I think these belong to your husband."

Item #8: When physicians become patients, even they may experience unnecessary denudations. The following is reported by Dr. Edward Rosenbaum who wrote the book "The Doctor" (1988). "Then I was subjected to the final indignity: they took away all my clothes and gave me a skimpy piece of cloth. I'm a pretty big guy, tall and, I've been told, barrel-chested. When I tied that piece of cloth around my neck, it wasn't long enough to cover the important parts. It was far too tight and hung open at the back. I felt as nude as a newborn baby and suddenly as helpless. . . Now I was a patient, literally stripped of my dignity. I was no longer in charge, I was being treated like a baby. . . At last it was time for the surgery. The nurse came into my room and treated me like a child. I know she meant well, but it was embarrassing. She wasn't more than twenty-five years old. . . Without asking my permission, she removed the sheet covering me, and there I lay on the bed, almost completely naked. All I had on was this hospital gown which reached only to my belly button. She wanted to help me onto the cart, but I wouldn't let her; I wasn't helpless yet. When I was settled on the cart, she again covered me with the thin sheet that I was sure everyone could see through, and I was wheeled down the hall to the elevator and they all looked down on me, and again I felt naked." (page 8)

Item #9: A student in a course I instruct told me that her roommate, a B.S. nursing student, told her that when she was doing a clinical in the local hospital, she was called to "observe a catheterization." When she entered the room where the patient was, she saw a physician, nurse and several medical students. To her amusement, the patient, who was anesthetized, was a male instructor whose class she was attendintg that semester. When she went home that evening, she reported what she saw to her roommate, "laughing," according to her roommate, "the entire time." "There he was, just hanging there," she reportedly said to her roommate. After commenting on how small his "you know what" was, she reportedly added that when she went to his class, it would be difficult not to imagine him with his clothes off and even more difficult to keep from "bursting out laughing in class." The roommate was rightly "appalled" and "shocked" at her roommate's behavior. What was really disconcerting to me was when I told this story to a class of B.S. nursing students as part of a lecture on the ethical treatment of patients, they broke out laughing.

Item 10: Probably the most outrageous report I received was from a Ph.D. candidate nursing instructor who taught nursing ethics. She told me and her class of students about having observed what she definied as a sexual battery when she worked in the OR. It seems that during the process of preparing a man for surgery, another nurse "lifted his penis, pulled it out, and commented on its length and size." The other nurses reportedly "broke out laughing" at this antic. When I asked the nurse if she reported the incident, she replied "no." (note: The American Nurse's Association's third code of conduct states, "The nurse acts to safeguard the client and the public when health care. . . [is] affected by the . . . unethical or illegal practice of any person.")

I could go on and on with anecdotes. I've had my own experiences, some but not all of which I have been able to nip in the bud. I went through 14 physicians before I found one who treats me with a level of respect that any patient deserves and whose office help does the same. However, whenever I must seek treatment elsewhere, I usually, but not always, run smack dab into a culture of entitlement in which providers (from students to physicians) are inculcated with the believe that they are entitled to unnecessarily intrude on patients' privacy without their consent. Those examples and how I delt with them will have to wait until later. -- Ray

Joel Sherman said...

Thanks for your post Ray.
To my mind these infractions break down into several kinds of violations which need to be handled differently.

First there are the violations due to simple thoughtlessness or poor physical layout. By far the best way to deal with them is by complaining right at the time of the event. Complain politely and if that doesn't work complain loudly. If more is needed complain to the supervisor. Most hospitals in particular track these complaints and will respond. This is especially vital for a man as modesty is assumed for most women, but some providers, nurses, or aides just have no clue that many men care as much. They have to be told.

Secondly, some violations are just plain illegal. I believe the 9th example fits that bill. Talking about patients by name to anyone who has no need to know is prohibited under most state and I believe federal law under HIPAA. A complaint here should be followed up on by the institution with disciplinary action up to and including dismissal. Lawsuits would also be effective as would formal complaints to the state regulatory board. I would also include the hospital CEO or board of directors. Institutions are in legal jeopardy for this kind of behavior.

Lastly there is the complaint about a male nurse being involved. That is more complicated, involves equal employment rights that cover the institution, and practical restraints on staffing. You can and should make your wishes known, but the hospitals or institutions may not comply or be sympathetic to them. Here your options may be limited.

Anonymous said...

My legal sources suggest that if the facts of the cases given are correct, most of them (numbers 1, 2, 3, 4, 7, 9, and 10) could be subjected to civil action and at least one to both criminal and civil action (item #10). Thoughlessness would not be considered an acceptable defense for a judge's summary judgement. Physical layout would not necessarily be an acceptable defense. Nevertheless, I was told, defense attorneys would try to obtain summary judgements from judges, but if the facts were there, they would most likely fail. If the cases went to trial, there's no telling what juries would decide. That's my take on the matter, for whatever it's worth.

One must also add a qualifier. The most difficult problem a potential plaintiff might have is finding an attorney to take the case. The problem may not be that the patient doesn't have a good case but that it would not be efficacious for a law firm to litigate it. -- Ray

Joel Sherman said...

Ray, I'm sure you're right about your assessment of potential civil vs. criminal actions.
I’m trying to suggest though what practically would be the most likely way to remedy the problem with the least amount of time and money.
For most civil violations, immediate complaints are likely to get the best results. If I was ignored, I would then consider other options if I felt strongly enough about them. But I'd consider voicing complaints to regulatory commissions before contacting a lawyer. As there are usually no direct monetary consequences of these transgressions, it would be hard for most people to finance bringing civil cases using an attorney.

Joel Sherman said...

Here's a horror story from a male nurse on allnurses.com who says he was injured as an adolescent by a female nurse who was bathing him and got offended by his reflex erection. It is more of an actual assault than a pure privacy violation. Many other comments about abuses by nurses are given. The entire long thread should be of interest re gender preferences and discrimination.

I personally have not seen or encountered any of this. Hope it doesn't happen nowadays.

Anonymous said...

Joel: As a follow-up to the "male nurse" story, I interviewed a male college student about 12 years ago who reported that a nurse was shaving the hair on his ankle in preparation for the removal of some lesions. Without explanation, she pulled his gown back thus exposing him. When he began to get an erection, she slapped it causing him to double over. When I told this story to a nurse educator, she reported that she was taught to use a flick of her finger. However, today that would be considered to be battery, she added. She had to leave before I was able to ask her why her first reaction was to the nurse's slapping the young man's testicles rather than to his having his underwear removed and his gown pulled back by the nurse. -- Ray

MJ_KC said...

I have never had what I would consider a privacy violation based on unexpected exposure or being visible from a hallway.

It is a simple thing for a doctor or nurse to ask you to lower you pants or underwear instead of just doing it unexpectedly or when getting ready to pull a gown aside.

When it comes to exposure to people in the hallway, there is a simple fix for this. Install a drape just inside the doorway that extends from the ceiling to just above the floor and pull this across as soon as the patient is taken in the room. That way when the door is opened, the drape blocks the view and the door can be closed before the drape is moved as the doctor or nurse steps into the exam area.

The hospital that I routinely go to is set up this way in every exam room and also in the emergency room. The ER rooms use floor to ceiling sliding glass doors, so the drape is a must. When I was given a physical exam in the ER two weeks ago, the young doctor made sure that the drape blocked the view before having me remove my clothes. It really does not need to be an issue and installing a drape should be a simple thing in almost any room.

Joel Sherman said...

MJ_KC, certainly curtains and drapes are used routinely in many places where privacy would not be otherwise guaranteed. This includes x-ray procedure rooms where several tests could be going on simultaneously, ER's and other clinics. They are usually not used in private offices where most examining rooms are theoretically private. But they could still serve a useful purpose as could screens to shield the patient from unwanted onlookers or chaperones or even indeed to give shy adolescents some privacy from their parents when desired. This would especially be called for when the physical layout of the office can expose the patient to others if the door is opened. I'm sure they could be used more than is commonly done.

amr said...

To further the discussion about office layout: My wife had to go in to get an MRI on her remaining breast as part of the more aggressive cancer prevention / early detection follow-up. I was allowed to be with her in the MRI room, but not in the control room because of “HIPPA”. There were several violations of patient privacy that I noticed at the center.
1. The door to the control room always remained open. Although there was an alcove into the control room so that you would have to stick your head into the control room to see the MRI room, anyone doing so could possibly see the patient.
2. The door to the MRI room was never really closed behind the tech as she entered the MRI room. Finally when the door once was wide open, I asked if I could close the door and reminded her about patient privacy. She did say she was sorry, and that they had started to do more of these types of studies here, and they were relearning how to be more descrete. There is a shade that can be lowered in the control room, which she did in fact lower at some point.
3. I will say that making sure my wife was minimally exposed did occur, but the opportunity for her to be exposed to someone in the hall did exist because of the door and shade situation.
4. The facility had at least 5 MRI rooms. I freely wandered the halls checking out the facility. (I made sure that a MRI was not in use before checking things out.) For some of the MRI rooms there was a common control room managing 2 MRIs. Therefore, the designers of the facility had no consideration for the privacy of patients in and amongst the techs.

The facility though did have designed in the ability to protect patient privacy. However with doors left open and shades not drawn, those built-in facility designs were bypassed. It was up to me to make comments.

Now to be balanced, because they were very careful to minimally expose her when she was being positioned, actual exposure was going to be unlikely. However, what I speak to here is that the safeguards that would have made it a moot point were not used. It would have been a simple thing as a matter of procedure to draw the blinds to the control room and close the door to the MRI when entering.

This issue here is one of training and a little common sense. My wife pointed out to me that the cost of not sharing a control room would drive up the cost of service. Also, it could mean that one or two less MRI stations could be fit into the floorspace.

--amr

Anonymous said...

Well, this is somewhere I never thought I’d be posting but I’d like to share an experience that my wife recently had.

She was in her office when the CNO walked in with scrubs on and asked her to come to the OR to meet with the CRNA, apparently he wasn’t happy with how the room was layed out and wanted to speak to her then. She wasn’t feeling well and asked if there was a case going on. As it turns out, there was and this patient was very sick (ruptured gall bladder). She refused to meet with him then and the CNO proceeded back to the OR without changing her scrubs to tell the CRNA that she wouldn’t meet him. 10 minutes later my wife received a phone call from him on his cell phone inside the OR where this patient was demanding her to meet him. She once again said no and hung up on him. Then she got an overhead page and decided to go back there anyway. She refused to enter the room and told him that now wasn’t the time to have this conversation while the patient was in the room. Of course he didn’t like her response and yelled at her as she was leaving the OR. She didn’t pay any attention to what he was saying because she was so upset.

Several questions I have: I may be wrong but if a person leaves the OR in scrubs, shouldn’t they have to change after walking through the hospital in the same scrubs? The CNO in this case left, went all the way through the hospital to my wife’s office, then went right back in without changing? I would think that wouldn’t be considered sterile? Speaking of sterile, they were willing to let my wife enter the OR room knowing that she was ill, while the patient had an open abdomen wound. Last, the CRNA called from inside the OR with his cell phone that we carries with him everywhere, this shouldn’t be in a so called sterile environment.

Point is these were unnecessary risk to take. The problem that was being discussed could’ve been addressed when a patient wasn’t in the room. Everyone involved in this spat never said anything to this CRNA about his behavior or actions. I have urged my wife to report not just him, but the hospital. She can’t because of the position she’s in. This isn’t the first time that a CRNA or doctor has asked my wife come to a procedure, they have no concept of privacy or consideration for their patients. We have documented this with all the names involved; just don’t know how to proceed with the information.

Jimmy

Anonymous said...

This is not my personal story but it is intresting as it happened to a male patient as most of the impropriority happens to females. Here is the link and it looks as if the patient may have a very good case.

http://www.foxnews.com/story/0,2933,323186,00.html

Mike ~ from the how husbands feel group

Joel Sherman said...

Jimmy, a few comments. Surgical scrubs are not sterile. They are considered 'clean' not sterile. They are routinely worn outside the actual operating room, but ideally should not be worn out of the OR suite. It is certainly not uncommon to see them worn in the rest of the hospital, though I think it is frowned upon if they are going back into the OR. Only the gowns that the surgeons and assistants wear on top of their scrubs are sterile. Don't know in what way your wife was ill that day. Having a cold (or most viral illnesses) is certainly not an absolute contraindication to being in the OR, that's what masks are for. Only exposed bacterial infections would be contraindicated. (For others CRNA=certified registered nurse anesthetist. CNO=? chief nursing officer).

Mike, I briefly commented on the story before under informed consent as that I think is the major violation. I gave a NY Times link. I think they broke the story. I'm not sure the medical details are accurate, at least I don't know how a rectal exam is mandatory for a head injury evaluation. I would agree that according to the story, the patient has a good case. Why do you say that most medical impropriety happens against females? That's not my impression, though it's true if you're considering only accusations of actual assault which this would fall under. Please continue to post breaking stories. That is what I’ve been trying to do.

Anonymous said...

Joel: I missed it in the other section. I gald that you also felt it worthy of a post.
I mention the reference to gender because out of the over 1200 news articles that we have collected at how husbands feel by using search engine key words like (sexual misconduct doctor) or (intimate examination lawsuite) we have only had 2 hits, this one and the one posted a couple weeks back about the tatoo on the penis case that involved male patients.

Thanks
MIke

Joel Sherman said...

Thanks Mike. Yes actual charges brought against physicians for sexual misconduct are overwhelmingly male physician on female patients. That was one of my points under chaperones. These charges are so rare against women providers that there is little excuse for them exposing male patients to unwanted chaperones.
But my guess is you are searching only under physicians and not under nurses. There are certainly documented instances of assaults by nurses, both male and female against both sexes. Several are mentioned in this thread including one by Ray in the OR and another by me from allnurses relating the horrible assault on a male patient which ultimately rendered him infertile. Assaults by nurses I'm sure are quite uncommon, but they are also rarely reported so a true incidence is difficult to judge.
Your mention of impropriety made me think you were including all the instances of unwanted exposures and violations of privacy which I believe occurs more to men than to women, though it is not rare in either case.

Anonymous said...

Joel,

My wife has a small case of EB that affects the lower portion of her legs. Being pregnant irritates them and causes the old scar tissue to blister. She had several open sores and didn't wrap them that day. The staff was aware of this and in the end, his agenda was more important than the patients safety. Also, I was once told that nothing you carry with you can be allowed in the OR because of the sterile environment, I would think that a cell phone would classify as one of those items? When you walk in any hospital they have signs that ask you to leave your cell phones off, that should apply to staff as well and especially in an OR. Jimmy

Anonymous said...

Anoy of 01-18:

My wife is an RN and at one time years ago worked in the OR. When I told her of the photo of the tatoo case a few weeks ago we had a talk about phones in and around the OR.
Her explination was that there was a nurse in the OR who's sole job is to man the pagers and cell phones of everyone who is steril and relay messages back and forth to them.
My reaction to her was, "well should the surgon not be giving the patient 100% of his attention and not taking calls"
Her reply was that as the patiant that he did surgery on before his present case might be waking up in recovery and might need a change in medicine so he has to give the order and it is a life and death condition.
After hearing this I bought it as a valid point. However I'm sure that if cell phones calls are allowed that from time to time the (honey be sure to bring home some milk) calls get throught as well.

MIke from the How Husband Feel group

Joel Sherman said...

Jimmy and Mike,
I agree that cell phones do not belong in the OR. Certainly no surgeon would stop a procedure to answer his cell phone. They'd have to completely scrub and gown all over again. But the surgeon may need to be able to respond to calls. Usually this would be handled by the circulating nurse or an assistant who is not scrubbed or standing at the OR table with the patient. They would relay the message to the surgeon and take his reply. It's a pretty routine occurrence.

Joel Sherman said...

An interesting aside for those whose privacy and modesty have been violated in hospitals. In the UK it is apparently still common to have ward rooms with mixed sex patients.
I guess we should give some thanks for what we don't have to face in the US.

Anonymous said...

All female nurses are perverts. I'm
a male who has worked in hospitals
for 30 years. They live to violate
the privacy of male patients. It's
a DOUBLE STANDARD. It's also illegal as well. Many men gave their lives for this country so we as citizens can enjoy our rights
under the constitution. Mainly the
4th amendment. THE RIGHT TO PRIVACY. When you are a patient you have a right to privacy. It is
a VIOLATION under the nurse practice act to violate your right to privacy since it is considered
unprofessional behavior. Complain!
complain! COMPLAIN! Get their name
and get their license.

Anonymous said...

Thanks for confirming what most of
us already knew.

Avram

Joel Sherman said...

Anonymous of April 29, 2008, 2:51 PM, I've worked in hospitals for over 30 years too and I know many nurses, none of whom I would consider perverts. On another board, there were posters who considered all male doctors as sex offenders. I don't think rants like these are very helpful.
But if you've had such long experience in hospitals, you'd be better off relating instances that explain your views. That could be helpful.

Anonymous said...

Female nurses may show you one side, but they won't show you the
other side. They will always act
professional around physicians and
family members. You don't see the other side. There are sites that
are dedicated to these tittalating
little stories that people enjoy
reading about. There is nothing
entertaining about it at all!
To violate someones privacy is
rude,callous and unprofessional.
Here are some stories I have for
you. My Father and my Brother died
from medical malpractice. My mother
was molested on an exam table. Do
you still want to hear my stories.
I believe in a god and he is a vengeful god!

Joel Sherman said...

Anonymous, by all means tell us about the incidents that bother you, though not malpractice per se if it doesn't involve violations of privacy.
Don't believe all the titillating stories you read though. Most of these sites are more fiction than fact. I do tend to believe what's on allnurses and a little of it is disturbing, such as the story of the OR nurse who exposed a patient's penis to comment on its size. More disturbing was that some nurses defended her. (Was this thread deleted?) But I don't think that's typical. My wife is a nurse and has never come across such incidents. I have also discussed some concerns with nurses that I know and all were genuinely shocked by these stories. I once came across two female aides who were bathing a middle aged man. He was completely nude and in great distress, though I don't know what the cause of his distress was. I doubt very much that the aides were doing this for salacious reasons. They were just taking shortcuts to speed their work. I complained to the head nurse who did indeed speak to them. All nurses and aides are taught to protect a patient's modesty though at least a few don't practice it.

Anonymous said...

I won't go into detail about my past experiences as a patient. No amount of talking about it will make me feel better or ever resolve it. I don't have any issues
with modesty. Zero! What I do have
issues with are double standards.
I'm not a male nurse,however, I've told male nurses what happened
and they say that well if I did that to a female patient I'd probably be fired or arrested. If
you don't think this problem is
widespread then you are very naive.
All you need to do is listen to what male nurses have to say on the
subject. On nursesean, web site
one male nurse said that the female
nurses have the market cornered
on perversion so to speak. I have
investigated this subject matter
on the net. If you visit allnurses
website there is a thread called
" have you ever had a patient
comment on his size." Read the
thread very carefully! The thread
whoa..inappropriate as well. But
then I believe that this thread was the smoking gun and they may have removed it. When you are a
patient and in great pain your
guard is down. Never again will
I let my guard down!

Anonymous said...

One thing I'd like to add. The last
facility where I had my last bad
experience was at the most prestigous facility in north phoenix az. You know the facility!
My point being is it can happen anywhere. I've had health insurance all my life. I am very
reserved as a patient and never
complained. People say nursing is
the most trusted "profession" That
phrase makes me want to VOMIT! I
have more respect for HOUSEKEEPERS!
I really hope female nurses are
reading this. You can't even begin to fathom my hate and distrust for
you people!

Joel Sherman said...

I may be naive, but if so I'm not alone in medicine. Try and post some url's so we have a better idea what incidents you're referring to.
I too am not greatly concerned about my personal modesty, but I am concerned about being treated with respect. That's never really been violated, but I do recognize that as a physician it's less likely to happen to me.
On a philosophical note, double standards have always been around. They may be diminishing in medicine and society in general, but I don't know if they'll ever be gone. If they affect you, complain ASAP. Nothing to be gained by getting sick over them.

Anonymous said...

To ANONYMOUS of the last few postings.

I understand you are very anxious and in general Dr. Sherman and other readers and posters to this site understand that bad experiences do happen. But for
your entries to help all concerned
here, you must try to be specific.

For one, please list the incidents
as detailed as possible so that
we may respond with productive
comments and suggest how in future
we would all need to handling something similar should it happen to us.

I think we all know the clinic you may have had some of these issue occur at but I don't think you should use institution names
here as Dr. Sherman deserves to
rest comfortable with your
comments. Apart from that, feel
free to share anonymously but
do pick a pen-name to identify
each of your postings.

I've seen your postings recently on Dr. Bernstein's site, too. You have come to the right places to bring these troubling medical incidents. I would suggest you
calmly air them here before posting complaints on allnurse.com, where you run the risk of receiving insensitive replys that will anger you further. You can post there after reading the responses of the audience we have here and at Dr. Bernstein's, Patient Modesty, Vol. 2. It will help to focus
and strengthen your arguments.

I can tell you need to talk.
Try to relax and get it off your
chest. Modesty violations cause
PTSS that can go on for months
after an incident. Men, who often suffered in silence through these shameful medical episodes, need to know they have a right to speak out against the great double-standard in patient modesty. However, you must understand that making statements
like "every female nurse is a pervert" is only going to cut into the sympathetic response your(our)cause requires.

OK. Now, please try one incident per posting with calmly collected thoughts and details. You're among friends who've been through
similar moments. We'd all like to help.
-- WJB

Pamela said...

A few years ago I had something happen. I had to go to the ER, as I was having a tachycardia episode and I couldn't get my heart to slow down by myself. The ER staff whisked me away quickly and set to work helping me. Before I knew it, my heart was beating normally again. After it was all over, though, is when my privacy was violated. (or at least, I think it was!) There was a guy in my "room" who I think was a nurse, although he might not have been. I don't know. He was there the whole time they were working on me, so I figured he must be a nurse or student of some sort? Anyway, I had those stickers from the EKG on me, and he came over to remove them. I told him I could do it myself. He told me no,it was okay, he'd do it for me. Before I knew it, he whipped my gown up and began peeling them off of me. The curtain wasn't closed or anything, and I was in full view of the whole back of the ER. I don't really remember if anyone was outside the room to have seen me or anything. It was just a bit embarrassing to have him do that. I was more than capable of removing them myself, as I've had many, many EKG's before. I think when I told him no, I'd do it and held my gown down, that should have been it. He could have at least closed the curtain. And I also know from experience that those stickers CAN be removed discretely. Anyway, maybe that wouldn't be a big deal to happen to someone, but it was for me. I'm a very modest young woman. (and of course, even younger then) Perhaps these doctors and nurses and other medical professionals see people's bodies all the time and it's no big deal to them. But it IS a big deal I think when it's your own body on display for all to see. Anyway, that's my contribution!

Joel Sherman said...

I agree Pamela. I can see no valid reason for how the man (probably a nurse) acted. He may have thought nothing of it, but certainly when you declined help, there was no reason for him to persist.

Anonymous said...

Pamela
I hope you complain to the facility, they may be more responsive than you think. It may prevent someone else from going through this and it will make you feel better. I am male and went through a similar incident with female nurse. When I complained I got a response indicating they would talk to the nurse involved, I don't know if it changed anything, but I felt better and less of a victim. I stated on the other thread all and all I think providers are great people, but they get used to "seeing things" from their side of the table and sometimes we need to remind them, the do this all the time, we don't, and we are the one compromised. Anon. obviously you have had some bad experiences...this is a good venue for the non-thrill seekers to help each other...hope you will at least try to get some feedback help from Dr. Sherman & Dr. Bernstein and the posters here, you seem to be in a lot of pain.

Anonymous said...

Sorry pamela ,I'm not sympathetic.
There are far more intrusions on
men than there are women in
health care. Despite the fact that
my mother was molested on an exam
table. It was and has been a
practice that if a young boy were
to get an erection while in the
hospital a nurse would strike his
testicles. We all know that an
erection is sometimes happenstance
and dosen't mean anything,
especially with little boys. Many
young boys grew up to be sterile
from this. Want to read one mans
story. Go to www.allnurses.com
forum,general nursing discussion
and then eek, theres a woman in
my room.
When men get equal respect for
their privacy in healthcare then
you come and talk to me.

Joel Sherman said...

I'm concerned with all patients' rights, not just male or female. Pamela's concern is just as valid as any other.
The incident on allnurses is horrifying (which I referenced in detail previously), but it was rare and certainly doesn't occur today. A million dollar lawsuit would result and possibly criminal charges. And one can find many instances of assault against women in medical settings so no gender is immune from violations. They are all worthy of concern. Male modesty gets less respect than female, but that is a different issue than egregious criminal violations and assaults which are rare against either gender.

Anonymous said...

I know of a major level one trauma
center in the southwest whose female nurses in the neuro icu
make it a point nightly to peek
under the sheets of male patients
not assigned to them. In the
trauma room male patients are
left uncovered while female
patients are quickly covered.
Double standard. Absolutely!

Anonymous said...

THIS JUST IN FROM THE UK:

A 45 year old Registered Nurse from Chadwell Heath, Romford has received a two year Caution by the Nursing and Midwifery Council (NMC) at a hearing held in London on Monday, 28 April 2008.

Sherril Gurley was employed as a Staff Nurse at Basildon University Hospital in 2006 when she used her mobile phone to photograph a female patient as they sat on the toilet and as they left the bathroom.

On a separate occasion Ms Gurley made inappropriate comments to a colleague about the size of a patient's genitals and showed a photograph of male genitals to the colleague. Although her actions caused no direct or indirect harm to either patient, the independent panel of the Conduct and Competence Committee panel deemed that Ms Gurley's behaviour fell short of what is expected of a Registered Nurse.

Commenting on the panel's decision to issue Ms Gurley with a two year Caution, NMC spokesperson Kristy Hempel said:

"Sherril Gurley's actions failed to protect the dignity of vulnerable patients in her care. Displaying a lack of regard for the ethics required of a Registered Nurse, she also failed to uphold the reputation of her profession and breached the Code of Professional Conduct. While the circumstances highlighted Ms Gurley's lack of insight, the panel took into account testimonials that spoke highly of her abilities and conduct since the events and an expression of regret and apology. The independent panel decided that given that the incidents were isolated and her good work history, a two year Caution was the appropriate sanction."

SHE SHOULD HAVE GOTTEN 2 YEARS
SUSPENSION! WHAT WOULD HAVE
HAPPENED TO A MALE?
--CHUCK McP

Anonymous said...

A male nurse would have been fired,
arrested and shot. I am so sick of
double standards. How did this
crap all begin? I hate females
in healthcare. I've been a patient
5 times and each time I'm violated
in some manner. My privacy was violated each time and on two
occasions the nurses were unethical. I admit, they caught me
off guard. I was in pain. My new
attitude is screw me once,shame on
you. Screw me twice shame on me.
It will never happen again. God
help the next women who tries to
screw with my privacy. If I ever
need any personal care I'm asking
for a male nurse. If I ever need
surgery I'm calling ahead. I don't
want any women there at all.

pt

Anonymous said...

I'm curious so tell me. What's in
it for you. Why do you have an
interest in this subject. Are you
concerned about your privacy when
you become a patient. Do you think
a nurse or someone will violate
that trust.
Want to hear something thats
disturbing. It's true.I've heard
female nurses say that when a
physician is a patient they go
out of their way to make it
an impersonal experience per se.
I've seen it as well. Yes, I
thinks its disturbing too, which is why I'm on this board and I make it clear that I hate female nurses only because of the
double standard that they promote.

pt

Joel Sherman said...

Not sure I really know why I'm interested. And I get nothing special out of it; nothing at all financially.
As Bernstein has stated, these subjects have not traditionally gotten much physician notice, and both of us have been surprised by the intensity of the feelings this subject arouses in some.
Nurses have traditionally been taught to protect the patient's modesty. Most do; some obviously don't. Men traditionally are not supposed to have much modesty. That was certainly true when I was a kid and all boys had to swim nude in my high school. Times are changing. Now young men are subjected to similar body image worries that women have always had, to our detriment IMO. As kids we never gave a thought to how our equipment stacked up against others.
I'm also interested in gender issues in general and the changing demographics of physicians. Too bad the influx of women in medicine has not been matched by an influx of men into nursing.
I personally am not very concerned with my modesty in a medical situation. I am more concerned that I be treated with respect and my privacy honored. It always has been so far, although I am sure I get more careful treatment when the staff knows I'm a physician.

Anonymous said...

Dr. Sherman, I think your comment "boys had to swim nude" is pretty telling. The myth that males are not modest has a lot to do with the fact that we are often not given a chance. Our minds have a way of "accepting" things we think we can not change, while we make struggle emotionally with issues, if the mind precives it can not change it attempts to normalize the issue. For example the Stockholm Syndrome where hostages start to identify with their captors. Accepting ones fate doesn't really mean we are OK with it, we just don't have a choice. I read a post by a female reporter who said she was accepted by the atheletes because they wend about their showers etc in a normal fashion..........they don't have a choice. I think part of the transformation if people in general are more outspoken and less accepting of things that make them uncomfortable. That condictioning starts in grade school with the double standard, when I was a kid you didn't speak out against treatment in school, if you got paddled you took it, if you got slapped up against the head, you took it and didn't protest. Not so anymore, when I was young, penis size wasn't an issue, being naked infront of females always has......jd

Anonymous said...

It was men who first stepped on the moon. The smartest man who
ever lived was Einstein. The
greatest math and physics minds
were men (Isaac Newton,hawkings
to name a few). The greatest astronomers were men ( Copernicus,
hubble)to name a few. Who discovered DNA, men. The list goes
on and on. In fact, it was men who
essentially transformed our world
as we know it today. It was men who
fought and died in all of the stupid wars. Yet it is men who get
the least respect and the least
privacy when it comes to healthcare. You see huge monies
generated for breast cancer and
huge publicity. Yet do you see the
same for prostate cancer, hardly.

Joel Sherman said...

Apparently UK hospitals don't have the same physical layout to protect patient privacy as we are accustomed to in the US. It is apparently common to have mixed gender patients separated only by curtains and for patients to have to walk past each other to go to the bathroom for instance. This may happen here in some ER's but would certainly be uncommon in this country except possibly in some ICU's where the patients are very ill and not ambulatory.
Here's the link.

Anonymous said...

Visit www.allnurses.com under general nursing discussion search
for trauma naked. When female
patients are level 1 trauma patients the female nurses quickly
cover them,however, male patients
are left uncovered.

pt

Joel Sherman said...

I read the entire thread through, pt. I have no doubt that incidents like that do occur and that men are victimized more often than women.
But do note that 90% of the posters disagreed with the guy's treatment and told him to do what we've all said, complain. Although one poster said that men are always left exposed more than women, you can't draw any general conclusions. Every hospital, ER, and nursing floor are different. It potentially only takes one complaint to get them to review and change their policy. I am only in ERs occasionally and haven't worked in one since I was a resident, but honestly I cannot recall any incidents of a conscious patient being left uncovered needlessly whether they complained or not.

Anonymous said...

That site is their sacred cow. Do
you really think they are going to
admit that they do it themselves?

pt

Anonymous said...

I think the site is really a pretty good glimspe inside their world and while no doubt they are aware we "outsiders" are looking at it, I have seen a lot of comments that would indicate they are pretty honest about their feelings, the anonimity of e-mail tends to do that. While I think this was wrong on several levels, one they did it in the first place, but two that they didn't do something when he specifically asked. There have been several threads on that site that gave the same information that males modesty was not precieved as being as much a concern as females. That said, while I still beleive the medical industry gets a C- at best for respecting a males modesty, I have been encouraged by the number of providers who side with the paitent rights when things like this happen.. They appear to be empethic and understand, they may not assign as much importance as the patient, but they do seem to genuinely care and often recognize they have become so used to it they just don't think about it unlike the patient who isn't used to it and is on the other side of the issue. I also apprecaited that many told him to complain...now one must remember he is one of "them" though in this specific instance he is also a patient. None the less, it appears the general advise was the same...complain to the facility. I was saddened to hear it happened, but encouraged by the response of the providers. JD

Joel Sherman said...

Yes I agree JD. I think allnurses gives a realistic cross section of nursing attitudes and opinions.
In my 40 years of practice I would say that the vast majority of nurses I have gotten to know well enough to judge have been caring people.
They may be more conscious of female modesty, but the vast majority of violations happen because they are too busy and take short cuts, not because they are trying to purposely embarrass anyone. That's not a good excuse as it doesn't take much to treat most people with respect, but it's easy to forget. Just remember to speak up.

Anonymous said...

Lets pause for a minute and reflect. If they were conscious
and concerned about male patient
privacy then this site wouldn't
exist.If you read through the
thread a majority will have some
excuse for leaving the blankets off. I believe that somehow this
empowers them.
I've worked in one level trauma
facility that patients were covered
with a blanket then their clothing was removed. Each area was examined
so I know it can be done.
In addition, did you notice that
when the subject of male patients
not being covered to the extent
that female patients are covered
no female commented on this! That
lack of response says to me that
it's true. I already know its true,
I've seen it a thousand times!

PT

Joel Sherman said...

A very different question: should presidential candidates be entitled to keep their medical histories private. Do we need to know Hillary's latest pap smear and mammogram or McCain's prostate status? I tend to think we should.
What do others think?

Joel Sherman said...

Here's a published report about a patient suing her physician for opening a door during a pelvic exam, exposing her to the waiting room.
This seems to be a fairly common scenario that you hear complaints about. This is certainly one way of dealing with it.

Anonymous said...

Great moment in the
patient modesty war.
I hope she soaks him good!
It's the only thing that is going
to get doctors and nurses to
respect modesty. More lawsuits,
please. Thank you.
- Avram

Anonymous said...

Apparently, many of the meps centers across the U.S., facilities
that provide the military medical
entrance exams have allowed female
office (non-medical) employees to
observe physicals. The process is
rather crude in that 30-40 men
are brought into a large room with
only their underwear. They are then
told to drop their underwear and
turn around and bend over. This all
in full view of females that have
nothing to do with these exams which are sometimes done by male
and female physicians.

JH

Joel Sherman said...

JH, I have read accounts of exams at MEPS (Military Entrance Processing Station) similar to yours which I have no reason to disbelieve. They all occurred under mandatory draft laws. I'm not aware of trustworthy accounts similar to yours since the draft ended.
I had an induction physical in the late 60's (which was for enlisted men, not officers) and it was nothing like that. There were about 20 of us being examined and no women were present. But it is clear that every examining area had its own procedures and what you describe is probably accurate for some of the large urban induction centers.
I think it is unlikely that anything like that occurs today with the all volunteer army, but I have no reliable information.

Joel Sherman said...

Here's another pertinent post by 'Frida'. See the informed consent thread.
She lists a variety of complaints about the way she is treated. All the complaints are valid, though each by itself is not flagrant, usually committed more out of carelessness than intent. They include:
1.) Doctors leaving doors open.
2.) Doctors or nurses talking, gossiping or dictating in public places.
3.) Lack of sound proofing so that you can over hear other encounters.
4.) Being asked personal questions in public areas.
5.) Gowns that don't cover.
6.) Exposing patients without prior warning.
And others.

A good review of issues that are easy to forget.

Anonymous said...

There is a post by a gentleman on
Maurice Bernsteins site regarding
his wife's stay in a hospital. In
his discussion he was dismayed at
the number of male staff that he
felt were "leering" at his wife while nude. He did not use that word specifically,however,that was
his impression. Those males involved were three med students
and two male nurses. When he voiced
his concern a female nurse said to
him " it's nice to see that you love her" close to that effect.In
addition,apparently they placed a
sign on her door that read no males
allowed. Personally,I don't have a problem with any of his concerns,
however, lets flip the coin just
to make my point. What if he were the patient and all of the staff involved were female. Would her
reaction be the same? Would the female nurse say to him " its nice to see you love your husband? What
would be the reaction if a sign was
placed on HIS door stating " no
females allowed".
pt

Joel Sherman said...

I'm sure your right pt, that the reaction would be different. It's not going to change in the short run unless everyone who cares makes their preferences known.
Those aren't my issues either, but everyone should be treated with equal respect.

Anonymous said...

I noticed this topic has been discussed
here and is currently on Dr. Bernstein's
Patient Modesty, Vol. 5.

Please reference a survey of roughly
160 men of Vietnam War draft age on
the subject of opposite gender humiliation during induction physicals.

http://www.misterpoll.com/polls/75277/
results.

Basically, it relates that of the 160
men in the responding group, 67% were
examined in groups of 10-50, or 50-100.
60% report being nude the ENTIRE TIME.
28% said they were clearly in view of
non-medical female clerical personnel.
55% said they were forced to perform
jumping jacks and push-ups while
naked in front of this cross-gender audience. (This is a staple of CFNM fetish porn.) MOST IMPORTANT: 65% of the men said they were "humiliated" by the experience, 25% said they were "very much humiliated".

It's clear that most men don't appreciate this treatment. Yet
everyone surveyed here just suffered
through it. Woman are not treated
this way because they protest. Even
if it's only the extreme 25% of modest men who are having trouble with current
medical equivilents of this type
of immodest treatment, they need to
protest loudly. Don't get humiliated.
Get angry! Tell them they are
humiliating you. Tell them they
wouldn't do it to a women. Tell
them you don't care if other men
don't have a problem. IF WE SPEAK
UP, ONE VOICE AT A TIME, DISGRACES
LIKE THIS WON'T HAPPEN AGAIN.

Even back then, a small sampling of
the group was treated with dignity
by overseers with some empathy.
They were allowed to wear their
underwear and we're only viewed
by necessary medical personnel.
In the end, most practices are
not universal. For every offending
medical party, there may be one on
the cutting edge of patient modesty.
Never accept that what you are being offered is the only way it is done.
Demand change to preserve dignity.
It's long overdue for men.
WJB

Joel Sherman said...

Thanks WJB. As you're aware, self selecting polls aren't generally very reliable, certainly not statistically significant. Those statistics sound reasonable though. I'd love to find reliable information about what pre-induction physicals are like today. I don't think it happens, though once again it is likely different from center to center.
Those types of exams happened in many countries, not just the USA. Soviet republics may have been the worst offenders where traditionally nearly all health care is given by women.

Anonymous said...

Thank you WJB. I too experienced a military induction physical whereby
several women (non-medical) were allowed to stand there and watch.
By todays standards that is a gross hippa complaint and people would lose their jobs at least in
the civilian settings. I cannot fathom why a physician (male) would
allow females to stand and watch male inductees be given a physical in the nude. I've come to the conclusion that these physicians have to be gay pervs getting off on a crowd of nude men. Allowing
non-medical female staff to watch
only adds to the gay circus event!
In my oponion,the females are pervs themselves for wanting to watch this! To give you an example
of what happens today last december
a 5th year chief resident took a pic of a patients penis with his cell phone. Then showed it to other
residents. He took the pic because
the patient had the word hotrod
tattoed on his penis. The chief resident was fired. The arizona state medical board issued displinary action against him. This
occured at Mayo hosp,phoenix.

Joel Sherman said...

There is no doubt that inductees were viewed by civilian non medical women at some examining stations, but I think you are wrong to put the sole blame on physicians. Most army doctors are peons in the service even though they are officers. They would not be in command of the procedures. They'd do what they're told like anyone else. The major concern at these MEPS was efficiently processing hundreds of men a day and modesty was the least of their concerns. That's not an excuse, it's just the way it was.

Anonymous said...

The Hippocratic oath has the following element. "I will respect
the privacy of my patients." Does
it not! Am I the only one seeing a
problem here? What if your wife or
daughter's physician allowed strangers from off the street to
view her pap smear. Would you consider them perverts for standing
there to watch. Would you consider
her physician a pervert for allowing spectators? Anybody here
ever visit southeast asia? Anybody
here ever carry a 60lb rucksack on
their back with an M-16. Not to mention 3 bandaleros and 15 rounds for the M-79 grenade launcher. Not
sure if you would see the end of the day. Who cares. Let's just insult and humilitate these people
while they get a group medical exam. Lets bring in 3 or 4 women and let them stand there and leer.

Anonymous said...

MEPS was THE reason I stayed out of the military.

I grew up in a Navy town. One of my career options was military aviator. I was in high school ROTC and did very well there. I was also considering police work and healthcare too. I ended up making my career in law enforcement and I have retired from one agency and am now several years into a career with a second agency. But back to the military.

I had friends who joined the military right out of high school. After hearing their stories about the MEPS physicals it really cooled my desire to go into the military, as much as I wanted to fly. I recall one guy who told me they did everything in underwear until the hernia and rectal exams. The recruits were told to drop the underwear for that part of the exam and that was it, as it was done last. It was done right out in front of everybody. There were females present and it was assumed they were nurses. This was at the MEPS center in Jacksonville in 1974. Another friend who joined the following year told of a different experience at the same MEPS center. There, they had all the men remove all clothing, including underwear, and go through the steps. He said one guy was really embarrassed and covered his genitals with his hands. Upon seeing that one of the nurses pulled him aside and made him wait, in the nude, until everyone else was finished and then put him through the steps with all the female nurses gathered around him. It shocked me to hear of that. The friend who related this story was a guy I have known all my life, literally from first grade through 12th. I have never know him to lie and we are still friends to this day. After his Marine Corps service he joined me on the police department. I have known him close to 45 years and I have never known him to lie.

After a few years on the police department I found I was still interested in military aviation so I looked into the Army warrant officer flight program. I thought I had found a way around the MEPS. I took a battery of tests that determine that I was aviator material, I recall one that called FAST, flight aptitude something or other. Anyway, I passed those with good scores. I had a concern about my flat feet and heard that the military would disqualify you for that. I had developed some friendships with the Navy pilots in town and arranged, with the help of the recruiter, to take the aviators flight physical before I joined up so there would be no surprises. The flight physical was very comprehensive. But since I was with friends, it was a one on one with the flight surgeon. It was much more involved than anything MEPS had you do. I got a waiver for my flat feet by doing a 5 mile run to prove I had no foot problems. I had hoped that by having the flight physical done in advance, when I got to MEPS, it would show that the physical exam was done. Well, it didn't work that way. We tried, but the Army lost out on a good aviator thanks to MEPS. There was just no way I was going to allow myself to be humiliated that way.

Later in my police career, the department paid for the very expensive helicopter commercial pilot rating. So I got what I wanted in the long run without losing my dignity over it.

I googled MEPS and it appears that things have changed. From what I have read they still do all the steps in underwear, male and females. But they now do the intimate exams at the end and in private. I haven't talked to anyone who has gone through recent MEPS so I am interested to know if things have really changed for the better.

Mike

Joel Sherman said...

Mike I have never heard a military induction story similar to that of your friend's. I have heard of SOB officers humiliating recruits to toughen them up or just out of sheer sadism. But I have never heard of that being done by women, not even in Eastern Europe.
I do believe that the part of exams that require full nudity are now done in private, though of course the physician could still be a woman. I go only by second hand accounts though. In prior years every MEPS set up their own procedures. I don't know how standardized they are now, but I wouldn't be surprised if they still vary from place to place. Still and all with an all volunteer military the dynamics are different. They don't own you anymore thankfully.

Anonymous said...

Previously, WJB commented regarding
induction physicals and mentioned
that "This is a staple of CFNM fetish porn". Posted 8-10-08. I don't know what CFNM fetish porn is and i'm sure I'm not interested,however,I can't imagine what kind of a woman who for no reason would be willing to watch young recruits get a physical.
Certainly, someone I would not
consider a lady! I think at the very least the military owes a lot
of men an explanation for these gross privacy violations.

Joel Sherman said...

Induction physicals' violation of men's privacy by having non medical women present may be of interest to fetish sites, though the violations are clearly well documented. I certainly have never heard of an academic study of the issue though.

The military gave almost no consideration to issues of privacy or modesty; they had a war to fight. Although women were treated much better in general, don't join the army if privacy is a concern. Violations occurred to all; probably still do.

Anonymous said...

Speaking of Female clerks viewing
male recruits getting medical physicals while nude. This practice continued into the mid 70's. As I recall, there was no war going on then. Whether there was a war or not was it appropriate?
Apparently, some of these females
viewing mass physicals felt it necessary to videotape the events.
These tapes are now for sale on
CFNM porn sites. They are in black and white and one tape I have shows
two female clerks in civilian clothes laughing at nude recruits.
The tapes are old and I'm having a company professional duplicate my
tape. I want to send it in to 60
minutes. I doubt they will air it
but then who knows!
LF

Joel Sherman said...

Thanks LF,
If these 'tapes' were on a porn site they'd have to be thoroughly documented. No home videotaping was available in the 70's and even 8mm film cameras would have been hard to hide unless it was professional 'spy' type equipment. So it's unlikely that filming could have been done surreptitiously in those days. That’s why films of those events are nearly nonexistent.

Anonymous said...

I paid $19.95 plus shipping for
my DVD. Porn sites only have to
document the ages of the participants if and only if they are having sex. CCTV was available even in the 60's. Analog and Betamax was available to the consumer in the 70's.
The tape I have is authentic.The
existing technology that was originally used was obviously transferred to a DVD as one can tell. The video is 1 minute and 38
seconds long. The video depicts 11
recruits in the nude performing series of exercises. There were more recruits in the room,however,
you can only see parts of their bodies. Two females are visible in
civilian clothing typical of the 70's. One female has her arms crossed and is laughing and talking to the other female. There is no sound. There is one army physician seen with a lab coat and
dark pants with darker stripes running the length of the side of the pants.Some of the recruits are obviously embarrassed about the ordeal.
Some things to keep in perspective. There was no war in the mid 70's. Many recruits were
17 with their parents permission.
You get the physical BEFORE you
are sworn in therefore you are still a civilian. The military dosen't need to document anything
obviously! The fact that some of these recruits are 17 makes this
child porn RIGHT. Am I right! Think
the military cares. Of all the privacy invasions that exist this is probably the largest MASS example of privacy invasions in the US as hundreds of recruits went
through these centers daily. There
are 65 meps centers in the US. One
can visit these on the internet.Go
to www.mepcom.army.mil/meps/index.html
One can even see who the commander is at each of these centers. I do plan to contact them as I'd like to know why these violations occurred.
LF

Joel Sherman said...

LF,
I certainly am not competent to give legal advice.
If the DVD you have is child pornography, it would also have been illegal to mail it to you and possibly even for you to mail it to the government.
If it was closed circuit TV, of course all the filming should be from one angle. Have no idea why the military would have installed CCTV in an exam room, but anything is possible. I certainly never heard of it. That information might be available somewhere. I would think you should ask the place you bought it from what the history of the tape is. If it is real, someone must know where it was taken. Betamax was available in the late 70s, but not small portable camcorders that I know of. I doubt you'll get a response from the government or military. The best course might be to have someone who was filmed sue the government for damages.
Good luck.

Anonymous said...

I'm with you pt. I'm so sick of these double standards. Nearly every problem I've ever had has involved a rude, incompetent female.

Anonymous said...

I am so happy to have found this site. Now I see I'm not the only guy that gets upset about the unfair treatment with privacy and cross-gender invasions. For a while I had begun to question my thought process since everybody I've ever talked to about it has given the same three ridiculous lines that I'm so sick of hearing; "it's no big deal", "better get used to it" and "get over it". While reading this I've contantly been nodding my head in agreement with nearly every comment I've read. Joel Sherman is an excellent moderater and I've found myself agreeing with nearly everything he's said. Thanks guys.
DG

Anonymous said...

Aside from physical modesty issues, what about the completing of the intake interview in the presence of the patient's roommate?

I was once admiited to a hospital for a liver biopsy. I was fully ambulatory and not feeling ill.
A young nurse came to my room with a clipboard and said she had to interview me. I said, "Fine, where shall we go to talk?" She said we would talk right here.

I said, "No, there is someone else in the room", as I gestured to my fully alert roommate, three feet away in the next bed. The nurse assured me that her questions were not personal at all, but I insisted that we go elsewhere for the interview.

She left to obtain permission to take me elsewhere, and I sensed that my request was extremely unusual, at least to her.

When she returned, she brought me to a small conference room where she asked me the questions and recorded the answers on the form.

Here are a few of the questions:
Date of birth? With whom do you live, where do you work, What is your occupation? How much education do you have? What brings you to the hospital today,
etc, etc., but then things got really personal. How often do you have a bowel movement? What is the usual texture of your stools? How often to you arise during the night to urinate? etc., etc.

Did it ever occur to anyone in that institution that I do not want to share this "impersonal" information with my roommate?
And if what she asked me was not personal, what types of questions would that hospital consider to be personal? What else is there that would be more personal than the ones she asked me? I can't think of any, can you?

Joel Sherman said...

A common violation of privacy. Most hospitals just weren't designed with privacy in mind. Thirty to forty years ago most hospitals still had ward rooms where there was no chance of privacy at all. And we're a long way from hospitals with all single patient private rooms where this wouldn't be an issue. Many nursing floors do have small conference rooms where it is possible to talk privately, but they may be used for visitors and conferences with families so access is never guaranteed. The problem will get slowly better as hospitals modernize but don't hold your breath.

Joel Sherman said...

This story is only peripherally related to patient privacy, but it is so unusual that I can't resist. A West Virginia female physician was disciplined for soliciting sex for her two teenage sons by recommending that a 17 year old female patient who had complaints of sexual problems go visit her sons at her house, giving her directions and all. Allegedly she recommended that she bring her 'cute' girlfriends along. Talk about a mother's love!

MER said...

Joel wrote: "Most hospitals just weren't designed with privacy in mind."

When you read about the history of hosptials, you see how true this is. From a design point of view, there was a connection between hospials and prisons. Why? The key word is "surveillance." Just as prisoners had to be watched, so to did patients (for an entirly different reason, of course.) This is why hospitals today need to be careful they don't lean toward becomming what sociologists call "total institutions," that is, institutions that completely control your every move. If you haven't read the philosopher and sociologist Foucault on the subject of power, prisons and the history of hospitals and clinics, I highly recommend him.

In this regard, I would call to everyone's attention a great article by Martin Johnson (a British nurse/professor) called "Notes on the Tension Between Privacy and Surveillance in Nursing." You can find at on Medscape: http://www.medscape.com/viewarticle/506842
You may have to register at Medscape but there's no cost.

I've been in touch with the author. He wrote his PhD on Nursing and Power. This article may help readers of this blog begin to understand the "tension," as the author calls it, between privacy and the need for nurses to know what's going on with their patients. Professionals recognize that there is a ballance that needs to be maintained. But sometimes, for the medical benefit or safety of the patient, the scale slides over to lack of privacy.

Now, I realize this itself isn't specifically connected to the "double standard" in nursing regarding male nurses. That's another issue. But the reality is that in today's medical establishment, males need to learn to negotiate their way through all the females involved until the system improves. This article may help people understand what it might be like in the shoes of a nurse, trying to maintain the patient's dignity and privace and at the same time having to know the specifics of the patient's condition.

On another note, I myself am recovering from some surgery. During the last few months I've had two procedures, one of which could be considered intimate. I researched both procedures as thoroughly as a layman could, asked most of the right questions, and went into it with my eyse wide open, so to speak. I became a participant-observer and took many notes. Overall, I must say, I was very satisified with how the medical community treated me. I was impressed with the dignified care and professionalism of all involved, especialy the nurses. In later posts, I will make some observations of the flaws I did see as well as the good things. But I wanted to just mention this. In these discussions, in criticizing a system that is in need of major reform, we sometimes are overly critical of the individuals involved within it. Not that some don't need criticism. They do. But from experience I'm finding that this "in-need-of-reform" system is filled with mostly caring and devoted professionals who understand what dignity and respect for individual patients means. At the same time I'm confirming my belief that patients need to do their homework,too, and make their feelings and requests known without escuses or embarrassment in a polite, tactful manner.

Anonymous said...

MER, some good points, I stumbled accross a article blog under "sports physicals" sorry i can not tell you how to find it. It was by a young female Pediatritian who did sports physicals on young males, she talked about how much she enjoyed the interation with the families etc...then and the point of her blog, she asked other Dr's if they really felt the hernia exam was really needed, she spoke of the embaressment of the young men and she really questioned the medical need to do so at that age and the value of it vs the embaressment...I found her blog so encouraging that she recognized the issue for these young men and was actively looking to do something about it. Now, if the administration of the school would recognize it and provide male's with a male provider or option. Similar to your observations, often I think it is the institution that is to blame and the providers take the heat...not always..but often...I mean, I am reasonably sure Dr.'s don't order those rediculous I.-C.-U. gowns for patients who are mobile, its the institution that does alan

Joel Sherman said...

Thanks for the reference MER.
Alan, too bad you can't find the reference. But I don't think it is likely that hernia exams will ever be considered optional for sports physicals. I would approach the problem another way. The intimate parts of the exam should always be done using privacy partitions so that only the doctor and student are there. There is no reason why a nurse is needed to chaperone. Privacy would obviate much of the embarrassment these exams cause. I have never understood why the usual description of these exams includes the presence of a nurse watching. I have seen descriptions of these exams on a college NCAA mandated level which are much worse. All exams in the open with all kinds of extraneous people present of both genders.

Anonymous said...

Dr. Sherman, here is a try her name is Dr. Alex Cvijanovich, her blog is the Pragmatic Pediatrician. The site (I struggle with this part) thepragmaticpediatrcian.blogspot.com/2008/08/sports-physicals. not sure if that will get you there or not, I googled sports physicals. I don't have a blog account so i could not post, but would like to compliment her. My question always come to, if we require exposure for male sports physicals and not for females, why do we hire female Dr.s with female nurses...but we as fathers have accepted it so we are partly to blame...we need to be vocal and play the double standard card as it has been played to advance womens issues, won't be quite as effective..but better than silence

Joel Sherman said...

Thanks. Found the correct link for this.
I certainly don't know the medical evidence for requiring a hernia exam for a sports physical, but it certainly is standard and required by nearly all sports physicals. I'll try to post there and ask what she can do to lessen the embarrassment. And she is correct. These exams do keep some kids from playing sports altogether.

Anonymous said...

Dr. Sherman

A quick question for you, is visual inspection required for a hernia exam, if the boys are wearing baggy shorts could a Dr reach through the leg and do the exam without having them drop them? I had a female PCP just have me undo my pants, reached in from above and pressed on the groin area, I don't know if she slighted the exam for modesty or just had a different way of doing it, while they may still be embaressed to a degree, being less exposed would seem to help..just curious

Joel Sherman said...

It's not my field but I doubt that you can do an adequate hernia exam that way. I certainly couldn't. But I don't really know why it's considered mandatory for a sports physical. People know when they have a large hernia and small early ones wouldn't be a problem for most sports, though it could be if you're doing heavy lifting, even just for weight training purposes.

Anonymous said...

Dr. Sherman,

Regarding your post of 9-25 at 5;55PM, the NCAA physicals; you mentioned you have read descriptions of those. Do you have a link? I tried googling it with no success.

Mike

Joel Sherman said...

No link, Mike. They were personal communications from a college athlete. I'm seeing what I can do.

MER said...

Joel: I read your response on that sports physical blog about the dreaded hernia exam. I was surprised that you didn't suggest as at least one possibility that the boys be given a choice of male or female doctor. All the other suggestions you made were fine as far as they went, and that might work for some boys. But we can't eliminate the entire gender choice situation. Some boys may just prefer a male doctor or nurse. And we all know that a young teenage girl would never be subjected to a male nurse for any type of intimate exam. I appreciate your advocacy in this matter, but we should never forget to remind people of the double standard, especially those in the profession.

Joel Sherman said...

MER, that question should be addressed to the school, preferably by the boys parents. It's not up to the physician. It apparently was a rural area and she might well be the only physician available.
I wouldn't assume there was a double standard though. Male physicians certainly do sports physicals on girls too. I'd only be upset if it was a policy of the school to only use women physicians, which is really against equal employment laws.

Anonymous said...

Dr. Sherman,

Even with male doctors performing sports physicals on females, I seriously doubt that such physicals are as public in nature as those performed on the males.

On a side note, on an FAA flight physical, men are required to have a hernia exam. Exams of the prostate in men or breasts in females are optional. Women are not required to show anything private to obtain an FAA flight physical on any of the 3 classes.

Mike

Anonymous said...

Female students never have to remove there bra or panties for any school physical. Many more then not times the school nurse is present for all physicals to assist the doctor. How many of us had a male school nurse? So if the male student has to pull his shorts down in front of the school nurse don't you think it would be nice if they had a male doctor? Yes I think if full nudity is involved there is a double standard here. See how early on in life this does really happen.

Alex

Joel Sherman said...

There will always be a difference between what is needed for a boy's vs. a girl's physical. Girls just don't need any genital exam which by the way would be much more intrusive than any male exam.
An interesting question is whether a hernia exam is really needed for a sports physical as opposed to a private complete physical. I'm not competent to answer, but maybe it's not required. I think though that for mass physicals, no nurse is needed to watch the intimate part, whether they are male or female. This relates to my comments on the chaperone thread, a nurse watching is just a chaperone.

Anonymous said...

What is it with these hernia exams. Why just for YOUNG people. I'm in my 50's. I've never had a hernia exam once I got into my mid years. Hmmm, one can't help but wonder. Besides,wouldn't you know if you have a hernia!!

Anonymous said...

Dr. JS,
You are exactly right in saying boys physicals and girls physicals are different and they should be treated that way also. I found your comment a little flip in throwing in the part of how different the physicals could have been. I certainly do not doubt that a women's body is different from mine and I doubt anyone else here would so I was a little confused as to why you even said that. I have no control over being borned a man as a female has little control being borned a female.
The doctors article was about was the hernia part necessary and how embarrassed the young men where. I am not a doctor and I cannot tell you if the hernia check is necessary but what I can tell you that having a female doctor check you for a hernia exam with a female nurse present is embarrassing. I played three sports a year so since 9th grade that was 12 spots physicals in total with always a female doctor and our school nurse present for entire physical,all pretty embarrassing might I ad. We lived in a suburb of Chicago in a pretty well to do school district so affording two different doctors to perform male physicals and females physicals should have been not a hard problem to figure out. Maybe most guys did not complain because they where just as embarrassed to bring it up to someone else. Why does it take a female doctor in the year 2008 to bring up the fact at how embarrassing the young men look. Who decide in time that the boys would just be fine with this? Who decided it was okay for the school nurse to watch all of this, why could someone not set her up a station with curtains up to get the vitals, or why could the vitals not be taken a day ahead of the physical? I use to see the school nurse in the hallway between classes and I was always a little embarrassed to see her and I never went to see the nurse , not once in my four years there not even for two aspirins if I had a headache. Trust me if female students had to have full nudity in there sports physical today it would be with a female doctor and a female nurse, I would doubt the school district and insurance companies would have it any other way, leaving very little room for law suits. To finish up here with a small imagenations school and sports physicals could be done without the either male or female students being over embarrassed for no reason at all.

Randy
(full of experience in this department).

Joel Sherman said...

Thanks Randy. My comment was aimed at the few people who think that if men get genital exams, women should too. That makes no sense if it's not needed.
I'm beginning to wonder whether I should open a separate thread on mass sport physicals. They seem to have replaced army physicals in terms of the potential to be humiliating.

Anonymous said...

I think the sports physical issue is indicative of the larger issue which extends beyond the medical arena and into our society as a whole, as does the solution. If female students were subjected to this humiliation male Dr., male nurse, nudity, what would have happened...of course we all know, the girls would have complained, some parent(s) would have rasied caine and the school would have changed, but I would guess few if any parents stepped up why...two factors, 1st because the boys have been taught to just accept it so they are to embaressed to say anything so once its over we just move on unhappy but glad its over, so parents don't complain and 2. We are afraid to challenge for being labelsed sexist or wierd. Therefore society is free to ignore the issue. Google reporters in the locker room, you will notice a couple of interesting things in all of the comentary by female sports writers, one is they are the victim, not the athelete who has his privacy compromised, one complained that when she used an exit through the shower where 2 men were standing in the shower naked someone laughed (how dare they)two..anytime an athelete or coach resisted or challenged they were attacked as sexist rather than recognize thd gender difference in the environment of a locker room DOES make a difference, and three the issue of the double standard when it comes to respect for male and female atheletes is never addressed. Pararells with medical treatment including sports physicals are very strong. A male complaining is going to be treated as a problem or abnormal, not a victim. Until we stand up for our sons and ourselves it won't change. Randy, I was lucky, our school brought in a male MD for the boys, female for girls, but have faced similar circumstances in other area's...I would like to ask you a question. Did you ever tell your parents or anyone when this was going on how embaressing and upsetting this was to you? If not why (I think I know the answer but would like to hear from you or others as I feel it has a lot in common with this total thread) alan

MER said...

I'm going to take a risk here and point out something that I've been contemplataing. A risk, because I don't want to be taken as an extremist or a conspiracist. But I think this entire discussion of male modesty in medical situations is part of a much larger picture in our society that involves under the radar, sociological, cultural attitudes and values about men.
Our society for many years now has been trying to resocialize men, especially young men and boys. We're trying to remove some of their masculine traits and replacing them with some feminine traits. Now, I'm not against both genders getting in touch with both their masculine and feminie side. Basically, I think it's a good idea.
But what has been happening is described pretty well in "The War Against Boys: How Misguided Feminism is Harming Our Young Men" by Christina Hoff Sommers -- and it other books and articles as well.
I also recommend a new book just out called "Guyland: The Perilous World Where Boys Become Men" by Michael Kimmel. The title of the review in the New York Times (9/7/08) is "Nasty Boys: A look at the American male as a crude agressive jerk."
Look at how men are portrayed in a significant number of films -- weak, undecesive wimps. Look how fathers are portrayed.
I'm not claiming to be an expert on what's happening, but I do observe it. Look at the whole "metrosexual" movement with some men -- the need to look, dress, behave not as a man but as something in between a man and a woman.
I'm not sure how, but all this fits into attitudes toward men and their modesty in our healthcare system. It seems that the medical community is consciously or subconsciously trying to resocialize men to just accept the fact that they shouldn't feel humiliated or embarrassed in any kind of opposite gender medical situation. A good part of this, I think, isn't ideological but rather economic. Most of the caregivers are women so the systems attitude is that men just have to deal with it. The system rationalizes the economic necessity for this by coming up with intellectual, ideological reasons for this being best, most healthy way to view life and sexuality.
What makes this so noticeable is that they don't do the same with women, generally, so the hypocracy and double standard becomes extremely obvious and difficult to defend.
That's why I think that ethical doctors and nurses are bothered by this situation, too. Like the female doctor who was disturbed by the hernia exams. But she continued to do them and didn't speak up to school officlas. If the did that, doctors and nurses would have to put themselves into a precarious professional position to fight or stand up for the rights of men under these conditions -- not a popular stance within their own profession.

Anonymous said...

Dr. Sherman,

I agree that girls should not get genital exams just because the boys do. I think they should get examined for hernias because they can get them too. Femoral hernias are more prevalent in females than males, but females can also get inguinal hernias as well.

Seems to me that people who have hernias know they have them. I have known several men who got hernias and they reported that it was painful and seriously hampered their ability to engage in strenuous activity. I don't think any kid with a hernia would be interested in sports until it was repaired.

Is there such a thing as a man (or woman) having a hernia and not knowing it until it was discovered on a physical? I am not a doctor so I can't answer that with authority. When I get my physical in a few weeks I am going to ask my doc if he has ever "discovered" a hernia that the patient didn't know he had.

I don't mind a hernia exam as long as it's conducted with respect and professionalism. What do medical personnel have against a male patient who is undergoing a hernia exam? Is there a reason to humiliate the patient? I don't think so. So why all the horror stories about abusive hernia exams? A nurse may not consider doing a fellow human being wrong in terms of offensive behaviors, but sees nothing wrong with simply standing there and watching a young man get exposed for an exam. Doesn't she see that that's highly offensive? Were not talking about mere embarrassment, but humiliation. I'd rather a nurse spit in my face than observe my hernia or prostate exam. I can at least wash off the spit, but I can't wash away humiliation. That stays with me and affects my future relationships with medical personnel.

The sad thing is that these humiliating hernia exams associated with sports physicals and military entrance physicals occur to mostly young males, typically teenagers, and at a very impressionable time in their lives. The danger of this is that they associate medical care with being humiliated, and that can have huge negative consequences later in life when they decline care that could save their lives.

What good is all this great healing technology if patients fear accessing it? It does no good to harp at men about getting regular checkups if the medical system has the serious flaw of failing to recognize the modesty of men. Apparently some medical people just think that men will just forget about it. When Randy mentioned his 12 sports physicals with the female nurse and doc, it is apparent that he hasn't forgotten about it. Did those 2 females who embarrassed him think it was somehow OK to do that?

Randy, how long ago was that? Is there any chance you could make contact with either of them today and tell them how it made you feel then and that you still very much remember the experience today? Who knows, they might still be at it.

I was fortunate with the whole school physical thing. All the years I went to school I had to have a back to school physical. We had our own family doc and he was the same doc that cared for me from infancy through college. I remember we took a school form to him to be filled out and signed that we had our exam and shots. Later, in jr and sr high, when I played sports, he would check the block "cleared for sports". The less fortunate athletes had a physical where the doc came to the school and performed the exams, including the hernia checks, since they were done at no cost. Once, the head coach felt we should all go through this ritual together, even the guys who had already paid for a physical with their own doc. I knew that the male doc had his female "nurse" or whoever she was, stand right there with him while he did the exams. I would have none of that and disappeared. The coach told me I couldn't play because I missed the physical, even though I already had one. Fortunately, I was the best defensive end they had so I won out, but my father would have gotten involved had the coach not relented.

When getting my back to school physical, the doc only asked if I had any pain or lumps in the groin area. He then checked the block "no" for hernia. I never got a hernia exam until I was 21. I don't think my doc was negligent, just realistic. If I had had a hernia I would have told him about it, and I wouldn't have waited until I was due a physical.

My first hernia exam was done in an employment physical for the police department. That would be a good one to relate under the topic of privacy violations as the guy was indeed a quack.

Mike

Anonymous said...

hey mike,
economics being the reason parents being able to afford going to the doctor or having them see the school doctor was off mark.
At my school district seeing the school doctor for school physical or your regular doctor was not an option you saw the school doctor. I am sure parents could argue it and I am sure a few did but that was the rule. How many of us had a company physical and we were able to pick are doctor, not many if not any.
Most sport physicals are to determine there is no problems but another reason was so school did not get sued down the road. Hernia checks are partly in place to determine if a student has one and it also in place for a student not to come back and say playing sports made my hernia worst and I want to sue you.
I definitely agree with what is being said in this thread but you came off very superior with yourself and not knowing how the next school district handled things.

Atlas

Joel Sherman said...

Thanks for all the comments. I will definitely open a separate thread on group sports physicals where I hope we can get others to input their experiences.
I'm not an expert on hernias, but small ones can be undetected except on a thorough physical exam. This might well be of significance if you were doing weight training in conjunction with your sport, but is not a clinical problem otherwise.
Reporters in locker rooms are a related issue, but not a medical one and I won't take it up except to say that reporters could be kept out of all locker rooms tomorrow if the leagues chose to. They only thing they can't do is to exclude only women reporters or make different rules for them. I personally wouldn't miss any of them. Or they could do what the WNBA does, permit reporters in for about 20 minutes and then throw them all out so that the players can shower and change.
I have a major interest in men's health and MER, I have also read Sommers fine book. Our biggest proponent may be Catherine Dube with whom I am still in contact.
None of this should dissuade women from also posting. Their complaints and problems are just as valid and I hope to give them equal attention.

Anonymous said...

Dr. Sherman

I realize the reporters in the locker room is totally different subject, but do you see any connection between societal attitudes as a whole and the medical arena or do you see them as seperate issues all together? I feel what we are fighting here is a society that believes males don't need concern for modesty like females do. I think the standard goes through many segments medical, sports, prisions, public facilities. While we are addressing it in a medical setting, it is a symptom of a bigger issue....and I agree with you, both your and the Dr. Bernstien's blag have evolved heavily to male modesty, hope fully we didn't run females away, the issue isn't only male, but I think it is more prevelant.

Anonymous said...

Atlas,
I think we have bigger fish to fry here than worrying about how we come across on a public forum.

Of course I only speak from my experience with my school system and there is no way I can represent the policies of all the other school districts in this country. In my situation there was a choice. In those days it seemed they were more concerned that you got your inoculation shots than anything else.

Also, when I was in school, our society wasn't as sue happy as it is now. I entered first grade in the fall of 1962 and graduated high school in the spring of 1974. Times are different now, but back then they weren't so worried about students coming back with a law suit over making a hernia worse. Today that might be a concern, though it doesn't justify humiliating young men.

Can we please stay focused on the major topics here?

Mike

MER said...

I think what Dr. Sherman and I are trying to say is that this issue is bigger than just school sports exams for young men. And if there's any chance of changing attitudes one must look at the big picture, which emcompasses our whole society.

I think it's no accident that the book "The War Against Boys: How Misguided Feminism is Harming Our Young Men" by Christina Hoff Sommers focuses on schools and education. And -- that the issue were talking about, sports physicals for boys, happens within the school setting. Historically, education has been used to resocialize, and that's what we're still seeing today. Lest you think this is a big conspiracy, it has more to do with embedded cultural values that lie beneath the surface -- values and rituals that we don't even think about as we go through them. They just happen and we accept that the happen whether we agree with them or not. That doesn't mean this ideology is coming out of nowhere. There are leading influencial intellectuals, who have been promoting these gender issues for years.

So when Mike says that we need to stay focused on the major topics here, I say this is the major topic. At the same time, this may not be the thread to cover this big picture. And there are many things we can do on the basic level of sports exams to help the situation.

Anonymous said...

http://www.syracusecityschools.com/~health1/PhysicalExamStudent.pdf

Hear is a link from google for a school/sorts physical.
What does self rating mean, when it pertains to the female students.
Eric

Joel Sherman said...

I certainly believe that school physicals, locker rooms and the respect given to male modesty are all tied to the same societal values. I don't think these values are static, but they are evolving all the time. Male modesty is more respected than it was 30-40 years ago, but it is certainly still not given the same consideration as female modesty.
I am still far more concerned with how boys can be humiliated than with how multimillionaire athletes are treated. (As far as I know BTW, women reporters are not given access to the locker rooms in Europe.) If the athletes were sufficiently troubled they could resolve the issue in short order, but the boys are powerless.
Eric, I don't know what a self rating means. If it means that the girl makes the judgment and not the physician doing the exam, it's pretty meaningless. You can find lots of these forms online. They all require a hernia exam. But I don't know what a male genital exam as opposed to a hernia exam has to do with the ability or safety to play sports.
I will start a sports thread soon, and copy these posts there so as not to intermingle them with more general violations.

Joel Sherman said...

I have opened a thread on group school physicals.
Please post on this topic there now.

Anonymous said...

Dr. Sherman,

I'm kinda on the fence whether to agree with you or not regarding your suggestion that male modesty is more respected than it was 30-40 years ago. Perhaps in some ways the medical community is starting to realize the modesty needs of male patients but it still falls way short of what it should be. 30-40 years ago there were many more male doctors than female. I only recall male doctors performing the sports exams in my youth but with a female nurse some of the time. Also, in the past when male patients in a hospital required a catheter, a male orderly performed the task. After about 1980 or so is when hospitals started requiring the nurses to do it, with the belief that they better understood sterile procedure. Of course, as we know, most nurses are female.

In looking at the Syracuse City Schools site (thanks for posting that Eric), when I checked the staff link, I counted 51 nurses, all female. 13 out of 14 health aides were female. It's a sure bet that any male student getting a hernia exam will have it done by a female, probably with another female "assisting". It was comforting to some degree that the parents had the option of having their own doctors perform the exam. Allowing the females to self rate is telling. I wonder if they would allow the boys to self rate their hernia checks???

MER,
I certainly agree with you that embedded cultural values have a lot to do with how our society as a whole approaches the issue of male modesty. We need to rewire our cultural biases to accept the idea that male dignity has value, and that will be a huge task.

Mike

Joel Sherman said...

Mike, your points are well taken. I was thinking of society in general when I said male modesty is more respected now than it was when I was a kid. There are exceptions such as locker rooms and prisons, but in general society I think it is true.
It is perhaps not true in a medical situation, though I think female modesty is also less respected now in medical situations as there are many male technicians and aids. They have an easier time refusing cross gender care, but like men, the majority will not speak up. The only aspect that's improved for women is that they can now easily find a woman provider if that's what they prefer.

Anonymous said...

Do any of you have an opinion on this...I feel the difference in treatment of male modesty vs female is two fold. 1st society is more sensitive/outspoken to the issue as a whole, and women are more sensitive/outspoken as well, might be a chicken/egg arguement. By sensitive I mean in accomodating or consideration for female modesty. That part of it arises from the past where women had to be more outspoken and active to achieve equal rights, that has made them more outspoken and society more receptive, the other side of that is male concerns are more likely dismissed as a tough see how you like it, its sort of a your turn now....I ask this as I obsverved the following on a local TV station (northern indiana). They were interviewing a NP (female) who was conducting a mobile prostrate cancer awareness project where they took a mobile unit from town to town providing low cost screening for men. She explaine it included DRE & PSA, she said she and her nurse did the exams, only took 5 min, etc. The female newscaster started laughing and making faces. The male anchor gave her a look and said..thats not funny and she just smirks. The same station is very involved in breast cancer awareness and screening and takes it very serious....can you imagine the uproar if the male anchor had laughed and made cracks about breast cancer screening and self exams. Nothing, no apology, nothing, no acknowledgement, the second thing...there were two females conducting the screening including the DRE for an all male client base requiring exposure, I would lay money when they do low cost mamograms through this same station the staff is all female, they have interviewed Dr's & techs all female.....what do you think? Sorry after writing this it may be in the wrong area...but follows the discussion going here,...alan

Joel Sherman said...

Alan, of course there's differences on how society at large views male modesty vs. female modesty. The modesty thread is all about that.
I hope you did your part by complaining to the TV station. Complaints like that can have an effect.

Anonymous said...

Dr. Sherman

I wasn't very clear with my post. The question becomes one of what is the mind set among providers/institutions that causes the double standard/lack of concern/recognition when it comes to males. Is it failure to recognize or is it recognition but lack of desire to accomodate. And is the result of the issues I stated. Is it the fact that women have developed the mentality and organizations to pressure accomodation? Is it simply our society is in a payback mode...are providers afraid not to respond to women but don't fear men or do they just not recognize it...and why is that? I don't know how we do it, but this dialouge would be so much more educational if we could get providers or experts to join in. Having people like Catherine and others like nurses, techs, hospital administrators would be so valuable.

I did complain and got a nice little letter that she meant no disrespect and she was sorry and it would not happen again yada yada yada. Told them it was the last time I would watch and would tell as many people as I could, looking back I wish I would have contacted the National Cancer Assoc. and asked them to write alan

MER said...

Anonymous said: "I don't know how we do it, but this dialouge would be so much more educational if we could get providers or experts to join in."

This problem has bothered me as well. But we are making progress. I see we have a female physician signing in on the sport's physical thread. That's good.

These threads can be threatening for some female providers, especially nurses. There sometimes seems to be an "us" vs. "them" mentality on some of these blogs from some men. That may scare some of them away.

Of course, you also see the "us" vs. "them" attitude come through on blogs like allnurses -- not just male vs. female conflict, but especially between medical professional vs. patient. That's not good.

Why we don't have more nurses, I don't know. I'm sure they're out there reading some of this. From my experience, non medical people are not welcome on blogs like allnurses. Maybe some nurses think they're not welcome here. I would hope we could encourage them to express their opinions and maybe give us a more inside look at where they're coming from.

Some of the new research and writing about feminism and men is suggesting that, in some cases, the feminist movement went too far -- that is, beyond just providing equal opportunity and more options for women, and into actually marginalizing and demeaning men and masculinity. I'm not reducing feminism to that, but I am saying that it did happen and we're experiencing some of the effects today.

For those who want to see how our discussion of double standards in medicine fits into the big picture, I recommend "Guyland: The Perilous World Where Boys Become Men. Understanding the Critical Years Between 16 and 26" by Michael Kimmel. Kimmel has also written a book called "Manhood in America." He's a well-respected sociologist and social historian, an expert in gender studies, from State University of New York at Stony Brook. I'm reading it now and it's excellent. It gives tremendous insight into the big picture. I'll contact him and see if he'll agree to look into this and Bernstein's blog. But remember, these people are extremely busy and, unless this subject especially interests them, they really don't have the time.

Also, "save the males: why men matter, why women should care" by Kathleen Parker. This is a less scholarly book but a good collection of facts and anecdotes that demonstrates the double standard in many other areas of our society besides medicine.

Anonymous said...

mer you have some of the same thoughts, there is a less...scholarly blog in the voy, it is filled with alot of fetish junk, but occasionally it appears some of the posts are serious. Occasionally there is post by a supposed nurse or healthcare provider...sometimes the posters are really nasty and rude to them. They may or may not be bonafide...but if they are they often stop posting after the abuse gets to bad, fortunately Dr. Sherman and Bernstein can moderate these and temper that. And I agree, I would not feel comfortable posting on allnurses...they are just as brutal with people they percieve to be outsiders....so perhaps we can all just encourage the medical folks on these posts to join in and see what happens...having Dr. Cvijanovich join in the sports physicals is great, hopefully she will stay with us awhile and encourage others to join in...alan

Joel Sherman said...

Alan, I think a sociologist could answer your question better than a physician. In fact we used to have one here but he stopped posting.
I think it's a combination of societal factors that are to a good measure hangovers from a different age, like real men don't care about or need modesty. Men are embarrassed to complain because of it, so many people never realize it's a problem. Women don't have that hang up. It's not specific to medicine.
As always, the best thing to do is to make your feelings known. You did well with the TV announcer. I'm sure she in fact will not do it again and she has learned from you.

Joel Sherman said...

Here's a link to a woman's blog relating a fairly common privacy violation. She was in stirrups awaiting a pelvic exam. She was positioned facing the door when the nurse went out exposing her to a man who was walking past. She didn't complain immediately waiting weeks or more to tell the physician.
These are usually inadvertent violations but could certainly be avoided with a little better positioning of the exam room or a privacy curtain pulled around the patient. This applies to male genital exams as well.
I think this kind of violation happens not infrequently in ERs as well.

MER said...

Joel:

I went to the link you mentioned above and read the story. I responded and since have had a bit of dialogue with the writer who goes by SeaSpray. She's a medical professional with many years experience and has acted as a patient (and staff) advocate. Her blog is well worth reading. She really knows what she's talking about.
She referred me to an personal experience article she wrote for The Medfriendly Blog, called "The Conflicted Patient." It's an extremely interesting piece about an experience she had in an emergency room as a patient, and how she, as someone who has fought for patient rights over the years, found it difficult to stand up for herself in her situation. I highly recommend it, not only for those patients on your blog, be especially for doctors and nurses.
Go to
The Conflicted Patient

Joel Sherman said...

I am in the process of reading My Angels Are Come by Art Stump, a very real account of the author's battle with prostate cancer. In it he describes a nearly unimaginable violation of his privacy. At the Memorial Hospital of South Bend, Indiana, he is lying nude on a table surrounded by therapists and nurses plus a young girl he has never seen before. As they start treatment, a nurse introduces the girl to the others as a high school student who is just there to watch, part of a program the hospital has with the school. He was never asked even then if her presence was OK. He was too paralyzed by anger to object at that time. The book goes on, and I haven't finished it yet, but this is about the most severe invasion of privacy, short of an actual physical assault, that one can imagine.
I hope most readers of this blog would have objected immediately or even better asked who she was to start with. But I'm well aware that while you're in the middle of life saving cancer treatments, it's hard to object and interrupt treatment.
As a medical student decades ago, I remember being given a tour of the radiation therapy department and witnessing a teenage girl receiving therapy while completely exposed. I'm sure no one asked her permission either, but it was a different era, and at least we were bonafide medical personnel though not involved in her care. Amazing that worse incidents can still happen today.

Anonymous said...

Dr. Sherman, I don't mean to step
on the Art Stump posting which deserves much comment but please
go to the following address for a
shocking case of young females
caring for elderly patients.

http://www.thesmokinggun.com/
archive/years/2008/1202081minn1.html

Are these young women members of the Future American Nurses Club?
Is this the female caregivers' mind at work? Are these the chaperones who are brought in to humilate men during exams? If so, we all have much to fear! I hope they'll discuss it on allnurse.com.
- Jason

Joel Sherman said...

Well Jason, your link relates physical assaults, clearly criminal offenses, whereas the Stump book relates an invasion of privacy, clearly much less serious. But both stories have in common the use of untrained or poorly trained teenagers for purposes that they are not ready for. The Good Samaritan nursing home in Minnesota was clearly responsible for supervising this gang of teenage girls and tragically failed to do so. In the Stump book, the fault was all the hospital's for bringing the girl inside in the first place, let alone without asking prior permission.
Hospital programs that introduce high school students to the health field are not rare; a local hospital has one. As far as I know the kids, both boys and girls, are never left unsupervised. These two stories will stimulate me to attempt to discover just how much patient contact they have and under what circumstances.

Joel Sherman said...

It's also worth noting on the Minnesota story, just how misleading our stereotypes can be. The story includes pictures of the two white girls who are of age and can be named. They look like sweet wholesome girls, more likely to be school cheerleaders than involved in sadistic activities with helpless demented patients as the victims.
Yes the article makes very discouraging reading.

Anonymous said...

That is truely a disturbing read. It sickens me. I live near S. Bend and am familiar with the facility. I know our hospital works with hospitals and know a guy who was asked if a female HS student would observe his colonoscopy.....I guess at least they asked...but it really does show how some providers become so insensitive to patients, and how the attitude that we are professionals becomes stretched to the point of ridulous......there is another thread running on the validity of allowing assistants in to write or document exams to speed things up for providers...and the provider tried to justify that they were given in office training...I'll bet these girls had in facility training as well....something I noted, the girls were charged with misdomeanors....think if they were male they would have gotten off so easy, sort of like the different penalties for sex with students depends on whether the teacher was male or female...truely disturbing alan

Joel Sherman said...

I've now talked to a couple nurses about these incidents.
Both told me about the same thing, that some hospitals run CNA (certified nurse assistants) programs which qualify the girls to get jobs as nurses' assistants. One said the formal training period was 2 weeks and then they worked under supervision constantly watched by a nurse. As CNAs they would have been giving bed baths and intimate care. Not much different than the Minnesota Good Samaritan case EXCEPT that those girls weren't supervised which amounts to criminal neglect in my opinion.
I hope to talk to a few more people. In these days of our 'girls gone wild' culture, I wonder how appropriate this all is. My mother was in a nursing home for years and received excellent care by both male and female aides. But I think I would have drawn the line at high school kids.

MER said...

Joel: What are the specific professional rules governing who can do this kind of intimate care and how much training they must have? Are there any real rules? It sounds like almost anyone can be given a few weeks training and then, under the supposed "supervision" of someone with creditentals, can do the work.

I'm sure there are guidlines, but what exactly comes under official rules? How can a patient be sure who has what training? Again, this whole issue gets to the subject of communication. Patients and their advocates need to be told exactly who will be doing what with them and what their qualifications are -- beforehand, before they get into a situation where they may be too vulnerable or unable to speak up.

In the name of cost saving and effficiency, we are moving more and more toward younger, barely trained, unlicensed healthcare workers. The supposed protection is that they are working under the supervision of a certified nurse or doctor. But we all know how that goes? The certified professionals are stretched so thin that they cannot possibly do any real supervision. We see this in education, too -- with uncertified aides supposedly working directly under the supervision of a certified teacher -- but they're not. I think students like the ones in the case we're discussing, are supposed to be working "directly" under the supervision of a professional. Directly, means they're right on top of them, right with them.

But I agree with you. I don't think girls that young (or boys) should be allowed to do that kind of work with so little training under any conditions. Frankly, even the 9-weeks CNA courses are not sufficent. They may learn the how to's or the procedures, but I'm not convinced they're mature enough at those ages. And in the case of a nursing home, the patients, their proxies or families should be told and must give specific permission -- informed consent.

This is a kind of informed consent that seems to be completely missing from our healthcare system -- consent for intimate care by the same gender.

Joel Sherman said...

My prior post should have clarified that the hospitals referred to run nursing assistants programs specifically for high school kids, probably mostly girls. They do this so that they can interest kids in health care and get more helpers working for them. Many do in fact go on to nursing degrees. CNA programs are usually post high school.
MER, I looked briefly. I don't think there are any recognized guidelines for becoming a nurse assistant, though some states do have licensure requirements and must have some guidelines. So you are right, a nursing assistant could be anyone in most states. A certified nurse assistant should have at least taken some course though this doesn't mean that the course was college level. The girls in the above cases obviously didn't even have a high school diploma. So being a nurse assistant is no guarantee of any professionalism. Starting salaries are poor, in the low $20000s most places.

Anonymous said...

one would wonder if the case cited in South Bend would not be basis for a Hippa suit. Doesn't have to be successful, just needs to be filed and on record to have effect.

MER said...

I think this case could represent the tip of the iceberg as to what's happening in a system that's under stress. I'm speaking specifically about nursing homes, but I think this could apply across the board. As we all know, there's a serious shortage of nurses and doctors, especially in some places and disciplines. There's no shortage, however, of illness and disease. And, we have a growing aging population. The system needs workers, and in crisis situations systems get workers any way they can.
A historical analogy: The "profession" of nursing is relatively young. The first nursing schools in the U.S. started in the 1870's. Soon, almost every little hospital had a nursing school. Why? Cheap labor. These nursing students weren't paid. They not only worked in the hospitals without pay, but the hospitals could send them out into the community to work with private patients -- the salary coming back to the hospital. It was a money making operation for the hospital.
There's a firm line between "getting kids interested" in nursing, and letting them do the kinds of care these girls were doing, apparently unsupervised. Obviously, it's cheap labor, doing the kinds of things that are not considered the most pleasant things to do; but serious work that needs to be done.
I'm confident the nursing profession is working to stop this kind of abuse. But the motivation to push this kind of activity is often administratively driven. The surface reason is to "interest" kids in the profession. The real reason is to get some extra help, cheap labor.

Joel Sherman said...

Anonymous of 12/5, you cannot presently file a private action under HIPAA for damages. Only the feds can do it, and they do so rarely. You could file a malpractice suit against the hospital without HIPAA being involved, but without physical injury or financial loss, it's hard to make the suit worthwhile. If the incident that Art Stump describes had happened to me, I would have complained directly as he did, but then I would have taken the complaint further to a state regulatory commission and/or JCAHO. Neither of these organizations would likely impose monetary fines, but it would make it much less likely that an occurrence like this would be repeated. Hospitals don't like bureaucratic interference anymore than we like dealing with city hall.

I talked to an educator at a hospital today and got more details concerning their high school nursing assistants programs. The kids take it for 2 years as juniors and seniors, I don't know how many hours a week this involves, but can't be very many. The first year they are taught routine care of patients and do indeed work with patients, though always under the close supervision of a nursing instructor. The second year, they can concentrate on special interests. The boys for instance may spend time in radiology. At the end of the two years they are eligible to take a test which would qualify them as a certified nursing assistant (CNA). MER, I'm sure you're correct historically with your outline of what the hospitals do, but I don't think it is a money making project nowadays. Nursing schools and all instructional activities are expensive to develop and maintain. Hospitals are happy just to increase the potential employment pool. They can't pay their own grads any less than others, at least not in today’s market.

Anonymous said...

The case regarding the abuse in
Minn. by these girls is truly
disturbing to say the least.
Makes you wonder, did they see
the nurses do this and think that
its OK. We all know this happens
all the time in hospitals with
female caregivers!

pt

Joel Sherman said...

It can be exasperating to take care of elderly demented patients. Many high school girls just don't have the maturity to do it, and should never be left alone. Few nurses fit in that category.
But I note in Minnesota that apparently the 2 girls who were charged were out of high school and actual CNAs. That is they were certified. I assume the kids in school were not. These two should be tried as adults and given jail time if convicted. Even a misdemeanor can warrant jail time and this case certainly does in my opinion if the accounts I've seen are accurate.

Anonymous said...

If they were 18 then they were not
girls,they're adults. Equally disturbing is the fact that if you
read some of the posts in Minn. regarding cna's it was said that
"if cna's were paid more this would
never happen". In other words in their mind anyone is capable of
these lewd sickening acts,but would
refrain if paid adequately enough.

PT

Joel Sherman said...

I have moved this post from a different thread:

Anonymous said...

Years ago, when sent to the Proctologist by my GP to determine the cause of sudden internal bleeding (intestinal ulcers it turned out), he had me positioned naked over an exam table, cheeks spread, butt up in the air, when the nurse comes walking in the door unanannounced (& unexpectedly) & roughly wipes my rectum. Every time I have mentioned to any Dr. about modesty or unlocked doors, they say "Don't worry, nobody will come in." These are the famous empty promises that can always be written off when they are broken with pat replies such as:
"Oops, who knew."
"Oh well, she has to do..."
And my "favorite", the ultimate in inconsideration & derision from the invader herself:
"So, big deal, I've seen it before, don't be such a baby."
That last one I actually heard also from a female at the YMCA who was picking up wet towels in the men's locker/shower room who claimed to have been a nurse, so she rationalize that it didn't matter & that she could view the men naked.
You say that men don't complain as often, but when we do; it falls on deaf ears on every level.
Rarely can you find a urologist whose office has even ONE male nurse. Every procedure is performed by her (bladder ultrasoud, e.g.)or assisted with her present (catheterizations). This even when I made it very clear that I wanted the Dr. alone to perform the procedure.
Also, may I ask, is it a violation of HIPPA to do the following: he would dictate his notes into a tape recording from a central nursing station loud enough for all to hear the details of each exam including the full name of the patient and their Circumcision status? Every patient in every examination room surrounding that central station (as well all of the staff, of course) could hear:
"Mr John Smith, a 55 year old Circumcized male suffering from impotence, was examined for Herpes and tested positive. Patient states that he was unable to use condoms in the past because the unusually skinny circumference of his penile shaft caused the condom to slip off."
I'm not joking, the doctor would reveal every private detail of each patient aloud while dictating those notes! In example above the name was changed to protect the unfortunate. However, I actually heard these numerous times while awaiting my turn. I never heard by own diagnosis, because I was out of the office by that time.
What do you think I should do? I sometimes bump into co-workers in Dr's offices and don't want my most intimate details made public! The doctor always scoffs when I discuss how serious I am about my privacy, and the more adamant one gets, the more that they think that there is something wrong with the complainer, not their own policy or practices.
Your assistance please!
-Frustrated & Humiliated

December 27, 2008 3:06 AM

Joel Sherman said...

Anonymous of today, I’m not offhand sure if discussing patient information in the hearing of others is technically a HIPAA violation. The act is mostly concerned with information transfer, not personal encounters. I believe it likely is covered though. But in any event it is a major breach of privacy which nearly every state protects. You could complain to the institution or to the state medical board.
For the other violations you mention you should complain immediately to the person/physician involved. If the response is flippant or otherwise unsatisfactory, you can continue to complain up the chain of command as outlined elsewhere on this blog several times.
It's too much to expect instant satisfaction from these complaints, but if you act reasonably, the complaints will likely be listened to and corrective actions will be considered at most places.

Anonymous said...

1. You all assume too much. Women have been subjected to:
a. gangs of medical students up to 12 lining up to perform pelvic, rectal, and breast exams on sedated women waiting for surgery, or young poor clinic patients who have been manipulated and lied to about what they intended to do to her.
b. I went in the U.S.A.F. our exams were also humiliating and violated our dignity. We sat in a hallway in paper gowns as male inductees walked down the hall, the door to the exam room was open and closed several times as our legs were spread open in full view of the hallway, male non-medical staff were present.
c. When women request male only staff for intimate exams or procedures, we are often humiliated, abused, and forced.
d. Women are more likely to suffer a rape by medical staff.
e. In the V.A. system students are short of female patients. They are required to care for 25% female patients; and thus women are super-exploited in the system. One reported over 20 pelvic exams over two days while waiting for surgery. I have my own story. I have complained and complained, only to be made out to be a mental case. Here is my story in the form of one letter in this process of resistance that goes on. You can find more at http://www.patrickdodd.com under lab rats and cadvers.

Frank Van Cleave,

This is as much information as I have to date. Please accept it as a response to Dr. James Tuchschmidt’s response letter dated March 12, 2008 sent to your office.
As early as 2004, my V.A. medical records indicate “Patient needs: Female
practitioner”. 1 When I was diagnosed w/breast cancer, I strongly expressed my resistance to having men around as I went through this type of surgery. I did not want to go to the V.A. and told Nancy Sloan it was for two reasons; one too many men around at a time when I am not going to want any men around, and two for such medical care as surgery and I needed to know I was in the hands of a good surgeon and in a clean safe environment. James Tuchschmidt is right, this is not in the records, not the ones I was given. However, I was very upset and made quite a fuss about my fears of male presence and participation as early as March. I have found what is put in and left out of V.A. medical records is selective and itself often manipulative. The V.A. claims the right to keep things from you if they think it is not good for you to know; I do not agree with that, and it just gives them the room to not tell you because they did things that were not good for you or were against your expressed will. If they did not know I did not want only women, then why did Dr. Kwong claim we were going in with “an all female team“? Why did she lie to me after the fact, but before the colonoscopy and thus, before my KNOWLEDGE and complaint regarding the bait and switch? One might expect a lie regarding student participation, but it seems Dr. Kwong lied about Dr. McConnall? There is only one reason for this; she was well aware I did not want men participating in this surgery.
Dr. Kwong knew I did not want men, Nancy Sloan knew I did not want men, and given the level of fuss I raised over the issue I have to assume much of the staff knew I did not want men involved in this sort of intimate care. I had wanted OHSU to take charge of my care under Champ VA, but they insisted I go back to the V.A., said I would have the same care there I would get at OHSU. I had signed papers at OHSU stating that I did not want students participating in procedures. This may or may not have something to do with their reason for refusing direct care and sending me to the V.A. where they seem to enjoy immunity for practices they can get sued for at OHSU. Nancy Sloan assured me that I would be safe, and all my needs cared for; so, I asked for Dr. Karen Kwong, a name I had been given by Joan at OHSU. I got to know and trust Dr. Kwong. I researched her experience, liked her calm disposition, and the idea of small steady hands. I was comfortable with her. I also requested and was assigned a female OBJYN to do a bilateral oopherctomy at the same time. I had talked with the OBJYN surgeon and liked her as well. I was told by Dr. Kwong going into surgery how unusual an “all female team” was in surgery. Either she was not telling me the truth; or something changed. Either way she certainly knowingly lied after the fact, as I would find out latter, and again this is a clear indication that she was well aware of my objection to male participation in such a surgery.
The day after the surgery a female resident came in to introduce herself as having assisted with the concurrent bilateral oophorectomy stating that I likely did not remember her as I was drugged; but that she had talked to me right before surgery. She was right; I did not remember her. I did not realize it at the time; but in retrospect this was the first hint I had that I was not being allowed the right of “informed consent” in terms of who would be touching and cutting on my body while I was unconscious. While I was aware PDX VA was a teaching facility for OHSU; I also assumed I would be introduced to all people including students that would be involved in surgical, invasive, and/or intimate procedures in advance. While Observation was something I figured I did not have control over, student participation, student intimate exams, and broadcasts I assumed would require specific consent. Stupid me, I thought I had rights.
A few days after the surgery, my husband told me that a man had come by and told him that he had spoken with me (if he did I was drugged at the time), said he would be sitting “second chair”, and proceeded on. As I had requested women, and had been told going into surgery that I had an “all female team”, I asked Dr. Kwong about this mystery man at my follow-up. She gave me the “dear in headlights” look that I have come to know as a leading indicator that a lie is coming. She looked at my chart on the computer screen, denied that a man was there, said she did the mastectomy, and shrugged. According to the records Dr. Shabnam Chaugle did the surgery and Dr. Kwong supervised. 2 While I would not have consented to a resident performing the masectomy, and wonder if this had not been a teaching project would I be suffering less nurve damage pain now, (Identification of and avoiding damage to nurves is one thing students are graded on when doing a masectomy.), I would be moving on with my life rather than writing this today had this been the facts of the matter. If men had not participated in this surgery, had I not been left in the care of men while under anesthesia, had they not lied to me, if they had told the truth and let me respond accordingly and with free will, had they not so blatantly violated my civil rights, you would not be reading this today. My husband identified Dr. Hannan Chaugle, Shabnam’s husband as the man who said he would be “sitting second chair”. (Very recently, I was told that another set of records maintained at the V.A., but not provided to me, indicate Gregory Adams, a urology resident, was the surgeon, and Donald McConnell the attending.) The question is, why can I not get consistent honest accurate answers to my questions? Why is Dr. Kwong lying? Was she even there? I was unsettled to say the least, and the issue comes up again.
Before I had reviewed the records, but after my husband had told me about the male surgeon and Kwong had denied the same, I went in for a colonoscopy. I had postponed the colonoscopy until a while after the mastectomy due to a widening recognition of the fact that trauma (including surgery) can increase the growth rate of cancer. 3 The G.I. clinic were well aware of my concerns. This alone would suggest it would be proper to ask about any trainee participation at the time of making the appointment. On the contrary such plans to involve students were intentionally concealed. When I was ready, I asked for and again was assigned a female physician. I was told I would have Dr. Collins. I told Dr. Collins I did not want men involved. Being concerned, I very specifically told her that I suspected I had been lied to by Dr. Kwong and did not want such a thing to happen again. She assured me “no men”. After I had been made very ill with an overdose of the laxative, after the I.V. was in, after something was injected into the I.V. to “help me relax”, after I was stripped, after I was stretched out in the procedure room (which I now realize was also a teaching room and more than one student was invited in after I was sedated), Dr. Collins came in with Dr. Mitchal Schreiner and Donald Miller a nursing assistant they called a “tech” and a nurse to attend to anesthesia. Dr. Collins introduced Mitchal as her fellow and he shoved a consent form in my face to sign. I was not asked! I was told he would be doing the colonoscopy. I have since learned this is a strategy systematically and intentionally employed to overcome potential or expressed objection. It was dark (or at least seemed like it was through the fog of medication), I was lying down, and I had been throwing up from being overdosed with a third bottle of Sodium Phosphate. (Which I am now convinced I was given because Dr. Collins did not want to wait long enough to allow my system plagued by a recently proven slow motility to work. She had the results of the gastric empty test at the top of the records as the most recent procedure.) When Dr. Collins brought in the men, she quickly stood to the side where I could not even see her to object. I was forced to face the men if I wanted to object to their presence. I was shocked, embarrassed, and humiliated and did not have the physical strength to throw Dr. Schreiner out. I signed. I was not “compliant” and there was no “misunderstanding“; I was lied to, manipulated, drugged, humiliated, and battered. Dr. Collins had plenty of opportunity before the O.R. room, to tell me about these men; she could have told me when she had me in a room to insist I need a third bottle of Sodium Phosphate. At that time, I could have and would have left. I was not given that choice. Rather than be honest, she hid the men from view and knowledge. She assured me there would be no men, and given her intent all along to bring in the men, this amounts to a conspiracy to overcome my objection to male participants. Latter, Dr. Collins claims she explained JACHO to me. She did not. I did not hear about JACHO until I read it in the notes. I am not convinced JACHO requires both the tech and the fellow, unless she did not stick around or was teaching a group of students gathered in the room rather than tending to my care. Also, there are many female fellows in the G.I. department. I saw a room full of them while I was on the floor a few days ago. I see no reason why I could not have been provided all females, and certainly no reason, if Dr. Collins bothered to stick around and supervise as she claims, for the techs involvement in the procedure.
By the time Dr. Collins introduced the male resident I already felt drowsy and week, clumsy and the room seemed dark. Furthermore, I was lied to about the techs role. In my opinion the consent fails under these conditions and thus this rises to the level of what some call “medical rape”. Others have argued that as such intimate exams and procedures are not sexual and; therefore, while a case of battery, such non-consensual intimate exams are not rape. However, professionals have been arguing for years that rape is not primarily a sexual act, but a violent one. A soldier or police officer could likewise argue that an act of penetrative torture is not “rape” as it was not done for sexual gratification, but for the sake of gaining information. The intent of the perpetrator cannot be the criteria for rape. So the question becomes is unconsentual medical penitration violent? I say YES. It extends the anesthesia time increasing risks, multiple penetrating exams increase chances of infection and can cause physical trauma, patients select particular surgeons based on experience and risk assessments and consent is based on this assessment, and many women experience non-consensual penitration of any sort as violence. 4 Of course women are not alone. Male patients are abused as well. One man who did not go all the way under suffered the trauma of 8 students practicing rectal exams prior to a colonoscopy. 4a I have read many accounts of such violence against patients, how the patients object and some physicians/students rationalize this practice, while other physicians/students refuse to practice in this fashion. I have read lawyers who defend physicians trying to tell them not to do this, and I have read some physicians response to this attorney practicing on their side of the fence such that by the time the dialogue was over he was contemplating crossing over to the other side. The most interesting, however was a male physician who complained when he had told a student ‘NO” and yet following the attending’s orders the student plunged his finger up the good Doctors rectum before he knew what hit him. 5 This physician/victem agreed, the act of unconsentual penitration is a form of violence. This is why it is only supposed to be done in emergencies, not as a means of overcoming the inconvience of consent or personal rights. There are many professionals who agree and some medical students have even risked their careers in refusing to do unauthorized exams. 6 Therefore, in good company, I maintain the act of anyone examining our cutting on intimate parts of my body and to whom I did not give explicit and specific informed consent has committed patient battery and in some cases (pelvic and rectal exams) an act of “Medical rape.” I did not fail to state what would make me comfortable (and very specifically what would not). I made myself very clear, but was again disrespected. I was also lied to by the tech about the role he would play. The tech introduced himself, said he was there to collect any polyps and take them to the lab. He said he realized I was not comfortable and would remain on the outside of the door. Then he went to the door, but remained in the room. He also participated in the procedure; he had his hands on the tube in my rectum, and likely had his hands on me.
After the procedure, my rectum hurt more than it should. I took a mirror and looked, it was badly bruised. I called Dr. Collins who had no medical explanation for the physical trauma. She stated that there were no problems with the procedure and no reason for the bruising and pain. I found this very alarming. I asked her had I not made myself clear that I did not want men involved. She said I had, and that she was sorry. I asked her why the “tech” did not leave the room as he said he would. She said she did not know why he did not step outside the door, but that she also heard him say that he would not stay inside the room. I knew I could no longer talk to her without losing it; I thanked her for her apology and hung up. I was angry that after telling Dr. Collins I did not want men, she did what she wanted anyway. I was angry that I had been lied to by Dr. Collins before the procedure. I hate being lied to as it takes away my freedom. I cannot make free choices; I cannot protect myself if I am being manipulated by lies and the concealing of information. Now it was obvious to me I was being abused for the sake of training, and I was still not being told the whole truth about who was doing what to me once they put me under anesthesia. After researching practices at OHSU/PDX V.A., it is reasonable to assume that Dr. Schreiner was likely not the only male trainee in attendance that day, not the only male who performed a rectal exam, and he was certainly not the only male who handled the scope.
In 2004 a colonoscopy plus upper G.I. (w/three folks involved) took 20 minutes in Roseburg for both procedures. Why should an uneventful colonoscopy in PDX take 45 minutes? Only one reason, my health was being risked for the sake of training multiple students. Physical symptoms support this conclusion. I am still paying for this abuse with rectal pain and abdominal cramping. A physical exam by another physician revealed fissures and a “butter fly shaped” infection that seemed to be concentrated on only one side of my rectum. This “infection” was very painful, itchy, and took it’s own good time in spite of anything I tried to get better.
After the gastric empty study and colonoscopy, I expected a follow-up appointment in the G.I., but had to ask for one. I thought I would be going back to the Dr. who ordered the tests, Dr. Kanigge, but the appointment was made with Dr. Collins. I accepted; I wanted to tell her to her face how I felt about her, at this appointment. I told her, “She is at best a poor physician and at worst a rapist.” She fell silent, and seemed to have no answers to my questions. Honestly one would think she was not there. She acts like she was either not there, or is working hard to bite her tong regarding the source of the physical trauma. After this appointment, Dr. Collins wrote in my notes that she had informed me that the male tech would be involved in the procedure. This is a lie. She said nothing about the tech. She introduced the fellow told me he would be doing the procedure, and then the “tech” Mr. Donald Miller introduced himself, and said he would be outside the door only to retrieve and deliver polyps to the lab. Dr. Collins did not introduce nor did she say anything to me about Mr. Miller. He remained in the room and participated in the procedure. It took four people over four times as long to do this colonoscopy as it did three people to do the same procedure in 2004, and in 04 there were more polyps removed.
After this incident, I decided I should take a closer look at my medical records. This is when I found Dr. Chaugle was named as the surgeon for the mastectomy, and noticed all the men that had been involved in my care while I was under anesthesia in June. 7 This was particularly disturbing to me as I am well aware of the mass of research indicating that 60% of male college students say they would rape if they knew they could get a way with the act. 8 Dr. Kwong had straight up lied. I asked Dr. Kwong at a follow up if this male who spoke to Patrick could have been a male student, she denied that any male physicians or students were in the room, and that she performed the mastectomy. In spite of her reassurance there were no men, “on the team”, there were men all over me. The records I was given upon request name one who did an EKG named Curt Basham, one who was involved in prep and surgical count named Ronald Gschwend, one Jeffery Hoke who was in charge of my care after the surgery while I was still under the influence of sedation. 9 While not in the records I was given, but according to a friend with insider access to V.A. records, a Gregory Adams was listed as the surgeon, and Donald McConnell as the attending. While trying to find out for sure who Shabnam is I found Hannan, showed my husband his photo, and my husband identified this man as the doctor who introduced himself and said he would be “sitting second chair”. Hannan is Dr. Shabnam’s husband and a California cardiac surgeon and alumni of OHSU. I was not introduced to one of these men before or after. These men were hidden and once I was sedated they were all over me. I had McConnall, Adams, and Chaugle, at least three men on top of me cutting off my breast, while who knows how many others watched? At this point I have no confidence that the women who said they did the oopherectomy did so and in the absence of additional male company and participation. The V.A. web site claims that women do not use the V.A. due to ignorance of availability. Women do not use the V.A. due to fear of this sort abuse. This is so violent, and from my perspective more harmful than a drugged date rape. It is more akin to a drug facilitated gang rape by family members, people you are supposed to be able to trust with your life. It has left me incapable of thinking about having to once again go under anesthesia. I would fight a rapist to the death; and I would rather die than go through this again. As I cannot trust female physicians, I have been left with knowing that the next time I need care requiring anesthesia, I will either have to negotiate family presence throughout the entire time I am under the influence, or reject care.
It was obvious they had made no effort to consider my expressed need for females, for dignity, autonomy, privacy, and security. I would not have consented to male participation had I been told. I DO NOT WANT MEN AROUND ME WHILE I AM UNDER ANESTHESIA. Furthermore, I was much more worried about the mastectomy than the oophorectomy. Had anyone bothered to ask; I would have said yes to the two OBGYN physicians (who at this point I am not at all sure really did the surgery), and only those two WOMEN. If asked, I may have approved of two more female students performing exams prior to sedation, no more than two, no while under sedation, and no men. NO MEN!!! Not observing, not participating. I absolutely did not want men around me while I was having my breast severed from my body, and certainly did not want them participating in the process. The V.A. knew this and rather than respect me, my autonomy, my rights, they lied, they cheated, they battered and in the end they committed “medical rape“. They did not make any attempt to limit male participation what so ever, only to hide such participation, to hide their dirty little secret. This is a perfect triangle of abuse; the perpetrators, the silent partners, and the victims.
Not only is this a failure of “informed consent”, as the V.A. is a federal institution, it is a violation of my civil rights. 10 Dr. Kwong had a duty to inform me that she would not be performing the surgery. The consent forms (signed in advance, though I now suspect they have other forms they have you sign after you are drugged) make it sound like the “resident” getting the consent is doing just that and no more, and that the “supervising” is the surgeon (supervising the resident and consent) who does not have time to fill out all this paperwork. In my case, a woman was the resident who attained the consent, Michelle Ellis. I did read the forms (presented as consent on the 16th two days before surgery), and the consent form being a bit obscure asked questions. It would take an attorney for a patient to know they were signing a consent for anyone to do the surgery and for multiple unnecessary intimate exams, and then they would argue over what such general language really means. I asked Michelle Ellis, and again I was told Dr. Kwong was doing the surgery. This misrepresentation violates the patient's right to rely without reservation on the belief that her doctor will act only to protect her body, dignity, and safety, and not expose her to unnecessary risks without her knowledge and consent. If Michelle is present in O.R. she is there as a unidentified student. As students are not listed in the records to which I have access, I have no idea how many male students, staff, or evidently husbands, may have been in attendance during these procedures. Records are available, but would likely require a court order or deep throat to acquire.
Given the prevalence of this practice of not telling patients that the surgeon they think will be operating is only supervising (which may or may not mean they are in attendance), of failing to introduce patients to residents, students, or trainees, who will be performing exams and/or procedures, given apparent Hannan’s presence, given what I have learned about teaching hospital practices in general, and OHSU/PDX practices in particular, given an infection in my pelvis after the first surgery, and the trauma and infection in my colon after the colonoscopy, there is reason to suspect that teams of students, were not only observing but performing unauthorized exams such as breast, pelvic, and rectal exams while I was under anesthesia. This sort of bait and switch and mass participation, unrestrained by informed consent and empowered patient control, has not served my medical or psychological health. I have suffered unnecessary pain, physical and psychological trauma, and multiple infections. Furthermore, it places women at greater risk of sexual misconduct while under anesthesia by establishing a culture in which women’s autonomy is meaningless, in which women are not self determining subjects, but objects to be subjected to the will and interests of others, all while women are the most vulnerable.
It is hard enough for a woman to go through a mastectomy, to have unwanted males involved is very violent and harmful. I cannot say I did not know this was a teaching facility; but I certainly did not know they would not inform me of, even conceal the extent of, student and/or male participation. All autonomy, all dignity, all subjectivity was stolen. I am very upset that a woman in this day and age with all the female practitioners cannot go through a mastectomy, oopherectomy, or colonoscopy without the security and peace of mind knowing that men will not be all over her. I have been assured no man in the V.A. would take advantage in a situation where a woman had been dosed with a date rape drug or other anesthesia, where he could expect to get away with it and no one would know. Excuse me if I do not buy the B.S. This is exactly what they did in the name of what? Education? Dr. McConnell had the authority and the desire to cut off a woman’s breast that day? If Dr. McConnell is willing to commit and facilitate medical rape for the sake of “education“, it is a very small step to rape for the sake of sexual gratification. In fact in some cases I would say the two may well go hand in hand. That is I think some of these Doctors find “medical rape” erotic. They claim no, yet some of them do not seem to be able to control themselves and end engaging in conduct that is blatently sexual. The lack of any rational justification, the lack of any empirical evidence that informing patients and respecting rights is any thing more than a mere inconvience, indicates some Doctors actually get off on exercising such abusive power against patients. I suspect this is the case with Dr. McConnell; the person who had the power to force other Doctors to step aside and allow him and other males access in spite of my opposition. Furthermore, while everyone keeps assuring me I was not left alone in male care, “during a procedure” they will not and cannot say the same about between and after procedures while still under anesthesia.
Statistics for rape are horrific. 10% of males admit that they find extreme violence (with little sexual content) against women erotic, and half find rape erotic. (A good reason not to want males present during a mastectomy.) As stated before, 60% of male college students asked said they would rape if they knew they could get away with it, and the Military culture is known for being abusive of women from recruitment to the V.A. 11 (A good reason not to want males providing care while under anesthesia.) While patient advocacy compared my opposition to male involvement in such procedures to racism, the analogy is not a valid one. Asians do not go about systematically abusing and raping white men. Asian care providers are not members of a population that is a real and current threat to any other demographic; male care providers are members of a population that remain a threat to women. Women are sexually assaulted by male care providers every day. These instances of concealment and blatant disregard for my very clearly expressed feelings regarding males participating in my care amount not only to sexual harassment, but also medical battery, and a violation of my civil rights. I had a right to exclude men from a surgery the likes of a mastectomy and oopherectomy, and procedures the likes of a colonoscopy. If OHSU/PDX V.A. could not or did not want to respect that I should have been told. AT that point I could have freely chosen to seek care elsewhere, chose alternative care, or tried to negotiation something I would be comfortable with at the V.A. (Such as family member presence by my side at all time during anesthesia.
These physicians have caused me grave psychological trauma and inflicted unnecessary pain and suffering. This is a breach of Dr. Kwong’s and Dr Collin’s fiduciary duty in relationship to me and my health care. The entire V.A. staff and especially the physicians had a duty to do all that was necessary and reasonable to ensure I made it through this tragedy with as little physical and mental health risk as possible. If that was not their top priority, if my dignity, autonomy, health, was to be subordinate to education or the whims of Chief of Surgery, they should have informed me that their primary interest was their own rather than my safety and health, allowing me to seek more patient friendly care elsewhere. This breach of the special doctor-patient relationship in favor of other interests has lead to a complete and total loss of trust in medical professionals and has caused me much, pain, distress, humiliation, and in all probability a sexual assault w/resulting STD. Hear me out.
After the bruising went away, the pain subsided a bit then came back worse. I went for an STD screen (western Blot), it came back positive for Herpes 2. 12 I was told this was a good test and the chances of a false positive were very low. My partner with whom I have been in a monogamous relationship for 20 years, subsequently tested negative. 13 I had a pap done in Feb of 07. This pap could be restrained and tested for the HSV 2 DNA and antigen. 12 If negative this would prove the exposure occurred sometime in the last year. I asked for those slides and was refused. I was also told by a man in Pathology that “I did not have HSV then, and I do not have it now.” I am not giving up on accessing those slides. He claims they will do me no good. However, they can test for the antigen, and while this cannot prove I did have the virus before, it can prove I did not, if it indicates I had never been exposed prior to this date. That would be rare as most people have been exposed, but my husband tested negative for exposure, we have been married a long time and we are of an age where we are less likely to have been exposed. Thus, while the slides cannot be used to prove I did have Herpes 2 at that time, they can prove I did not, as they can indicate I had never been exposed to the virus. Given the refusal to release the slides, I am suspicious they may have done the test themselves and know I had not been exposed prior to Feb, of 2007. If this is so, it may amount to covering up a rape. (unless took a machine from another patient to me, keeping it warm and infected) While the V.A. may make excuses for not relinquishing the slides, OHSU did not refuse me access to the biopsy slides. The “flag” referred to by the V.A., according to Dr. Collins, supposedly states “don’t even ask”. After much research, I am now well aware of the “don’t ask, don’t tell” training practices used by OHSU faculty on “public“ patients. This is exactly the practice Dr. Kwong/Dr. McConnell employed when he stepped in and she lied before and after surgery about who did the surgery, male presence, and perhaps her own presence. I have every expectation that I will be lied to and my requests ignored should I once again find myself anesthetized by PDX V.A. I can have no confidence in what I am being told by people who I know as a matter of practice mislead, misinform, obscure truth, outright lie, and manipulate patients. All of which I now know is done at PDX VA. Under these conditions how can I even have confidence that I had cancer. OHSU/PDX VA needs to train students, OHSU faculty at PDX VA have demonstrated that teaching is their priority over and above veterans’ health and well being; OHSU is in control of both imaging and pathology upon which diagnosis is based. In September of 2007 I rec’d a letter from Nancy Sloan telling me my mammography had turned out OK. I called her to let her know that was not so good as I had a mastectomy. She checked it out and said that it was the MRI of the right breast the letter referred to, but the letter did not say MRI it said mammography. I would have, and did at the time, just assumed this was an innocent error; but now, I realize I can never assume innocence concerning OHSU/PDX VA. (I checked the stats. Female Veterans are twice as likely to be diagnosed with breast cancer as women in the general population. Why? This is a good question for research.) …
As OHSU expands it teaching operations to all V.A.s, abuse will also expand. As the V.A. allows teaching institutions access to all V.A. facilities, as all Veterans suffer a heavier burden of training medical students, female vets will be super exploited. Being in short supply relative to the demand for training opportunities in female specific care, women will suffer a greater number of practice exams and a greater number of student errors. In the absence of informed consent as a limiting or controlling factor female veterans who seek V.A. care will suffer a greater risk of harm than is reasonable.
While some physicians claim that unauthorized exams and ghost surgeries are necessary to education as no one would consent to student care; research indicates this is simply not the case. Research shows that 87% of patients when asked will allow student participation in their care. 13 Most will want to negotiate numbers, such as limiting the number of students who can perform pelvic or rectal exams; some will want to negotiate gender specification for intimate procedures. Most will want information about the level of supervision and student participation. This is a patients right, and time after time patients prove to be amazingly generous. Patients have proven to have more confidence in the students than the students do in themselves, and when included in the process as a subject rather than an object patients can offer highly constructive feedback. 13 It is not necessary to teaching residents in a surgical setting to employ sexual harassment, deception, manipulation and even what some, including this patient, have come to call, “medical rape“. In terms of practice exams (which require a high volume of student training), if there are not enough willing patients, such exams can be performed on paid subjects, called “standard patients” just as models are paid in art classes. Medical schools may need to expand their pool of patients served and be more willing to ask every patient (not just the “public” patient) to participate, spreading the burden out over a reasonable number of FULLY informed consenting patients. In cases of surgery, the physician and student may have to take some time with the patient. The student may have to take the time to get to know the patient and provide some amount of care for the patient prior to surgery. In the end this has to be the patients free, (not a coerced, manipulated, and selectively informed even misinformed) choice. Otherwise we may just as well call the V.A. what it seems to be; fascist medicine.
I have been informed that surgeries at OHSU and PDX VA are often videotaped. Audio or video, I would like to see all data regarding these procedures. I want full and complete disclosure as to who was present during, who performed exams, and who participated in these procedures. I would like to see video of relevant hallways, recovery room, and O.R. while I was in their care. I had a pap February of 2007. The slide is on file at PDX VA. I would like for it to be handed over for an independent test for HSV DNA and antigens. If this sample test negative, I would like for all staff involved in my care be tested for Herpes 2. Those who test positive should be tested further for the particular strain, which could be subsequently evaluated for a match with my infection. If a match is found I want full cooperation from the V.A. in seeking all evidence and information required for an effective prosecution. Either way, if this was Donald McConnall’s call, he should be prosecuted for the violation of my civil rights, battery, and unless they can prove they left a female with me every moment I was under anesthesia, endangerment. By stepping in and taking over this surgery, knowing full well I did not want him and other men involved, this man has proven his willingness to comitt, perhaps even passion for, medical rape. He should be removed as Chief of General Surgery at PDXVA. Given all the deception (which they like to call a “missunderstanding”); I cannot know for sure who did the oophorectomy. Those women could have been fronts for men as well. I would like policy regarding informed consent be changed. I have enclosed a copy of The American Medical Student Association’s, “Principles Regarding Patient Rights”, as well as, a “Draft of Proposed Legislation Concerning Informed Consent and Medical Accountability”, by Eileen Marie Wayne, M.S. 14 ALL consent forms should be presented at least 24 hours before surgery, and ALL participants and any student exams revealed and explained verbally and in writing. The goal should be full disclosure, not tricking, manipulating, or deceiving a patient. When a woman indicates in any way she is not comfortable with males participating in her care, staff should immediately ask questions necessary to record in detail patients limitations on male participation and then those limits should be respected save an unforeseen emergency. If undesirable male participation will be hard to avoid, or in a particular case not in the patients best interest (as would be the case that a particular staff member is the only one well trained on a particular procedure) the patient should be informed, introduced to the male and honestly told in full the extent of his expected participation and why she is better off in his care. I am not opposed to ALL male participation in my care and I resent staff implications that this is the case. One man involved in my pre-surgical sentanal node mapping, either sensitive to my discomfort, or to women’s discomfort in general, informed me that he was on the team that invented the procedure being done, had done it on hundreds perhaps thousands of women. He was good, professional, and had an excellent “bed-side manor”, he was not severing my breast from my chest, or poking around orifices, and most important, I was not under sedation. Not a problem.
What I am opposed to, is not being able to control that participation, from restrictions to prohibitions depending on the care being provided, and the hit I get off those participating when introduced. I am opposed to being lied to by my medical providers, confidence in whom is of utmost importance. This is a reasonable request being made by a reasonable woman.
Patients have the right to choose whether, how, and under what conditions to participate in training of medical students. But in many cases permission is sought at the last moment, making it difficult to refuse. In some cases a “better to ask forgiveness rather than to ask permission” strategy is employed. In others a “don’t ask, don’t tell” policy used. The should be told when the appointment is made and given all information necessary for consent to be informed including status, experience level, supervision level, and sex.

http://hardright.blogspot.com/2005/08/rape-and-consequences.html
http://www.dianarussell.com/menrape.html

PS Not sure what it is about, or that it is at all related, but Roseburg V.A. called and said a man named Donald was asking about me, they did not know who he was and called to let me know. It seems he wanted some info and called more than once. I have read about rapists in medical facilities that will seek some sort of contact with patients after the fact, but most likely this was not the case.
Also, I was told that someone accessed my medical records using Vethealth and my SS# from outside the V.A. system; the person thought I had, but I had not due to my fear that such action may compromise privacy.


Cc: Peter DeFazio

Joel Sherman said...

This post is long and I haven't finished reviewing it. I note it can be found elsewhere on the net and apparently concerns a Portland Oregon veteran’s hospital.
Two preliminary thoughts: 1.) the main complaint concerning her inability to get same gender care is similar to many of the male complaints on this and other blogs. This request is generally difficult to grant in most hospitals for any surgery. The operating rooms just aren't organized that way. If a hospital can't provide it though, they should certainly be upfront about it and let the patient review her options.
2.) The specific comments about how women are treated in VA hospitals are new to me. When I was in training at a VA hospital, the patients were about 99% men. I have no idea what the mix is now. But the complaints mentioned, that is women patients being used extensively for training purposes, certainly sounds like a serious and valid complaint. I personally hated the time I spent in training as a resident at a VA hospital. The system was dehumanizing and all bureaucracy. But that was decades ago, and I don't know what it is like now.
More comments to follow.

Anonymous said...

AT the PDX VA treats women very poorly. They even ask women to undress in front of students and residents and often do not offer gowns of any kind. They refused to refer me for a breast prostetic in retaliation when I complained about their violations of informed consent.

Joel Sherman said...

Your complaint is a common problem that happens to both men and women, that is being exposed in front of students and residents. When you entered the hospital, they may have made you sign a statement that permitted it, even if it was in small print and/or they didn't really give you time to read it. Nonetheless if you object your wishes will usually be honored. I must tell you though that there is a difference between students and residents. Residents may indeed be the primary ones taking care of you in a VA hospital and if you refuse to permit them, your care may suffer. That does not apply normally to medical students. However they too need to learn. I personally would not object to students or residents, but I would consider restricting necessary exposure to the staff actually taking care of me.

Joel Sherman said...

I have moved this post here to what a consider a more relevant thread.

Anonymous has left a new comment on your post "Chaperones, A Violation of Privacy":

Something horrific happened to me in a hospital leaving me feeling degraded, humiliated and traumatized at the most vulnerable time in my life. I was abused. It happened where I felt safe and cared for.

Now I am a patient advocate representing victims of sexual abuse who need hospitalization. Everyone has a right to feel safe.

Imagine being assaulted in a hospital and then when you need medical care return to "the scene" asked to wear what you wore then by people who are wearing what the abusers wore (scrubs). Next you are asked to expose your body to strangers of the opposite sex.

That scenario is my life. "To do no harm"....privacy rights are guaranteed by the constitution and the medical profession has decided to put employee rights ahead of patient privacy. Oppostie gender nurses who work with intimate care on a one on one with patients do not make previous victims of abuse feel safe. Victims do not want to be viewed by members of the opposite sex. There is no basis of trust with strangers.

Laws need to be passed mandating same gender care if needed for those who have issues with bodily exposure and trauma.

It is a travesty that the medical community doesn't address the issues of the victims of the few "bad apples" and protect us. It is unexcusable that there is not accountability or responsibility to limit and discipline this activity.

Joel Sherman said...

Anonymous of Feb 5th, I'd like to respond to your comment but you need to give us more information as to what kind of abuse or assault occurred. Was it a physical or criminal assault or was it an assault on your privacy.
It's hard to make any suggestions without being clearer on what actually happened.

Anonymous said...

I have done considerable research and here is what I have learned about patients' rights violations including privacy.

1. Patients rights are violated for the sake of education in horrific ways from sharing inappropriate info in inappropriate ways to gang medical rape in the form of ghost surgeries (procedures performed by other persons than whom you were told would be performing), practice exams (multiple rectal, breast, and pelvic exams on women sedated and waiting for surgery), informed consent violations including the use of drugs induced compliance. It is no wonder women are raped by doctors, students, residents, even janitors while under sedation. Most women never know and most rapists in hosptials get away with it for years before caught if they are ever caught and are often allowed to continue practice even after being conviced of offenses. Medical boards serve to protect doctors not patients. In fact western medicine is founded upon the medical rape and experimentation on slaves. Dr. Sims the father of OBGYN as we know it today, was a monster who performed surgeries on slave women, one over 30 with no anesthesia though available and used by Sims for his white (non-Irish) clients. Truth is,ALL patient dignity, autonomy, and privacy goes out the window once sedated. Just a bunch of criminals in green and white.

Joel Sherman said...

Well I posted this rant because there's enough truth in its exaggerated language to have some merit. And we've had plenty of rants by guys.
Still and all, I'm not aware of women being raped under sedation, fondled, yes, raped no.
In any event this blog is about privacy, not criminality.
But I will post links to documented abuses if commented on.

Anonymous said...

Not long ago I had the standard screening colonoscopy (male, 50 years young). I was escorted to the procedure room by a middle-aged nurse, instructed to remove my clothes and put on the gown. A few minutes later she came back in and covered me up with a nice heavy warm blanket and introduced a male assistant who would be helping the doctor. He lowered the gown and put on the heart monitor leads then replaced the gown. The nurse put in the IV, the doc came in and started the procedure.

Everything went fine and the next thing I knew I was being rolled to the recovery room where I was introduced to another nurse. She talked to me ask if I was feeling ok and that she would be keeping an eye on me for about 30 minutes, then I could get dressed and leave.

I was still completely covered by the blanket but I didn't realize that the gown had been pulled up above my waist during the procedure. After the 30 minutes had pasted the nurse asked if I thought I was ready to go and I said yes. She said she would get the blanked out of the way and promptly removed it. Now everything I have below the belly button is in plain view. She says that she is sorry and reaches down and covers me up with the gown.

I then get up and start to the bathroom to get dressed and she takes hold of the back of the gown in the back and holds it until I get to the bathroom door. She also said that I could do anything I needed to do in the bathroom (not sure what she meant by that) and get dressed. The door was left open while I got dressed.

So I guess some patients would feel "violated" but it really didn't matter to me. She did get a very good look but handled the situation very professionally. To me it was not sexual in any way and was probably inadvertent.

Could it have been a conspiracy between the nurse in the procedure room and the recovery room nurse where they sent her a little "present"? Maybe, but not likely. Even if it was it's no big deal to me. So I guess you could chalk this one up as an accidental exposure but not a violation. I suspect they see all kinds of "parts" all day long and it's just part of the job.

Joel Sherman said...

The comment was made under male modesty that 1 in 4 women are sexually assaulted during their lifetimes. I commented that the statistic comes from feminist literature where they defined what an assault or rape was in their own terms using very very broad criteria which often the 'victims' did not themselves agree with.
Here's the other side of the story, a masters thesis first noted by MER which reviews the literature and concludes that 1 in 6 males have been sexually abused. The author freely offers that it is very difficult to standardize terms and methodologies so these figures are coarse approximations, but it makes the point that women are not alone in being subjected to abuse and that it is a major problem for all. It does make me wonder though why so much is said and legislated about protecting women from abuse and relatively so little concerning men who are portrayed as abusers frequently but uncommonly as victims.

Sam said...

My American colleagues tell me horror stories about the treatment of women in the States.
Women brainwashed to believe annual and very invasive gyn. exams are required every year or you're being reckless with your health.
The dehumanizing treatment includes - Women being asked to undress before the Dr arrives, left naked with a sheet or paper gown, stirrups are used and frequently requests for female Doctors and NO medical students are ignored or dismissed...
One woman is still so traumatized she hasn't seen a Dr in the States for 20 years - her health care needs are taken care of in Hong Kong. (during business trips)
As an 18 year old girl she was subjected to multiple internal exams by a male Dr and two male medical students (a female nurse was also present) - shaking and hysterical after she was hurt by one of the students - she was left to "calm down" before they returned and completed their practice session. She says the male doctor's voice still haunts her, "just relax sweetie"..."almost there, you're doing a great job"...
She said the nurse left the room twice during her ordeal and the door was ajar for a few seconds each time, exposing her to the corridor - she felt like she'd been pack raped.
She said even though most fear live in dread of these exams, most are afraid to stay away...the scare campaigns have been so effective.
Naturally, she never returned to the University Clinic for her free annual exam despite huge pressure to do so...
She subsequently received treatment for post traumatic stress disorder.

These stories sadden me - that women could be treated in this shocking way.
America - the home of human rights and free speech - what is going on?
As an Australian woman, I have NOT been subjected to this insanity.
The medical thinking here (& in the UK and Europe) is totally different - these exams are not carried out on asymptomatic women - they can be harmful (false positives, discomfort, pain, low clinical value, anxiety and avoidance behaviour)
I think Germany is the only other country were these annual exams are carried out...
Cervical screening is offered every 2 years in Australia (which is too frequent and exposes lots of women to false positives and unnecessary follow-up) however, I did my own research, spoke to a pathologist and family friend (a senior Dr) and made my own informed decision not to participate - my Dr has accepted and respected my decision.

My US friends tell me that you can avoid these exams until you need birth control - then you're denied the Pills until you submit...
Umm, coercion = no consent.
It is well accepted that the safe use of birth control pills has nothing to do with cancer screening - this bundling is highly unethical behaviour and is being challenged by many senior US Doctors today - but most doctors persist with their demands.
Why? Is it money, control, the fear of litigation (defensive medicine) or just bad medical practice continuing...
One of my colleagues and her husband used condoms for 10 years to avoid Doctors and only used other methods when she started working overseas and could access these methods with a simple blood pressure check. (all that's required for the Pill - plus giving the Dr your medical history)
I'm not sure how this disgraceful situation has evolved in the States and why it is permitted to continue.
I look at a group of intelligent, successful women who've been so traumatized by the dehumanizing treatment of Doctors in the States, that they've rejected the entire system.
I should add women DO NOT undress before a Dr appears in my country and stirrups are NOT used (except maybe in surgery) - women in my country only see a gynaecologist if they have symptoms or are pregnant. We do not have routine gyn. exams. (pelvic, rectal, bimanual etc)
I've had ONE pelvic exam in 42 years (for symptoms)- in the States I'd be up to 24 or so and that's with NO symptoms!
I have been greatly disturbed by the plight of my US sisters and shudder to think of the women being herded in for these unnecessary horrifying violations as we speak....
Someone needs to get mad and speak to some lawyers and Oprah Winfrey - FORCE this madness to STOP...US women are entitled to live their lives in an unmolested and dignified way.

Joel Sherman said...

Thanks for your comments Sam. I am a specialist and not involved in gynecologic care at all so I'm not qualified to give a current medical opinion on this. But I believe in the US it is recommended that women get a Pap smear every one or two years from the time they are sexually active on. If you have differing references, please post them and I'll read them. I don't know the recommendations for women on BC pills.
In the US women have their choice as to who they see for obstetric and gynecologic care and would have an easy time choosing a woman physician. Female gynecologists are now in the majority. The only exceptions would be women who use clinics. In private offices it would be rare that anymore than 2 people would be present during exams, the physician and a nurse. Women clearly have the right to ask any observers or unnecessary people to leave, and no one has to submit to practice exams, though many patients don’t feel they can speak up. But they should. Undoubtedly many women are traumatized by these exams and much of the trauma is preventable. Discussing these issues is what this blog is about.

Anonymous said...

I've learned just recently about the requirement for women here to get a pap smear for birth control pills. That sounds as ridiculous as high school boys requiring hernia checks by female doctors AND nurses in order to play sports.

In cases like that I would give the same advice I give to men, CHOOSE a doctor of the gender you prefer and don't be afraid to REFUSE to allow students, nurses and assistants to be involved. If an assistant is necessary, insist on one of your own gender. I know it's easier said than done though.

There are only a few occasions when I feel ashamed to be an American, the birth control pills issue is one of those times.

DG

Anonymous said...

"As I lay there, these nurses came and took the sheets off two men and began to shave them. You know, their pubic hair. They didn't say anything, just took the sheets off them. . . Right in front of me, they shaved them. I couldn't believe it. I was real embarrassed. . ."

YOU were really embarrassed? How do you think THEY felt. That is a time when I would be prepared to hold the blanket down over myself and would YELL at them for their incompetence and horrible disrespect. Everyone has to INSIST and stick up for themselves or this abuse will never stop.

Anonymous said...

SAM I think the experience of women in this area in the past was probably pretty tough. I do not think the current experience is like that. Not that there are not exceptions, neither my wife not my two daughters do an annual pelvic. There are suggested schedules but they are not forced upon anyone. As stated, there are not only many female gyn's, there are women's clinics with all women staff.
I think the US is a big screening-prevention society. Perhaps to a fault, I don't know what the life expectancy and benefits are between how we do it here and where you live..if any. While you see this as an afront to women, I would also question, men are encouraged to have yearly DRE's and PSA's to screen for prostate cancer, after a certain age we are advised to have yearly skin exams, we are advised to have a colonoscopy after 50 or before. Is this common where you live. Many providers suggest a annual physical, I don't think many countries suggest that. Whether this is preventive or profit motivated may be up for discussion...I think what you see may be more societal than sexist.....and if you want to see sexist, while there are all female facilities..don't see that for men, a recent hospital ran a free breast cancer screening, advertised "our all female staff", when they later ran a "prostate cancer screen" and had the female doctor who was going to be doing the screening telling the importance of doing both the DRE and PSA.....OK well then....perhaps the issue is more we as patients...male and female not making the effort to be informed and in control of our own health care...alan

Anonymous said...

alan, I don't see any benefits of these screenings on life expectancy as Australia's life expectancy is higher than the U.S.'s.

Joel Sherman said...

Here's another thread on allnurses. The poster says in her hospital they are supposed to take peri-rectal swabs for culture on all new patients. I've never heard of it.
The poster is against the idea commenting that we strip patients of their dignity. She has it right. I haven't read the entire thread yet.

Anonymous said...

Dr. Sherman,
the thread is pretty interesting. I usually walk away from the allnurse threads with the feeling that a majority of nurses do understand, a fair percentage actually agree and a percentage are just in my opinion cold and self serving and have a God complex. There are often a large number who reconize the patients right for modesty concerns and accomodation and even recognize they themselves have the same concerns....of course there are those who think it is all about them as the "almighty, all knowing, provider and how dare you question the great and powerful OZ"....but all and all I find these threads more comforting than disturbing.....

Dr. Sherman, do you feel our society over screens? Do you feel the apparent higher frequency and range of screening that we as a society have for both male and females is driven by profit or a true belief that screening while expensive has a net positive result in health and finances when one looks at the cost of curing one person exceeds the cost of screening 100? I follow suggested screening with annual prostate, did the colonoscopy at 50 etc., my insurance pays for screening 100% so I assume they feel it is cost effective.......alan

Joel Sherman said...

Alan,
I don't think you can generalize about screening tests. Some may be over used, but they are all different. National guidelines are usually carefully scrutinized and reflect solely medical indications, but this may include cost effectiveness. Individual doctors may have their own feelings. I'd be most suspicious of doctors who do the screening tests in their offices and who stand to profit by them.
I follow prostate recommendations closely because I have a positive family history. There is no clear answer as to what should be done. Because of my family history, I have all the screenings done on myself.

Joel Sherman said...

Here's an article from the UK that they are allocating cash to end mixed gender ward rooms in one institution there. That's kind of incredible. I'm not aware of there ever being mixed gender ward rooms in this country in my memory, about 60 years.

MER said...

Joel:

There's been quite a bit of controversy about those mixed gender wards in UK. What's interesting, is that almost all of the articles I've read have focused on female sensitivity. There seems to be hardly any concern for the men on these wards. But the women complain about harrassment, or flashing, or seeing things they don't want ot see. I point this out because it seems to conform to what I've found in this country regarding men and modesty. The big concern has been female sensitivity and protection -- not how men feel about their modesty.

Joel Sherman said...

Haven't seen any other stories about this MER. Can you post some links?

Anonymous said...

http://www.dinningtontoday.co.uk/news/Cash-to-end-same-sex.5238069.jp

Joel Sherman said...

Here's the topic MER commented on. A Boston physician is offering group appointments for cardiac patients. These do include some physical exam, but if the patient needs to disrobe, the exam is done privately.
Obviously the patient has agreed to this, but it is still distasteful to me as a violation of privacy. There may be no exposure, but who wants to outline their medical history to a roomful of people? I'd have to be pretty desperate to seek care under those circumstances.

MER said...

I would like to urge all readers of this blog to read the book, "My Angels Are Come" by Art Stump. It's a detailed account of a 62-year-old man going through prostate cancer treatment. You get the kind of detail that you won't get from hospitals or doctors before the treatment begins. He goes into very personal issues related to privacy, modesty, relationships with caregivers, etc. You won't find this kind of inside information about what goes on in hospitals in very many books.

At one point in his early treatment, he is laying naked spread eagle on an exam table ready to undergo a procedure, when he notices that other people are in the room. Then he heard a tech introduce a high school girl was there to "shadow" the procedure. The tech comments, "She's just here to watch."
You need to read how this event affected his psyche, almost drove him to violence, haunted his dreams, humiliated him. You also need to read about how he questioned whether he should even complain because he felt it might influence how his life-saving treatment at this hospital would go. It shows how frightened and vulnerable patients can be. Untimately, he spoke up and complained.

What bothered me was that, when this event happened, several nurses and techs were in the room. No one put a stop to it. Perhaps they were too busy doing their jobs. But I can't believe that one or two of them just didn't have the guts to stop this humiliating privacy invasion from happening. No one intervened.

But the book is about more than this one incident. He writes about other privacy violations and attudes he encounters. But most importantly, he is able to separate the sometimes cold, inhuman hospital culture from the kind and caring people who work there. That's important.

Everyone needs to read this book, especially doctors, nurses, CNA's, techs and other caregivers.

I would like to start a discussion with others who are willing to read this book and respond to what he is writing.

Joel Sherman said...

MER, I am not surprised that the nurses and technicians didn't intercede on Art Stump's behalf. It almost certainly wasn't the first time the hospital brought kids into clinical areas and violated patient's privacy. It was a program run by the hospital which the employees were expected to cooperate with. If they had any disagreement with it (which they should have), they would likely have expressed it privately through the physicians in radiotherapy and not publicly in front of patients. Their jobs could be at stake.

MER said...

Joel:

And what you say, Joel, is exactly what Stump points out -- the fact that the upper management is creating these "policies" or "situations" where modesty violations happen. Why? Because hospital management isn't focused on patient comfort or dignity or respect. At least not unless it affects the bottom line. They are focused on recruiting, HR issues, unions, and making a profit. And they are in charge. And the medical staff, good people at heart, are afraid to confront this upper management.

But this is where true professional ethical decisions happens or don't happen. This is where the rubber meets the road in medical ethics. Do you stand up for what you know is right and prevent an ethical wrong from happening? Do you stop a patient from being humiliated and risk your job?
I guess not.
This is why patients need advocates. I don't want to believe this, but it becomes more apparent that upper management hospital policy and decisions drastically affect how front line caregivers make ethical decisions day to day. Good as these people are, they won't risk their jobs to protect your dignity or privacy.
That's sad.

Anonymous said...

Dr Sherman, you say you have decided to have screening for prostate cancer.
That is a luxury few women understand...
Can you imagine being required or forced to have the tests to access a medication you need...something totally unrelated?
No screening = no medication.
That's what women face in this country.
We are not asked, we have no choice if we want birth control and there have been many cases of doctors refusing other totally unrelated medications until they have screening.
Men get to choose, we don't...unless we avoid doctors altogether.
How can that be ethical or legal?
Kate

Elka said...

It is puzzling this yearly stirrup exam that American women endure.
In the Netherlands, the prostitutes of the red light district in Amsterdam are offered cervical screening no more often than other women. Tests are offered from the age of 30, 5 yearly until an age settled with your Dr...sometimes 50, 55 or 60.
No later than 60.

Prostitutes would have the highest risk of this cancer.
The doctors know however, that it's still a low overall risk.
It's not a very common cancer like lung or breast cancer.
They've worked out testing before 30 or too often causes serious problems for women, even in this high-risk group.
American women would surely face many harmful investigations when they start so young and having it every year.
No wonder you are concerned with this state of affairs.
I hope you can change things.
Can't you point to other countries who don't test so often and have no more or even less cancer than the States?
The extreme yearly gyn. exams pressed on American women are not done here, not recommended or offered.
I'm 38 and have never had a pelvic exam.
Of course, no woman is forced to have any test. It's up to you.
My doctor thinks smoking is very bad but isn't worried about women not wanting cancer screening.
She thinks smoking is the worst thing you can do to your health.
Our doctors don't seem to be concentrating on this cancer and are more likely to focus on your entire lifestyle choices.
Safe sex, smoking, weight, alcohol consumption, exercise, eating a balanced diet, sleep patterns, stress levels.
Perhaps, that is just my doctor, I doubt it as my friends tell me the same thing.
No woman needs to stay away from her doctor if she doesn't want this test.

Anonymous said...

I don't see this as a male v female issue.
It's disappointing to read men dismissing a violation of a woman's privacy.
I sympathize with ALL patients who have their privacy violated...men and women.
We should all stand together on this issue.
I see us all powerless in the medical setting.
It's very hard to make a stand in a setting where the system has all the power.
I have read that men and women in the military are treated like cattle.
I even read a male gynecologist saying he'd always get work in the military where women have no choice of doctor. That shook me, that he'd be happy in those circumstances...callous and uncaring if you ask me.
I feel angry for all people treated disrespectfully.
I believe these people will only change their ways when they face serious consequences for inexcusable breaches to our privacy and dignity.
People in the military and everywhere else should be treated the same way...respectfully and intimate exams should always be carried out privately with same sex doctor. (if requested)
These exams should also only be carried out if necessary and only with patient consent. I don't believe military men or women should be forced to have smears or prostate tests. (unless they ask for them - they should be optional extra's)
I also disapprove of the stranglehold on women and contraception in this country.
I won't allow myself to be manipulated in that way, so condoms and natural methods will have to do.
I will look into this HOPE alternative and would even drive or fly to another area to get access.
My husband would love a break from condoms.
He understands why it's necessary though.
If I were facing all of that every year, I'd prefer not to have sex.
LH

Joel Sherman said...

I will once again copy these posts to the women's thread as they have equal applicability there.

Joel Sherman said...

This post concerning an Australian crime is moved here as it is more appropriate here.
But I want to emphasize that this blog is concerned mainly with medical privacy violations not with outright criminal offenses which are a totally different issue. No one defends the latter.

Bill has left a new comment on your post "Cancer Rx & privacy: My Angels Are Come":

The authorities don't do much to protect patients, so the rounding up of doctors who didn't report Greeves is hypocritical.
We have a convicted rapist still practising in this country.
They've told us he won't be able to see women.
Oh, great...that makes it alright then!!!!
Surely this person has shown us all that he is not a person to be trusted and working as a doctor places him in a position of trust.
How can they effectively monitor his activities day to day when he's still allowed to work as a Dr?
If he offends again, it's too late for his latest victims. They'll live with the pain of the assaults.
Why is it the patients always seem to come last in these matters?

http://www.news.com.au/heraldsun/
story/0,21985,24552266-2862,00.html

Maggie said...

"And we all know that a young teenage girl would never be subjected to a male nurse for any type of intimate exam" Quote

That's not true.
A male nurse was sent to shave my teenage niece before surgery to remove her appendix. She refused him and it caused quite a fuss.
I also read on Dr Bernstein's forum about a father who tackled a hospital after a male nurse was sent to shave his teenage daughter's pubic area. In that case, the male nurse argued with the girl when she refused him saying it was discriminatory and that his training was the same as a female nurse. Missing the point completely.
In my niece's case, the man was a decent and understanding person and a female nurse was arranged.
Of course, my niece can stand up for herself...another young girl may have just allowed it to happen and been terribly upset by the experience.
Personally, I think it's very poor for a hospital to send opposite sex care for something very personal.
I know they're busy, but that is no excuse...you just organize yourself and make it a priority.
I also read on-line about a 19 year old girl attending a student health clinic and finding her preference for a female had been forgotten or disregarded when a male nurse practitioner entered the room.
She permitted the exam and was very distressed afterward and intends to avoid doctors into the future.
I really think enormous damage is done with this sort of thoughtlessness...or is it callous disregard? Or, something worse....
We don't have routine gyn exams in the UK....but if I had gone through what that girl described, I wouldn't have coped mentally, that's for sure...it sounded like an assault. I'm 48 years old and never been required to have that sort of exam...why a normal healthy teenage girl might need it...is beyond me.
The routine exams you have in the States really make it more likely you'll have a privacy violation in your lifetime.

Anonymous said...

Privacy violations as a child can cause problems throughout life.
I was hospitalized as a 4 year old in 1962 with a persistent skin problem on my arms, legs and back...every day the nurses removed all of my clothing ready for "rounds"...then the Dr would appear with other men in tow. They didn't speak to me, just to each other (which somehow made it more frightening)and I was asked to stand so they could all closely examine my skin. I would stare at the floor, afraid to look at them or try to grab onto the nurse.
There was absolutely no need to remove all of my clothing as the rash only affected my arms, legs and back.
I felt terrified, vulnerable and insignificant. I deeply feared these men and had nightmares for years about them. I also started to wet the bed after my discharge.
When the rash flared the following year, I cried and pleaded with my mother not to take me back to the Dr.
This resistence to see Doctors continued...every cold was a battle between my mother and I...
I also concealed symptoms fearing a trip to the Dr. My mother was concerned but felt I'd grow out of it.
I didn't...
I have feared doctors and hospitals ever since and have only seen a female Dr once or twice in my life for general things.
The anxiety and fear has never diminished...and I'm sure it never will...
I fear loss of control, loss of dignity and my privacy.
Thankfully, I have great health and go to great lengths to remain that way.
I think doctors do enormous good and also an enormous amount of harm.
My treatment was fairly standard for interesting cases back then...over the years I've heard other people talk of similar things...the feeling of being surrounded, alone and afraid is common. In those days, parents were not permitted to stay with their children so feelings of abandonment probably also added to our distress. No one to protect us from harm.
When people have a "thing" about doctors, it can often be traced back to childhood.
HG

Joel Sherman said...

We're your parents ever there to witness these exams, HG? They should have protested.
But the early 60's were still a time when people were loathe to challenge authority figures, which doctors were. I hope it could not happen today.

Anonymous said...

It seems that if so many people are upset about these issues and that people are traumatized, why not just genderize medicine for procedures that require bodily exposure? It would create an environment that is patient friendly. It can't help if patient's with heart disease have elevated blood pressure because they are upset.

If everyone would refuse at the last minute to go into the OR, or refuse treatment in the ER, or walk out of a test, things would change.

Isn't it interesting that mammography suites for the most part and some labor and delivery floors only have female techs and nurses.

We pay for these services. Notably, female patients complained, refused and lawsuits filed for real or percieved violations.

The least little alteration of their routine makes all these professionals look like idiots when their process cannot be followed.

Angry objections when a young girl or boy is sick, subjecting them to humiliation will at the least cause refusal of future medical treatment and...at the worst ptsd. Let's get real and start doing something instead of wining.

New studies show that extreme humiliation causes extreme psychological damage. Vulernabilities are so strong during hospitalization that to add this is an outrage! Anyone who objects should never be forced or intimated into opposite gender care or be exposed in front of lots of people. Medical care is in the 21st century and the psycho social aspects of medicine are in the 1600's.

It's more outrageous that the medical community knows all the damage they are creating and are so arrogant they won't recognize it or offer support to someone who has been subject to ill treatment. The line is so thin that assault and battery charges are dismissed instead of prosecuted. Maybe that would help to change things!

Anonymous said...

Great comments, Anonymous.

MER said...

Good points. That's why I've turned my attention lately to the fact that patients, family members, advocates, need to be educated to speak up immediately when these situations happen. I hate to put it this way -- but the element of surprise is quite effective. In some cases, it's consciously used on patients by the system. On the blogs it's been called the "ambush." You're suddent confronted with some kind of opposite gender situation with no warning. It's interesting how intimidating that can be. So you shut up and just take it.
Well -- the reverse is true. Doctor, nurse, techs -- are certainly used to some people who complain about varous things, including request same gender care. They have their cliche lines for responses, lines that usually shut down coversation and make life easier for them. But they are not used to a patient who rejects those cliches and responds with logical, provocative lines of argument that dismantles their assumptions. That will come as a shock to them and may intimidate them.
Now -- I hate to turn this into an "us vs. them" situation. But that's what the system has done by playing this game. And patients need to learn how to defend themselves from a system that is sometimes more interested in itself and what works for the system, than they are intersted in patient comfort and dignity.

Anonymous said...

"In that case, the male nurse argued with the girl when she refused him saying it was discriminatory and that his training was the same as a female nurse. Missing the point completely."

It may miss the point completely but it sounds like the same ridiculous arguments men get from female nurses in the same situation. Along with "I've done this many times", "I'm a professional", "you don't have anything I haven't seen before", etc. All are very stupid arguments that completely miss the point about respecting patient modesty, dignity and morality.

Anonymous said...

My usual response being " yes,
prostitutes call themselves
professionals as well and that
has nothing to do with it. It's
all about me and what makes me
comfortable. Now please put the
cellphone camera away and go find
a male nurse.

PT

Anonymous said...

I like your style PT.

Anonymous said...

I was a appalled by the story of the military woman in VA that had been used as a teaching subject. I had a somewhat similar history. It weas in an (allegedly) high profile private hospital. I was lied to, and they had covered the crap thy did from the beginning.... They knew they were doing things without my consent. Like her, I had two males doing an oopherectomy (only one ovary) on me rather than famale only, as I had stated. Not only that, they told me they would leave a bikini incision only to wape with a horrible vertivsl scar form the navel right down to the pubis. Worse, after they removed the whole ovary, it turned out I had nothing except a bening cyst. Here's what happens: it wasn´t a teaching hospital (someting I wouldn´t tolerate) but they were short of guinea pigs to practice on. I don´t smoke, had excellent cholesterol levels, etc. Tey had asked me forwell over a dozen blood samples in the previous year...They were singling me out for theri crap.... I haven´t sought the hospital recors yet, something I intend to do, but I had private insurance at the time, (paid out of my husband's own pocket) so paying your own way actually doesnt´t prevent you being used to practice on. Turned out that what I had was just an exploratory laparotomy for a training (but not teaching,) project.... The operation was very rushed, and I was in pain, but it was in no way and emergency like they claimed. They lied to me, they said that if i wasn´t operated on fast, I would certainly die, and they pressurized HARD my husband and me to do what they wanted...only to find out later that I had nothing at all...no, I wasn´t "saved" adn they didn´t even apologize. I "thanked" their services by stoping the emergency service, health insurance, everything...I even made a liveng will to make sure I am no EVER operated on again, let alone by thoise people.
The OB/GYN (male) entered my room to aanounce I was positive for VDRL, out loud in my bed where my husband and everyone would hear everything (not to mention the young female and male nurses). After that, I don´t go to the doctor, and I dont´t want to go to the gyno, whether male or female, (but I hate male ones with a passion). EVER. Given the coice between cancer and medical care like that, I certainly would choose cancer. REALLY.

Joel Sherman said...

Here's a followup story to the abuse of elderly patients in nursing homes. The case mentioned above in Albert Lea, MN is still dragging through the courts against the 2 out of 6 girls who were 18 or over at the time of the incidents.
This article also lists another case I was not aware of from Minnesota. This one is not going to court because all the victims have Alzheimer's and there is no one who can testify. I really have no idea how common these incidents really are. I haven't seen any reliable statistics quoted.

Anonymous said...

I would like also to comment about a post of mine that was "redited", and I do not agree that there is "vulgariry", you may change language but I will not tolerate censorship of ideas.... Anyway, I was hospilatized in a psychiatric hospital, and it was awful..... You had to leave you cell, house keys!!!!, etc, with the excuse that other inmates will rob you!!! It was like jail: you couldn´t get out. NEVER..... Not even to exercise, and we have absolutely no criminal record! It was a very comfortable house, but it was mexed gender, and they sent a male nurse to give an injection in the bottom to me (I am female) Never again!!!!!

Anonymous said...

Why is it that they always send males to give females shots and females to give them to males? It must be planned that way because it happens so often. Again, it only matters what the nurses want to do, the patients just have to put up with whatever they get.

Anonymous said...

Realistically, what chance do I have to get a colonoscopy with no women involved?

Joel Sherman said...

I wouldn't know, anon, but it's not zero. You won't know until you ask. It is possible that it can be done with the physician and anesthesiologist only present. I recently had endoscopy and that was what happened. It was their routine; I didn't ask for any special accommodation. An IV was started by a nurse prior to that outside the procedure room, but there was no exposure.
Every person who asks makes it easier for the next person who may ask.

Joel Sherman said...

This fascinating link was given on Bernstein about a New Mexico female ENT surgeon who performed genital exams on men under anesthesia for ENT procedures. The surgeon was belatedly reported after years of abuse and lightly censored. She's now required to have chaperones present. The whistle blower was fired and is suing.
We're about 30 years behind when it comes to censoring female physicians for sexual abuse vs. male physicians. Traditionally surgeons have gotten away with a lot of inappropriate behavior in the OR, but it is now a major offense. I guess the mindset is still that it's less serious when a woman does it.

Anonymous said...

That really ticks me off. I'll never understand why female medical "professionals" have everything handed to them on a silver platter. Do the majority of men, including law-makers still believe women don't get sexual feelings or find men attractive?

Does anyone think most men still have the attitude from decades past that any boy or man that refuses to be stripped and "handled" by a woman (in medicine) is a sissy?

Hopefully future male law-makers will have the guts to stick up for men's rights. You know female law-makers don't give a crap. Just like female doctors and nurses female law-makers love to have that "power" over men. Most seem to think that todays men have to pay for our ancestor's sexism.

Joel Sherman said...

I have moved this post here.

Anonymous has left a new comment on your post "Women's Privacy Concerns Part 3":

Joel Sherman wrote:

"Where I have practiced for over 30 years, there has never been a public complaint against the 20-30 Ob-gyns in the area though there have been several against GP's."

What difference does this statement make? Where I have live for over 50 years, I have have never known anyone who has been murdered.

CW


The statements aren't comparable. I haven’t known anyone who has been murdered either, but there are 5-10 murders a year in the area I live. The fact that no Ob-gyns have been publicly accused of misconduct is a crude measure of how common it is. In fact I'm not aware of any incidents in the entire state for the 35+ years I have been here. This would cover several hundred Ob-gyns.
If you have references, post the information or links.

Anonymous said...

In the days when there were almost no female doctors, I didn't see doctors. The family doctor started acting in a strange way when I hit about 16...looking me up and down, staring at my breasts while speaking to me. I never needed anything that required exposure, but all of a sudden he started asking me about breast problems and whether I'd started having sex. I thought it was inappropriate as I was there for the flu or a hockey injury.
It embarrassed me, particularly as it accompanied his obvious interest in my body. The final act that finished it for me was a tap on my bottom as I left his rooms one day. I struggled with that, was it inappropriate? Was I over-reacting to be upset by it?

I told my father and he understood why I didn't want to go to the Dr. You didn't really report doctors back then.

When female doctors started appearing, I was around 30 and I felt happier to see them, but have never allowed routine intimate exams. I don't think they are necessary and seem to cause lots of problems. I haven't been pressured by my Dr, she deals with the reason for my visit and behaves professionally at all times. I signed a form to excuse myself from screening.
I feel terribly sorry for women who have no choice of Dr.
I don't feel as strongly about the subject now, because there is no reason to see male doctors. If it makes you uncomfortable or you're concerned he might be getting some deviant pleasure out of it, just see a female doctor.
I do feel terribly sorry for women in countries with no female doctors. I'd be back to avoiding doctors.
Male doctors derive some satisfaction from seeing SOME female patients, but I think it's only a small number of women at risk and who attract them - the young and attractive.
For me it now comes down to the comfort factor, I just don't feel comfortable with male doctors. I'm a modest and private person anyway and even though I've only needed one embarrassing exam, it was horrible with a female Dr. I managed and it doesn't play on my mind.
The creepy male doctor still plays on my mind...being made to feel like a vulnerable lamb cornered by a slobbering and expectant wolf. The thought of that man examining my breasts or something even more intimate makes me shudder.
Women need to see the Dr of their choice and sometimes that means being firm or waiting, but that's fine with me.
With a female doctor, I've never given these issues a thought, because I feel comfortable with her...but I still don't allow routine exams. If it isn't necessary for whatever problem I have, then I don't allow it.
Mary

Joel Sherman said...

Mary,
American medicine always puts a emphasis on being thorough so it is hard to accuse any physician of being unnecessarily thorough because of prurient motives. It's probably fairly common. I don't give women physicians a free pass on this topic either. It's not my field but the majority of male genital and hernia exams may be unwarranted as well.
However unquestionably if the physician makes you feel uncomfortable, see someone else. Clearly at least a good half of patients are more comfortable seeing same gender physicians for intimate exams, especially if they are young.

Anonymous said...

Hi Dr Sherman,
This was in the UK.
I felt that Dr was trying to take advantage.
I've never since been asked about my sex life or had a Dr pressure me for breast checks. The only time a breast check might be done is during a consult for the Pill. (I've never taken it)
I hear that doesn't happen anymore and a news article a few months ago said women should remind their doctors not to examine their breasts during these consults. (or any other unless it relates to a breast problem)
Certainly during consults the only unrelated thing that might be mentioned is cervical screening if the woman is over 25.

I understand American doctors don't confine themselves to the reason for the consult and do thorough physicals. That has never been the practice here.
It would make it even more imperative that you have the Dr of your choice in your country if every part of your body is going to be examined every year. I'm relieved that has never been recommended here. I wouldn't agree to exams like that, I can't see how they help. If they did, our doctors would be recommending them as well. At best, they must be of debatable value for doctors to disagree on their value.

Mary

Anonymous said...

As a cardiologist, you may be able to answer a query. A friend had a procedure, an angiogram, and was horibly exposed during the prep stage. She objected and several people were asked to leave the room.
A colleague had the same procedure done at a local private hospital and was prepped privately by a female nurse and the sheet and small towel were moved about to give access to her groin, but her breasts and genitals were covered at all times.
My sister is having this procedure done in 2 weeks and is very nervous. The horror stories have upset her. I rang the hospital and was told they try to minimize exposure, but was basically fobbed off.
How were these things managed when you were doing these procedures?
If one facility can manange the procedure preserving the patient's modesty and dignity, shouldn't they all be able to achieve that?
(I hope I have the correct name for the test, she's having a couple of things done...she's worried about the test where dye is injected into an artery in her groin to take contrast pictures of the heart)
Heather

Joel Sherman said...

Heather, I don't know what happened to your friend. The only exposure during cardiac catheterizations (angiograms) that I'm familiar with at several hospitals is during the prep. Then your groin is exposed on that side, but not much else. Otherwise you are draped. The prepping could be done by technicians of either sex. If that's a problem, ask ahead of time and the chances are you will be accommodated. I've never had any patient ask or comment about the prepping so I suppose some institutions could become casual about it.

Anonymous said...

In my friend's case she was asked to remove all her clothing and put on a gown. The nurse just pulled off the gown, leaving her totally exposed and started to prep her. She complained...
My sister fears that may happen to her. I've told her to mention her concerns to the nursing staff and her cardiologist. If there is no exposure, she doesn't care about gender. Otherwise, she wants female staff. Her cardiologist is female.
She's very sensitive to this issue after being sexually assaulted as a teenager...being in control is a huge issue for her.
Thanks for your advice.
It seems my friend hit a very sloppy and insensitive nurse.
Heather

Anonymous said...

The gown doesn't need to be completely removed for an angiogram. The heart will be monitored so electrodes will be placed on the chest. Sometimes breasts will be exposed during this time. It shoud be quickly and minimally.

The groin area might need to be shaved before insertion of the catheter. The entire genital area should not be exposed. A towel can help to limit exposure of breasts and genitals. The gown is completely on during the test.

Anonymous said...

Now imagine similar exams and procedures done to men by women. Considering nurses are 95% women, men don't have much of a chance. Not to mention there are many intimate exams given to men during a normal physical that have to do with genitals. Females can be pretty creepy too and insist on intimate exams we don't believe are necessary. But we don't have the choices that women have.

For this reason I don't receive any medical care unless I can be guarenteed a male nurse or assistant if one is needed along with a male doctor. If that can't happen (which it hardly ever does) I refuse their care because women don't belong in the exam room with me, ever. I'm destined to die young I guess.

Anonymous said...

In the interventional suite or
cardiac cath suite most angiograms
as well as cardiac cath procedures
are performed via the femoral artery.There is absolutely no
reason for the genital area to be
exposed.The site will need to be prepped and drapped. The interventional or cardiac cath tech
does the draping and prepping.
The nurses role is strictly to
monitor the patient and administer
meds.For the uninitiated,the femoral artery is accessed via an
area just adjacent to the genital
area. An appropriate technique is
simply to draw the gown just exposing the hip. Placing a sterile
towel over the gown all the while maintaining patient privacy and
ensuring the area can be prepped.
To completely remove the gown and expose the patient is absolutely unnecessary.


PT

Joel Sherman said...

PT, there may be slight genital exposure during the prepping depending on how much hair there is, the location of the femoral artery and how careful the technician or nurse is. But yes, there is never any need to remove all drapes.

Anonymous said...

My father was in a car accident last year and found himself in the emergency department with a broken arm and concussion. His clothing was cut off and a sheet was thrown over him. He was surrounded by people with the sheet moving back and forth. A curtain sectioned off the area where he was held - it was actually a glass walled room with the curtains sliding around the bed. He drifted in and out of consciousness and came around to find himself completely naked with the curtain wide open and a busy emergency department going about its business. He thought there were also visitors hovering waiting to see their relatives.
He told us he instantly forgot his arm and tried to cover himself. He's unsure whether he moved and dislodged the sheet or it was removed and not replaced. He doesn't blame anyone but made the point that modesty and dignity are things we'll cling onto regardless of the circumstances. (or many of us anyway)He felt lying there naked and not caring would have been a very bad sign.
A nurse finally noticed his balancing act to try and retrieve the sheet and came to his rescue.
Relaying this story to the family, we all agreed we'd be trying to retrieve the sheet as well. Most of us don't like being completely exposed even if we had the perfect body.
I think it's a powerful instinct...are we born with it, is it a reaction to something that happens in childhood or something we're told?
Interesting...I think it's a protective response.
Anna

Anonymous said...

It doesn't matter what's necessary, all that matters is what is easiest. Patient dignity means nothing.

Anonymous said...

Anna:

I suggest you report this incident to the hospital ER your father went to. You can do it in a respectful way -- but until we start reporting these incidents, not just on these blogs, but to the admin staff of these hospitals, we're not going to make much progress. Yours is a good example of how an ER can and should be able to accommodate basic modesty even in emergency conditions. There was no excuse for exposing your father that way. When you write your letter, ask them the "medical" reason for such exposure -- the "scientific" reason for it. Obviously, there is none. They can't defend it. So, there must be other reasons. Ask them what those other reasons are.
If they're honest, it will most likely come down to neglect, lack of empathy, too busy, etc. A nurse finally came to the rescue -- but who left your father in such a state in the first place -- was it a doctor, a nurse, a tech? This attitude is a mindset, and mindsets can be changed, even in ER's.
Hospitals are aware of this problem. But they get to a point that they really believe that, if they don't hear complaints, people don't really mind this kind of treatment. But my point -- until we start putting our complaints in writing, we'll just keep having these problems and they may get worse.
MER

Anonymous said...

And to the anonymous writer who posted after Anna's story --

Patient dignity means what individual patients and their advocates decide what it means. If a patient (or the advocate) is capable of making his/her wishes know, and doesn't -- the message is that you're respecting my dignity or I really don't care. The interpretation may be wishful thinking on the part of the caregiver, but that's how lack of communication works. If the patient or the advocate points out a problem and insists that it be corrected -- that's creating a definition of respect and dignity, too. You will most likely be listened to, respected and accommodated.
Patients and their advocates need to make a conscious decision to stop hiding and make their wishes known. If you do this civilly, most caregivers, mostly nurses, will actually advocate for your dignity. Personally experience has taught me this. I know some don't agree with me. I'm not saying it will always work -- and when it doesn't the patient and advocate need to be assertive, yet still civil. If that doesn't work -- get up and leave, or work your way up the food chain to those in admin. Most bullies don't expect their victims to fight back. Start fighting back and the coward bullies will quickly fade into the woodwork.
MER

Anonymous said...

Excellent post Mer


PT

Anonymous said...

The creepy male doctor (especially male gynos of the old school) really do exist. If you´re young, well shaped and slender, and yes, tanned, MAKE NO MISTAKE, LADIES, they do give you the once-over... And they probably talk about it over a beer at the pub later, as well. Males complaining about the unprofessionality of female nurses have every reason to stand up for their rights. But they should understand that a doctor can just have as much an ego... As they´re higher up the food chain, they´re actually much more difficult to replace, because they´re more experience. Ad to that patient vulnerability (the really bad ones like that). We should STOP THE GENDER WARS.... At a higher level, women have much more difficulty than men being accommodated...I would kill myself rather than going to any gyno, I don´t want any male doctors around my nakedness ever, (that´s why I don´t go to the doctor anymore) and you have every right to refuse female doctors and nurses as well!

Joel Sherman said...

Here's a thread started by someone from the patientmodesty.org organization talking about women who don't want to see male gynecologists for their exams. It says some do this because their husbands don’t want them to see male gynecologists.
There are now many comments, the majority negative. Many commentators felt that a husband who won’t let his wife see a male gynecologist shows a lack of trust in his wife and displays a controlling attitude more than anything else.
The discussion is interesting. I don't really have a thread that this fits well into.

Anonymous said...

Interesting thread, Joel. For me, the key to this particular issue is whether the wife and husband agree upon their modesty values. If they do, that's their choice, their value system. But, if the wife feels comfortable with a male gyn and the husband objects, then it seems to be more a matter of jealously and control than modesty. Same is true with jealous, controlling wives.
I also note that so often, threads labeled "patient modesty" (like this one)turn out to be mostly about female modesty. That's why blogs like yours and Dr. Bernstein are so different.
What also interests me is how little we know about what's behind so much patient modesty. This subject needs to be researched. So many caregivers approach it from a position of sexuality, e.g. the patient thinks I have sexual feelings about him/her. That mat may be true for some patients, but not all, and I don't think most. Many caregivers seem to believe that if they assure the patient that they, the caregiver, has done the procedure many times, has seen it all, that nakedness is just all routine for them -- they assume that these comments reassure the patient and make them feel better. And that may be true for some patients, but not all. With good intentions, the caregiver, rather than acknowledging the patient's valid feelings, reverses the conversation to focus on how the caregiver feels.
These seem to be threads that run through these discussions. This is why it would be valuable to go several steps beyond where the few studies have gone on this issue, and have focus groups with patients asking them their specific reasons for feeling the way they do about their modesty in medical situations. I think caregivers could use this information in many beneficial ways.
MER

Joel Sherman said...

Thanks for the comments MER. In fact patientmodesty.org does have a section on male modesty and links to this and Bernstein's blog. I do think that our two blogs have helped raise awareness of the issue, though it is still minimal.
But I agree that we know very little about why people are modest. For some it is based on religion and faith like in the above cited blog. For the rest it is poorly understood. Some people, traditionally women, are ashamed of how their bodies look. Now men are catching up with those feelings of inadequacy. Others were just raised to be modest and have it ingrained in them. But I think you're right, no study of gender preferences has really explored in depth why the responders feel that way. It would be very valuable.

Joel Sherman said...

THIS THREAD IS FULL. PLEASE GO TO PART 2.

Anonymous said...

Attn blog author:I made changes in my comment. Please post this amended one if you will.
While working in the trauma room at Metro General Hospital in Cleveland Ohio I witnessed this scenario of the double standard of modesty for male patient many times.The police would routinely walk in the trauma room and were allowed to stand around and watch as patients were put through the necessary but extremely embarrassing ordeal required in trauma resuscitation. If the patient was a female the curtains would be immediately closed and kept closed until the entire trauma procedure was complete. If the patient was a male the curtains were always left open and the police officers which often included female officers were allowed to watch as the patient was stripped naked, under went a digital rectal exam and catheterized. Allowing the police especially female police officers to watch this is blatant patient abuse. I think this double standard of modesty for male patients is an extreme violation of medical ethics and standards of decency that are supposed to apply to all patients. Police should not be allowed to enter the trauma room in the first place without permission or be allowed to " hang out " there while patients are being treated.

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