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Wednesday, October 1, 2008

Group Physicals

Do they humiliate young men? This topic includes school physicals and military induction physicals. There's been enough discussion of this to merit its own thread.
Some deleted comments are re-listed on Dec 16, 2008.
This thread is now FULL. Please continue on Part 2.
A summary article on sports physicals is now available on my companion blog. 

202 comments:

1 – 200 of 202   Newer›   Newest»
Joel Sherman said...

These physicals occur on a high school and college level but may be quite different. Most high schools would prefer that the athletes get their own private exam, but for many an urban high school and for all schools serving economically depressed students, it is not a feasible option. So they generally provide for a group physical.
High school sports physicals are not standardized and it's hard to generalize. Some are apparently done with reasonable privacy where the guys stay at least in shorts until the hernia check which is then done in privacy without spectators. The latter however may be with a nurse chaperone watching. Worse some schools do not perform the hernia exam in private and anyone in the room can see what's happening including women, usually nurses, who may be present. The doctor may be either male or female, but the latter is becoming increasingly common.
Many boys find these exams intensely embarrassing. Worse, some avoid sports altogether because of it. These exams seem to be modeled on the induction physicals which were given en mass to draftees in earlier wars. These kids are even younger and less able to deal with them.
I see no reason why the intimate parts of the exam can't be done in private, behind a privacy screen with just the physician present. The boys should be in shorts for the rest of the exam. No physical exams for women athletes are performed with so little regard for their privacy as in the above examples. If a school uses only female physicians for the girls, male physicians should be used for the boys. Boys and girls should be treated with equal respect. This is not done many schools.
College physicals are usually only for NCAA sports and are mandated by the NCAA. I will copy here posts from elsewhere on the blog and then add a private dialogue I had with a college athlete 2 years ago concerning their physicals which seemed to be even more humiliating.

Joel Sherman said...

These are some of the posts on the Personal Privacy Violations thread. I have edited them a little for continuity. The originals are untouched.

Anonymous said
MER, some good points, I stumbled accross a article blog under "sports physicals". 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

September 25, 2008 5:32 PM
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Joel Sherman said...
Thanks.
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.

September 26, 2008 8:32 AM
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Joel Sherman said...
... But I don't really know why a hernia exam is 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.

September 26, 2008 3:34 PM
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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.

September 26, 2008 7:50 PM
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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. (P.S. Elsewhere it sates she's the only pediatrician in Truth and Consequences, NM)

September 26, 2008 8:24 PM
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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
----
September 27, 2008 4:30 PM
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.

September 27, 2008 5:57 PM
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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).

September 29, 2008 11:21 AM
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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.


September 29, 2008 12:45 PM
----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

September 29, 2008 4:24 PM
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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 to let the players 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.

September 29, 2008 7:50 PM
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Anonymous said...

Dr. Sherman
In my school we had sports physicals for junior high. Grade 7th thru 9th.
Eric

Joel Sherman said...

About two years ago I emailed with a college athlete about their physicals after he posted on another forum. I have been unsuccessful trying to reach him again. He was not anonymous. His emails were quite credible and detailed and I will mostly summarize what he said. I still have the emails but not his original post.
He said he was a soccer player at a big ten school on a scholarship. Every year everyone had a physical upon which his continued eligibility and scholarship depended. Because of this, none of the players felt they could complain about it.
But his description of the physicals was startling. They were held in the locker room and the guys went from station to station all of which were in the open. For some they wore shorts, but when needed for hernia exams they were fully naked. There were many people there of both genders including medical personnel, but also including NCAA representatives and incredibly salesmen as well. He described a non medical woman standing right next to him when he had the hernia exam.

Some quotes from his emails:

The college physicals are very invasive and you are treated like a piece of meat. And I have friends at other schools who report the same. I can understand the drug tests and the stress tests. I can understand taking a pint of blood. I can even understand the skin exam. But I do not understand why college guys have to get prostate exams. I have heard of athletes dropping dead on the field with a latent heart condition, not a prostate infection. In the medical questionnaire, we get asked "how many sexual partners did you have in the preceding 12 months?" And somehow your answers get circulated. Confidentiality, it seems, goes by the wayside when there is an answer of note.
---
I do not think guys enjoy women coming in to the locker room when they are showering/changing. In fact, my experience is they do not. And, I also know that some pro players have clauses in their contracts regarding both reporters and cameras in the locker room.
I am not sure what the story is about group physicals. I know I have heard they can screen tons more guys in a group environment. But is that really the only answer? As far as the audience of both males and females at our physicals....it doesn't just happen by accident. They obviously get invited (or maybe they sell tickets!) I suspect most are in some kind of official capacity, with the exception of that sales guy I met. And the medical community does not really recognize privacy between the sexes. My dermatologist is a female.


Anyway, I have not been able to find any other descriptions of NCAA college physicals. If anyone has anymore information, please post them.

MER said...

This post may belong under the chaperone category also, (and I ask Dr. Sherman to place it there too if he thinks it should be there) but I'm posting it here first because of the "observers" or "chaperones" so often included in men's sports physicals in particular and men's exams in general.

Sociologists have done much writing about the role playing involved in medical exams. If requested, I'll publish a brief bibloography on this site. Essentially, role playing helps to "professionalize" intimate exams, desexualize them. Sociologists call this dramaturgy, that is, little dramas that are reinacted in operating and exam rooms. Operating rooms are often referred to as "Theaters of Operation." There is a script, masks, costumes, props, etc. Patients not familiary with hospitals and doctors must improvise in these situations. Patents have to get their cues from the doctors/nurses because the patient isn't familiar with the script.

Now, psychologists and sociologists who study embarrassment suggest that embarrassment often happens in these situations when one party doesn't follow the "script" or play the role. Patients may already be embarrassed, but professionals have developed mechanisms to avoid their embarrassment -- specifically, this role playing model. If the patient drops his/her role and. for example, says he/she wants the same gender caregiver, that's not in the script and the medical professional may become embarrassed him/herself. That can create double trouble.

Now, when you read Lawler's book, "Behind the Screens," about nurses and how they deal with body issues, you find that in these role playing situations involving intimate care, it's expected that the patient will be embarrassed -- especially with female nurses and male patients. Nurses expect that. In fact, if it doesn't happen the script isn't being followed, that is, the patient isn't following the rules, and that can cause the nurse/doctor embarrassment. When the dramaturgy breaks down, everything becomes extremely uncomfortable for all involved. Furthermore, there is significant concern on the part of female doctors and especially nurses, that they will be sexual harrassed in these situations where males are not embarrassed and may actually desplay exhibitionist tendencies. In fairness, nurses do experience a significant amount of sexual harrassment from males in these kinds of situations. However, what has been mentioned in a few studies but has never really been researched, is this: Sometimes men are so humiliated or embarrassed that they lash out in their anger, they say things that are or could be considered has sexual harrassment. They may use off color humor to defuse the situation and that's perceived by the nurse as harrassment. And sometimes female doctors and/or nurses approach the males with such poor communication skills that the males respond in a way that is perceived as sexual harrassment.

My point in all this is that this is perhaps why there are other female observers during these kinds of exams. Some females just don't feel safe or comfortable doing these kinds of intimate exams on men, and in our sue happy culture, are covering themselves with chaperones. Also, and I'm on more shaky ground with this, the script calls for the male to be embarrssed. If he isn't, there may be trouble, in the eyes of the female examiner. I'm not saying doctors and nurses are doing this consciously, but a female nurse or doctor haveing another female chaperone, creates a situation where the male is bound to be embarrassed which is what is expected. That's why a male patient may hear from a nurse or doctor nurse that their embarrassment is "perfectly natural...don't let it bother you...men get erections...it's perfectly normal." That's the expectation, and when that expectation isn't met, the little drama brakes down, both parties become embarrassed, and communication really gets bad.

Now, I've given you the Lawler source. If you want to sociological studies, I'll supply a brief list of sources.

But I think males need to understand what's probably going on in these situations. If you step outside the role during the little play, you need to be prepared for what might happen.

Anonymous said...

MER-I read something like that on google and posted awhile back in the chaperons thread. It was an article about female doctors always using chaperons to keep guys mainly in-line as they said.
Seth.
but your post was much more in depth.

Joel Sherman said...

Thanks MER. Interesting post. Feel free to list references or email them to me if you prefer.
All that you said sounds correct though I’ve never before heard of it. I'm sure some men say the wrong thing to women providers out of embarrassment and not with intent to harass. Though clearly the latter happens as well.
I'd like to find a better reference as to what percentage of women providers use chaperones for their own comfort. I think it's the main reason for their use as opposed to men who use them mainly for legal protection.

Anonymous said...

I'd like to ask what should be obvious. If Dr. Alex is aware that all these young men are uncomfortable with her in this
capacity, why is she involved
with the job? Go take care of
some young women who don't want male doctors. End of discussion.
-WJB

Joel Sherman said...

I disagree with you WJB. Most boys would be embarrassed by any examination whether by a man or a woman. It may be somewhat worse for most boys with a woman physician but it is far from the whole story. Girls are embarrassed by any examination as well though for sports physicals in particular they don’t usually have to be exposed. But high school girls who want to be on contraceptive pills, and there are many nowadays, have to undergo far more embarrassing and intrusive exams.
The most important thing is to be treated in privacy with respect. Dr. Alex does this and is to be commended. And she is apparently the only pediatrician in her community though there are other physicians.

Anonymous said...

Dr. Alex should be treated with respect. My guess would be maybe Dr. Alex could communicate with doctors in surrounding school districts and switch up things, if a school district only had a a male doctor the female doctor could do the female physicals at both schools. This sounds rather simple coming out of me and yes I know economics are involved and contracts but it could be worked out that all parties involved be comfortable. This could be a pioneer approach but this could happen.

Dr. Sherman-I mean you no disrespect but you can not compare a girl wanting to have sex (and yes I am glad they are on the pill) to the same age teenage boy wanting to play football or more then one sport a year. Yes gyno exam and first time gyno exam are over the top. In this day and age that teenage girl will have the choice of a female doctor and a female nurse and even her mother can be there to hold her hand. Another reasons that this is also humiliating for a guy he may develop an erection with the female doctor which is a very nature thing but a sixteen year old does not know that.

Dr. Alex also I mean you know disrespect, every household in America has a different modesty level. My mother stopped seeing my brothers and I nude when we were about eleven years of age. The doctor group that was in my parents health plan required a parent to be present during a patient of eighteen years of age. My father worked twelve hours a day, my mother was present once a year to see me complete nude for the hernia exam at the doctors. EXTREMLY EMBARRASING!!! Know with hind sight things could have been handle different with the doctor, a dressing screen up something to help. My mother could have asked a uncle to accompany us and my mother could have spoken to the doctor after the exam. Know one ever talked about it, the doctor never seemed to realize every household had a different modesty level. My mother never asked how we felt about it and my brothers and I were not brought up to questions are parents or a doctor.
My point here Dr. Alex please do not think because a female doctor is older we are going to relate her to our mothers, it just could be wrong for some boys.

Does everyone see how early all this embarrassment starts for some boys and for some guys it does not end in the present health care system. Being prepped for surgeries and foley's inserted in the hospitals all by female staff. Urologist having no male staff for test and procedure. IF you look at the age this starts to boys you will have some frustrated male patients and some seem bitter.

Randy
Full of expierence and actually not bitter. There is a soultion for every problem. We can not surgar coat the problem and justify everyone likes surgar.

Joel Sherman said...

MER, I agree that there is little data available. 'Somewhat worse' does almost certainly downplay the problem though I think most adolescent boys are acutely uncomfortable with any genital exam. I have seen comments from anonymous sources that the large majority of adolescent males would prefer a male doctor for these exams, and I think the same is true for young women preferring a female gynecologist. With the increasing prevalence of female pediatricians boys may become more comfortable with it, though the entry into adolescence can change everything.
But I disagree that adolescent girls necessarily have any more choice in picking physicians than the boys have. This is usually up to the parents. If they care and there's a choice they will take the child's preferences into account. Otherwise they will take what's available and affordable. It's not always same gender for boys or girls. But I certainly agree that girls are more likely to get their modesty protected than boys. This won't change unless the parents and students speak up, and few are willing to for boys.
I don’t know if Dr Alex will repost, but guys don’t insult the women physicians who care enough about these issues to speak up. They’re not the enemy.

Anonymous said...

If you have a hernia most of the time you will know about it. It's
not life threatening. There are
more important medical problems
facing young boys and girls such
as scoliosis. This is a disorder of the thorasic spine that can
essentially ruin someones life if
not discovered early. By wearing a corective brace for a few years will correct the curvature. I see many young adults in the hospital
for pneumonia or some respiratory problem and after a chest xray its discovered they have scoliosis and never knew about it. By then its too late for a corrective brace. Where was the school nurse. Busy out watching young boys get hernia exams thats where!
But you see the young are preyed
upon. Boys are targets in schools for these useless group physicals. I can't but wonder why in the world they are done in groups. Mass groups where nudity is required in front of people who shouldn't be there. I'll tell you why. It's deliberate, planned perversion. In my oponion its a form of sexual assualt propagated
by some gay physician who gets a kick out of seeing groups of nude boys! Of course it makes it much more thrilling if there is an audience. Particularly, if nurses are there watching as well. Adds to the thrill of embarassing people.
Many parents never questioned this because they are not aware or simply don't get it. You don't see or hear this happening to young girls do you. Of course not. That would raise a flag! Nobody cares about the feelings of young boys.
Young boys are not supposed to have feelings and nobody questions when they are herded into a large room nude. There are many kinds of hernias as well such as hiatus hernia that affects mostly older adults. Do you ever see older adults all herded into a large room nude for group physicals. Have you ever heard of this happening. Of course not!!!!!
Because no one wants to look at older people nude. It's all about preying on the young. Older people are much more wise and would question this if it was requested.
People need to wake up to this sickness. Young people are psychologically affected by this and some will not seek medical care
because of this humilitation.

lm

Joel Sherman said...

Gay physicians are responsible?? Do you have any evidence for that at all? You think all the military group physicals were done by gay physicians?? My guess is that a good half of these physicals nowadays are done by women physicians.
Let us keep this discussion within bounds.

Anonymous said...

I think WJB is right on the mark with
his/her comment. It's not enough that
Dr. Alex is sensitive to the embarrassment of young men by the hundreds. What is she doing to help
fix the problem? Is she informing
school officials that these boys should
have a male doctor, no female nurses
present, and privacy, as a matter
of policy? Is she ready to remove
herself from the situation or is she just paying lip service to it? Let's see her tell these young men in a group,
before starting exams, that they have
the option of seeing a male physician
and let's see her make sure that
that option exists for them. She needs
to champion this with school officials.
She needs to tell them she knows there
is a problem. Then they will be going
against the recommendations of a doctor
which always opens the door for lawsuits. Unfortunately, the only
thing administrators understand. Witness how women's modesty has come to be respected more than men's through the
legal challenge. Yes, she's sensitive.
Bottomline: So what?
-- KYLE

Anonymous said...

It's estimated that 10% of us are either gay,lesbian,bisexual or
transgendered. Furthermore, its said that there are about 7000
deviate medical doctors in the US.
The hippocratic oath states that
"I will respect the privacy of my
patients." Why is privacy so lacking? Because its deliberate! Its not just gay male physicians that violate patient privacy. Its
strait female physicians and nurses. The latter two so much more and on a grander scale. Recently,I spoke with a male ultrasonographer and here is what he had to say. A male patient recieved a script for a testicular ultrasound. This patient then went and had it done, 7 TIMES. He would call around to different facilities
to insure there was a female tech doing the procedures. He's definitely raincoat bound and I'm sure when that thrill runs out he will start flashing young children in a schoolyard. His behavior certainly only adds to the lack of percieved privacy that most of us men want.
As I previously mentioned in an earlier response that the young are preyed upon and this is happening at an alarming rate. I'm reading almost twice a week in the newspapers about female teachers having sex with their male students.
Hmmm, one would think that there
would be someone for these young people to voice their concerns to.
Where was the school nurse when this was going on. She was out watching young men get their hernia exams!

MER said...

Thanks for your post, Alex. We need more advocates in the profession like you. The double standard certainly exists, but the issue is broader than that and involves the dignity of both men and women.

I'm beginning to believe that a significant number of doctors and nurses just don't think this is an issue, on an intellectual level at least. But when they themselves enter the healthcare system and see it from a person, emotional point of view, their eyes are opened.
I posted an interesting professional article about this issue on Dr. Bernstein's blog. It's worth reading. Find it at:
http://virtualmentor.ama-assn.org/2008/07/ccas1-0807.html

Here's another interesting article about gender bias in medicine (I didn't post this on the other blog):
http://health.tesstermulo.com/?p=464

Alex -- I hope you encourage more research in this area. The first article above at least shows some research, although Joel commented that until we know the ages of the children, it's hard to verify the results. Little research has been done about teen or adult attitudes toward opposite gender care.

But, as I've mentioned here and on other blogs -- much of this comes down to the communication skills of the doctor or nurse. Doctors and nurses also need to really delve into the assuptions they have about how their patients feel about certain things. There needs to be more communication, more questions from the professionals to determine how the patient really feels -- considering how sick, vulnerable, embarrassed or frightened they might be.
Just because the patient doesn't express these emotions verbally, doesn't mean they don't exist. Frank discussion won't always work, but sometimes it will. But, as I've mentioned before, doctors and nurses carry with them into the exam room their own personal baggage, their past experiences with the body and sex. Some are just not comfortable talking about it.

Anonymous said...

MER,
I enjoyed the article you referred to in your response. I do think that we should pay as much attention to patient modesty and dignity as we do to healthcare privacy. Unfortunately, as we as physicians are pressed to see more and more patients, I think that those kinds of issues tend to get swallowed up, even though they don't take extra time.

I've seen physicians completely disregard issues of modesty because they are so used to seeing certain body parts that they don't even realize anymore what they're doing; there is nothing intentionally disrespectful done, yet it has that effect. It's that kind of mind set that gets some physicians in trouble. However, this does not account for all instances of ignoring privacy and modesty. Although I think that medical schools need to do a better job of teaching communication and sensitivity, there is already a staggering amount of info they have to pass on to the students, and, maybe I'm being negative here, but there are some people who can sit through lecture after lecture on preserving patient dignity, and they just won't get it!

I have enjoyed reading the comments about how girls wouldn't get this kind of treatment, etc etc etc. This truly made me laugh!! Women have put up with insensitive treatment from male physicians for a long, long time. That has only started to change fairly recently as women's rights have come into focus and as more women are entering the medical field. I think that the issues we are discussing here cross gender lines, both on the patient end and the physician end!! Playing the "my pain is worse than your pain" game only detracts attention from the real problem...

Anonymous said...

Alex (hope its Ok to use your first name, less key strokes)..thanks for joining us....you obviously have the emotional comfort of patients in mind, you have taken active steps to minimize when they are your patients, and even taken steps to provide them options when they weren't. This is something we as patients don't think matters to many providers. As you indicated many of us feel there is a double standard, we hear all sorts of conjecture from our side as to why this is, do you have an opinion on why? Is it just the sheer gender embalance in numbers of providers so institutions don't/can't deal with it, is it lack of recognition on providers that male modesty is a concern, is it males either avoid medical care or don't speak up, is it perception on our side? As noted there doesn't seem to be a lot of imperical data, but from the provider side of the issue...do you have thoughts why this is??? We don't get an opportunity to hear from the providers side.
Anom Oct 7, 10:55 I agree with a lot of what you say, but would have to challenge part of it. I agree the approach is all patients modesty should be addressed and respected, and while the larger issue should be what do we need to do to assure all patients are respected...the issue of the double standard does weigh in on this. Why is it acceptable in many area's to disregard male modesty and to do so openly. Also we can look back on historical aspects to see how and why we got where we are, but I wonder if trying to make up for past offenses does not contribute to current issues...don't know that it does or doesn't, but saying in the past women suffered this or that has been used to justify current condictions in some of these discussions. Using this issue, While Alex seems to be an exception, there have been discussions of female Dr.s with female school nurses conducting these exams on young males, the obvious issue, if there were two males doing exams on female students requiring exposure what would happen. I have never personally experienced it, could all be fantasy stuff, but have seen it written numerous times. For males this issue is going to become more of an issue, since around 90% of nurses are female, slightly over 50% of med students are female, and given the role NP's will play in the future with the small number of Dr.s going into internal medicine...the choices are going to be less and less...yet, there is very little concern about that as there was getting females to become Dr.'s. So while I agree the ideal answer is to come up with a solution for all patients...I don't think we can so easily dissmiss the double standard that males are now experiencing anymore than we could move toward equal rights without acknowledging the obvouis embalance and injustices women have expereinced for generations and still face. I raised two daughters, I hired a lawyer to challenge our schools sports program, I know females still have a way to go to get equal treatment. The first step is acknowledging those inequalities. There is no equality until it is equal for all regardless of who is on what side of the issue. Surely you will acknowledge that even if its for liabliity issues, female modesty is more of a concern to the medical community (which inlcudes administration) than male modesty. And while I am sure there was/are insentive male Dr.s out there treating females...we have the perception here that the whole medical system down plays or dismisses male modesty....did I misunderstand or am I wrong on this??? And please don't take this as an attack, I am so encouraged to have providers involved in the conversations I don't want you to feel persecuted or ganged up on and leave...I really want to understand and hopefully provide perspective from our side....alan

Anonymous said...

Sorry to be a frequent poster, but it was bothering me that we seem to be attacking providers who recognize and attempt to address the issue for not doing enough, I would ask those who have posted here that Alex and others who are actively trying to address this issue..but not enough for the poster.....what have YOU personally done to advance this issue...this has to be attacked from all sides...are we expecting providers to fix this for us...when we should be leading this...alan

Joel Sherman said...

Post as much as you want Alan.
But yes, it is important that the discussion remain civil and rational.
Those few providers who are concerned about these issues should be supported, not blamed for what they are trying to help.
Any posts that cross the line will be deleted.

Anonymous said...

I played sports through middle and high school (football and basketball) and never had to go through a group physical. On one occasion in 8th grade at a new school, they said the nurse would be there for the physicals that day; the coach gave us the option of going to our own family doctor or staying for the exam. I went to our family doctor and he didn't give me the hernia check. I never had a hernia check until I started my second full time job at 25 years old. Like lm, I question if it should be part of the physical since 9 out of 10 times you’re going to know if you have one. With everything in medicine based on statistics, I'd like to see how many cases are actually found during these exams. In my 31 years on this earth, I have yet to know of anyone who even had a hernia. I feel that like many things, this is done because it's always been done this way.

It's encouraging to see providers thinking outside the box for a change. I applaud Dr.Alex for not just recognizing this problem, but actually trying to change the way the procedure is done to minimize embarrassment. Some may argue with the way she does this exam with a drape since visualizing the area is suppose to be just as important (please correct me if I’m wrong Joel).

Alan brings up a good question: What have we done to address this issue? I think that would be a good discussion in the organizing thread. I myself can tell you that outside of posting on these blogs, I’ve only addressed this in my cases. I’d be interested in learning what others have done outside of taking care of their needs? It may just give me ideas on other avenues that I myself could take. Bottom line is that things aren’t going to change on their own; look at where we are today. It’s going to take a group effort to force this change IMO. Jimmy

Joel Sherman said...

Some may argue with the way she does this exam with a drape since visualizing the area is suppose to be just as important (please correct me if I’m wrong Joel).

I'm sure Dr Alex could answer that question better than I could, Jimmy. Visualizing the area is important, but I don't know what it has to do with the fitness to play sports. Sports physicals have a limited objective, i.e. to make sure that it is safe for the participant to play. They are not intended to be general or complete physicals. A thorough physical at the time of a sports physical might be a convenient time to do a complete physical when done in a private physician's office (especially for adolescents who may not come otherwise), but has little role in a mass screening physical.

Anonymous said...

I have asked women if they ever get
a hernia exam for a sports physical. The answer was "never". A
hernia is not gender specific. Anyone can get one. The most important determination should be to rule out any cardiovascular problems. You hear about kids dropping dead. At least the poor kid didn't have a hernia. Wouldn't you think schools would have some kind of screening process. Blood pressure screening. Where was the nurse,out watching young men get their hernia exams!

lm

Joel Sherman said...

Inguinal hernias are very uncommon in women and they routinely don't do strength exercises where they would be a problem. So it wouldn't make a lot of sense to check for them routinely.
But cardiovascular health certainly is vital as well as general skeletal health depending on the sport.

Anonymous said...

Alot of males don't routinely do
strength exercises either,however,just because they are male dosen't mean they should automatically get a hernia exam!

pt

Anonymous said...

To answer the question about visualizing the area when I do an exam: I do visualize by moving the curtain over, otherwise I couldn't really do an appropriate hernia exam. Like I said earlier, the curtain is more for a sense of privacy, but I do look behind it to see what I'm doing...just like women experience with breast exam when they have a paper jacket on.

I do agree that we need to see the evidence behind doing these exams. At this point, a hernia check is considered standard of care, which is what the lawyers care about. However, healthcare research dollars are limited these days, and I don't think hernia checks are high on the list. I'm not saying to give up though!

Regardless, I do use the exam to discuss other important health issues like the importance of doing self-exams for testicular cancer, a topic that generally does not pop up on it's own during a physical. A teachable moment is always useful.

Joel Sherman said...

Thanks for your comments doctor. Yes, a hernia exam is standard of care and that won't change unless some actual papers are published in rebuttal.
Your comment on teachable moments I agree with, but can only really be done during private sports physicals. It's hardly practical for mass physicals.

Anonymous said...

I have no reason to doubt what the Dr.'s say about hernia's being more common to males and therefore the disparity between genders. Two questions come to mind. What other possible ailments male or female are just or more likely that are not part of the exam and why. Where do we draw the line on where we limit our exam...why. Given the limited amount of time available during group exams... And second, even so, realizing males are going to have to be exposed, but not females, yet we still in many cases seem to taylor exams around female modesty, even though there is less need to do so...alan

MER said...

As anonymous wrote above (I think it's the doctor) -- "At this point, a hernia check is considered standard of care, which is what the lawyers care about."

It's too bad, but that's too often the deciding factor as to what the standard is.

Joel Sherman said...

I've finally been stimulated to read a little about hernias. Lots I don't know about them. There are the classic inguinal hernia and a fairly recently described 'sports hernia' which doesn't bulge.

Here's a quote taken from the first page of an article (the only part that's freely available):


Preparticipation Examination
One of the three major goals in performing the PPE is to
screen athletes for injuries or illnesses that may require
further evaluation or treatment [5]. Although routine
screening for inguinal hernias has largely fallen out of
favor, inclusion of the genitourinary examination as part
of the PPE is physician dependant; therefore, inguinal
hernias should be evaluated on an individual basis [5].
The PPE should include follow-up questioning for
any complaint of groin pain or discomfort and a complete
physical examination as dictated by the history. As
outlined in Table 1, the differential diagnosis of groin
pain is extensive. The symptoms of an inguinal hernia
may range from an annoying heavy feeling in the groin
with intermittent discomfort to a surgical abdomen with
incarceration and bowel obstruction. The discomfort is
typically worse later in the day and may radiate to the
testicles in male athletes [6].
The physical examination may be embarrassing for the
athlete, but if done with modesty and confidence, is typically
well tolerated.


I'll try to get more info, but it will take awhile. Don't know how important legal issues are, though Dr A. may know more. Note the comment that routine screening has fallen out of favor.

Anonymous said...

Thanks for the reference Joel. As I stated earlier, anyone that has this problem is going to know and will probably seek treatment themselves if they have any of the symptoms described in the article. Its one thing to get help and be embarrassed when you actually need it but to embarrass anyone just because it has been the standard of care for so long is another. I agree that it well may be a good screening tool when there is a problem, and I’ve heard of professional athletes having sports hernia. I just don’t think it’s should be called a screening tool unless it’s found when a patient isn’t aware of it. With all the talk right now about health care dollars being limited, maybe it would be wise if they would look at these “standard of care” procedures and see which ones (or parts of) truly are beneficial to both them and the patient? I’m sure they could save some dollars there. Jimmy

Anonymous said...

I don't think the hernia exam is the problem here. I think the problem is the manner in which it is conducted as it relates to disregard for privacy. Would the exam be such a problem if it were conducted by a male physician, in a secluded area. True it would still be embaressing to a degree, but nothing like it is when it is done by member(s) of the opposite sex infront of other students. Many have posted discriptions which I find hard to believe but have no reason to doubt. Alex's discription verifies at least a opposite gender exam. When I was in high school in the 70's ours was conducted by showing up, putting on your gym shorts and getting in line infront of the locker room which housed the coaches office. Outside in the gym the nurse did the vitals, wieght, and hieght, handed you the chart and told you to step into the locker room, a male coach was there, told you to wait, a student came out with chart in hand, the coach took it and told you to go into his office which had windows but drapes closed. The male Dr. was waiting inside, did the hernia check, filled out the form, signed it and sent you out....not fun but not that bad. Where the validity of the hernia exam comes in is in light of the fact that facilities are either unable or unwilling to provide for the modesty of the male student whether that be a private area or male Dr...no nurse present...why is the exam nesecary given the embaressment and in light of the fact that I would assume there are other ailments that are as or more common to students that are not checked...its an either or proposition, give the hernia exam and provide for the modesty of the student, don't provide the accomodation and don't do the exam, or do a complete exam for both genders, seems like we are picking and choosing alan

MER said...

Re: Alan's post. I agree that the issue isn't so much the herina exam as it is how it's done and the privacy involved. As I mentioned in an earlier post -- at one point not too long ago, a female doctor or nurse would not be conducting this exam on a man. Of course, there were not many female doctors, say, before WW2, and male orderlies were more often used with men. Note that many of the stories we're getting about opposite gender sports and military exams begin to appear in the 1950's and then through the 1960's and 1970's. Something changed in society's attitudes toward how men are treated. The fact that women became doctors is part what happened, but that's not all. I think (and I could be wrong) part of this lack of respect for masculinity and the resocialization of men emerged from radical feminism after then 1960's. Now, don't get me wrong. I'm not coming out against the feminist movement. But every movement has its extremes, and even some of today's feminists admit that some things went too far. I won't repost, but refer to the books about men that have been coming out recently. I've posted titles on both this and Dr. Bernstein's blog.
So -- what I'm saying is that societal assumptions about how men feel about their modesty must be challenged. It's just assumed that men and boys either don't mind these kinds of exams, or that they just need to get used to them. They probably don't care one way or the other, the mantra goes, but if they do, we need to resocialize them.
And I can't help but believe (and I admit that I could be wrong about this) that, whenever you get a large group of young males together for any reason, you may have a problem controlling them -- their aggression, rough-housing, arrogance, verbal assaults, etc. I'm talking about large group physical exams as sports and military exams. One way to guarantee control is with nakedness and embarrassment, even humiliation. I'm not saying that evil people do this consciously I(although that could be the case in rare situations) -- but it is a way to handle these large groups of men. It's a technique that has been used historically in controlling people. Look what happened in Iraq at the prison. But then, that's another story. Or is it? Men using women to help them control, embarrass and humiliate other men.

Joel Sherman said...

As I've said before, the important part is to do the intimate parts of these exams in private, at the minimum behind privacy screens which any school can afford. For me that is more important than the gender of the doctor, though others feel differently. But I certainly believe that for mass physicals on adolescents especially, preference should be given to same gender physicians.
MER, at some MEPS inductees were purposely kept naked the whole time so that they could not run away. This was usually done only with problem inductees who had already tried to avoid the draft. Once again though every center made their own rules.

Anonymous said...

I guess I should’ve ended my last comment with the statement that “For an exam that offers the patient no findings (more times than not) and needlessly exposes him, privacy is the least thing that can be provided for that patient.” Of course privacy and choice should always be an option for this exam, if it has to be done let the patient determine who/where and move on. I feel that the only reason that it’s ever done in an open environment for others to see is to humiliate the patient. There’s really no other reason or excuse. Sorry if I went off topic a bit. Jimmy

Joel Sherman said...

I think the reasons are many. Humiliation and control may have been predominate at some MEPS preinduction physicals, but it varies for school physicals. Ease, cost and efficiency are probably primary at most school physicals. Then there's the feeling that guys don't care, and if they do, they must be wimps. Most guys know it's not macho to complain about embarrassment, and they and their parents won't complain to the school.
In the physical sports especially such as football, it's not cool to be a 'new age' sensitive guy.
The fact that many adolescents are indeed embarrassed is something the coaches may think that they need to grow out of.

Anonymous said...

The observation spawns a lot of questions. The schools probably realize the odds of being accused of something improper or complaints arising from female students/parents are much more likely than male students...therefore they accept the obvious double standard, its just easier. The question then becomes why do we allow the double standard to be acceptable when applied against the male student, but will challenge the double standard against females. I think the answer is society has ingrained in us discrimination, double standards, and affirmative action are all things that apply to females and minorities...not males. Society has a hard time accepting that these discriminatory actions are just as wrong against males as they are females, males are traditionally the preditor or perp and females are the victims. The only way to change that is by following the lead of females and minorities in protesting and resisting....in this setting that becomes very difficult. Students have little power and must rely on parents. In general, it is the mother who is the liason with the school...and from the coaches I had growing up, complaining about anything, much less modesty would get you criticised, punished, and intimidation. The answer is educating our male childeren that they have the right to resist, the right to protest, and the right to bring these things to thier parents...we then as parents must back them. We need to instill in them protesting-qustioning something that makes them uncomfortable is the right thing to do. I taught my daughters from the start, no one has the right to make you do something you are not comfortable with, don't let any make you feel like you have to do something, if you ever feel something is wrong come to me, tell me....could be generational...but don't ever recall those conversations with my father...That is a long process but one worth fighting. alan

Anonymous said...

Coaches have little to do with this situation. This is between the school district their insurance carrier and their lawyers and the agreement release they produce. A contract is drawn up between the school district and the doctors. Parents of minors sign the release form and teenagers of both sexes lignup for the school or sports physical.
What bases are covered in the release forms is different between every school. The physicals favor the sex that is possible likely to bring up any kind of suspicion of any kind of misconduct. What is not been brought up here in sports physical a skin check should be done to check for ant contagious skin problems including a quick look at the pubic hair. That is very hard to accomplish when female students are given a gown and their mid region is completely ignored. So as unfair how the male student is treated he is getting a much through physical.
Ricky-----

Joel Sherman said...

Ricky, I don't know how the sports physicals are arranged. My guess is every school district does what it wants. But I am sure that protecting the privacy of the students has to be the primary responsibility of the examining physicians. If they insist on private areas for intimate exams, it will happen for the boys. The girls will get it no matter what happens.
There needs to be national medical guidelines for sports exams. I'll look to see if I can find any.

Joel Sherman said...

The NCAA publishes online a lengthy Sports Medicine Handbook. It covers a lot of topics in detail but says little about the actual physical exam, and nothing about how it should be administered.
The only specifics about what the physical exam should include are:
This initial evaluation
should include a comprehensive
health history, immunization history
as defined by current Centers for
Disease Control and Prevention
(CDC) guidelines and a relevant
physical exam, with strong emphasis
on the cardiovascular, neurologic
and musculoskeletal evaluation.


I searched the document and the word hernia doesn't even appear so I assume it's not a significant issue. The word privacy only occurs in the setting of keeping medical records private and says nothing about the form of the exams.
On a high school level, I'm sure there are no general guidelines.

Anonymous said...

Please note the part about musculo-skeletal exam. That is very important in young people. If you are say 15 and you have the beginnings of scoliosis you wouldn't know it. But then if gone
undetected by the time you are in your 20's it's too late. So much for hernia exams. We all know where
the school nurse was!

Anonymous said...

As a pubescent shoolboy in England during the 70s I vaguely remember a physical examination held at the school by a female doctor and a female nurse.

We had the hernia check but I do know we were afforded some privacy in that my class, all boys, sat in our underwear in a waiting area and we were called in one at a time to have our checks.

If I had been asked to line up naked with the others and be checked in an open space while teachers and non-medical staff watched I am not sure then if I would have had the nerve to refuse or complain.

The gender of the doctor is not an issue in my eyes. I recently asked my doctor about the possibility of a full medical check for men of a certain age but she told me they do not do them anymore. The fact she is a woman is irrelevant.

My youngest son is 14 but as far as I know such medical checks in England have been phased out in the public (state funded) system. If he told me that he was going to have one I would seek assurances that he too would be given some consideration regarding his privacy and if it was not forthcoming I would refuse to allow his participation. If he went I would seek to assure him that whatever the doctor sees or whatever happens he should not be embarrassed or upset as the doctor will have seen it all before. My son thought he needed to see a doctor recently (it was a false alarm) but he did say his biggest fear was getting an erection.

I had a genital check as a young man of about 30 while trying for a family and needing some medical assistance. During the examination of my genitals the doctor sat in front of me and gave me a thorough check and during this time (with my permission) a young trainee female doctor stayed in the room even during the prostate check. Rather than be embarrassed I found the situation quite amusing but then again I was a man, not a teenage boy.

I did read somewhere that some US states require a parent to stay in the room during the child’s medical up to the age of 18. If I had to have a full medical with my mother in the room it would not have bothered me too much but I am sure she would have excused herself once the shorts came off.

Joel Sherman said...

I did read somewhere that some US states require a parent to stay in the room during the child’s medical up to the age of 18.

One sees that claim made from time to time, but I don't think it is true anywhere. No state specifies who must be in the room with a patient. Some individual practices may make that a policy, but it is never a requirement. In fact with older adolescents it is to be avoided as frequently one cannot obtain a full history in front of a parent.

Joel Sherman said...

Here are ? current (2002) military recommendations for the use of opposite gender personnel during medical exams:

2-7. Presence of individuals of opposite gender during medical examinations
a. Use of non-medical personnel for medical functions should be minimized to the greatest extent
possible. Non-medical personnel can be used as urine collection observers and chaperones, but not used
where they directly contact or independently test applicants (i.e., draw blood, conduct an eye exam,
conduct a hearing test).
b. Only authorized MEPS medical personnel immediately involved in conducting medical
examinations are allowed in an examination area with applicants in a state of undress. Members of the
opposite sex (except examining practitioner) are not allowed in these areas while applicants are present.
c. The MEPS must provide a chaperone during a medical examination when female applicants are not
completely dressed (such as the orthopedic/neurologic examinations) and the examining practitioner is
male.
d. If an applicant or practitioner requests a chaperone, the MEPS will provide a chaperone.


I'm not quite sure how to interpret all of it, but it must be an improvement over prior eras. At least the use of opposite gender non medical personnel is formally frowned on. As always, more protection is offered to women. My military experience is minimal, limited to a medical reserve unit in the 70's, but we did a few exams on women including rectal exams without chaperones present.

MER said...

Thanks for that MEPS reference, Joel. I note that date is 2002. Most often, the reason for specific regs like due to past violations. No reason to address these issues if there haven't been problems. It's good to see the military recognize this issue. But the regs make it clear to me that they're responding to a time when they were not sensative to this issue, and this makes many of the stories we read about past military exams seem more reliable.

Joel Sherman said...

Yes MER, I never had any doubt about the basic authenticity of many of the preinduction stories where at some MEPS the boys were exposed nude en mass to non medical and civilian women watching. It by no means happened everywhere but certainly did at some large urban centers. I personally never saw it. I had a preinduction physical in a college town where they didn't bother to look at my papers and didn't realize I had a commission as a physician, i.e. I was an officer. So I stood in a large room with 20 others, nude at times, but there were no women present and I wasn't traumatized by it. But still, one never forgets.
I find it kind of ironic that the military now shows more consideration to their inductees than is shown to many if not most high school and college athletes. What causes this disconnect?

A few comments about the actual policies. Strange that they would exempt urine collection from the standards. They don't spell out whether the guys must be observed clothed or from what angles. The statement also seems to say that for the physical only the examining physician can be opposite gender, but I can't believe that the regulation is intended to exclude women nurses. Lacking still from the statement is any indication that the guys should at least be allowed shorts except for the genital exam and that the genital exam should be done in private or behind privacy screens. So guys could still be standing around nude in large groups. It's an improvement, but not yet one that most of us would like.

MER said...

Know what's interesting about this subject and this thread?
I haven't been able to find any accounts written by military nurses or doctors (or female civilian clerks) who took part in these MEPS exams in the past. Where are they? It's as if they've disappeared from the face of the earth. There's a considerable amount written by the men who were embarrassed or humiliated by the event. But nothing from those who conducted it.
My guess is (1) They've just forgotten about it. It was everyday stuff; (2) They recall it but don't see it as an issue; (3) more likely, they vividly recall it and are ashamed to even admit they took part in such a display.
Note that we've gotten at least one female doctor who does school hernia exams on boys to contribute to this thread -- and she didn't feel comfortable with what she was doing. My take is that other female doctors don't feel comfortable either but just don't want to talk about it.
Anyone on this thread -- if you know of MEP personnel from the past who conducted these kinds of exams, see if you can either interview them or get them to contribute to this thread with their memories and feelings about the experience. I can't believe there's no one out there who has significant feelings about the part they played in these exams. And when they look back, I can't help believe that they now feel somewhat guilty about what they put those young men through.

Joel Sherman said...

MER, I once again suggest you go to the Yahoo group 'group-physical-exams' for more information. You have to join and it is considered an adult site, but it's not pornographic. The main moderator of the group served at the LA MEPS and recounts in great detail all his experiences. He was an enlisted man, not a medical officer. His posts are quite believable.
There are many thousands of posts so it would take a long time to get through them all, but you'll learn a lot if you're interested. I believe there was a recent post from a guy whose mother served in one and he recounts her recollections. Like all these sites, some posts may be fiction, but I believe that most are real.
The professional people who served in these induction centers are probably mostly in their 70s now and not doing much blogging. I'm sure most of them would just say they were following orders. My guess is that physicians were not in charge of most of these MEPS, so it is quite variable how much say they had. The first priority was always filling the mandatory draft quotas as efficiently as possible. Male modesty was the last thing on their minds and most guys from that era were used to male nudity. That doesn’t mean that most weren’t embarrassed. A large number of these guys were going to be injured or die on the battlefield.

Joel Sherman said...

More on hernias. Here's a post from a nurse practitioner on the subject:

Just tuned in and think I have the idea about what is going on. I have a question. I am a NP and as one do sports' physicals. Lot's of boys get upset when I do a hernia exam and I don't blame them. I try to explain why and what and have their parent there. but for some it is traumatic. but, hernias are traumatic. Any ideas on how to make it better? I used to have them do squats to screen kids. A doc I worked for suggested that but where I am now requires the full exam. This is not so much a bioethical issue since i do try to maintain privacy and modesty and make it just another part of the exam. But I am looking for some feedback on making it better. Fact is, I don't like embarrassing the kids either.

Apart from providing complete privacy I don't know what else can be done as long as hernia exams are mandatory. The guys should be told ahead of time what to expect though. But I do think it likely that mandatory hernia exams are not necessary in screening physicals. It should be enough to ask if there's a problem, especially if complete privacy can't be offered.

MER said...

Joel:

Three comments:

1. I have checked out that site and, I think you'll agree, that the vast, vast majority of the accounts are by the men who went through the exams. Most complain about the procedure. A few said they didn't mind. It seems almost split as to whether there were female doctors/nurses and clerks around.
Something seems to have happened beginning in the 1960's regarding men's modesty. Before that, you'd never find clerks viewing these exams, nor female doctors examining men. Of course, from WW1 thru Korea, there were few female doctors. But even the female nurses wouldn't have been involved with the intimate parts of the exam in those days.
Social changes started happening in the 1960's, and I think it was directly connected with the growing feminist movement, more women in the military, more female doctors, etc. It seems that we see this double-standard begin in the mid to late 1960's and run through the 1980's. Then something happened. Maybe complaints. Who knows? But certainly, since the Gulf War and our military's dependence upon an all volunteer force -- and, I think, a definite change in the male demographic, attitude changes. I'm not sure, but I think more younger men would put up more resistance, especially because they're volunteers. Younger men buy into gender equity more these days, but that also means that they expected fair treatment for themselves, too. Maybe I'm wrong. Maybe the military realized how unfair and unethical some of these exams were. Or maybe the military doctors had some influnce in changing things. But it's clear to me as I read the worst of these accounts, that these procedures were as much about power and humiliation as they were about the health of the recruit. In some cases it was blatent; in othes it hid behind convenience and perversion. Don't dismiss the psychology of how much power a clothed person has over a helpless naked person. And, when the genders are reversed, we can multiply the significance of that power.
2. There are some doctors and corpmen and nurses who write their memories (not many), but I've never seen anything from one of those young, female clerks.
3. I need to be careful how I say what I'm about to say. I'm making an analogy, and I realize it's not a full analogy. But I'll risk it.
To the doctors and nurses and clerks who say we were "just following orders" or "We weren't responsible for how the exams were conducted" -- I thought we confronted and dealt with those excuses at Nuremberg. Now, as I said above, I'm not comparing these actions to the horrors of the what the Nazi's did, not directly anyway. But you can study how forces like the Nazis used nakedness as a definite policy and tool to control and humiliate people.
We are dealing with, as far as I'm concerned, with human rights abuses. And doctors and nurses, especially, should answer to a higher moral authority than even the military -- their oaths. Of course, this is really where the rubber meets the road -- when a person has to decide whether they'll face the consequences of following an immoral or unethical act or just go along with it. You can't convince me that most of those involved didn't know what they were doing was at the very least unethical. Perhaps they rationalized their behavior. They were human beings and human beings do that. But deep down, one of the qualities that makes us human is our ability to empathize with others of our kind. And you can't convince me that deep down these people didn't "know" intuitively that they would not want to be in the position of those recruits.
Sometimes the Golden Rule sounds trite. But it's not just a cliche. One will find the "Do unto others..." concept embedded in almost every culture around the world.

MER said...

Joel:

Regarding your recent post about the hernia exam.
1. It shows how uncomfortable a good many doctors (and I think nurse) are about this issue. It backs up some what I said in my last post. But they don't often talk about this in public, and some just rationalize their feelings. They know there's an ethical problem. It's not just about privacy. It's also about gender politics(see my comments below).
2. It fits into what I consider to be a widespread attitude within our healthcare system -- "Gender doesn't matter." Patients should just accept intimate care from whatever gender is available without complaining. Frankly, this attitude applies to women also. Some male nurses resent it when turned down by female patients, and try to convince them that everything's okay. With males, though, as we've discussed, it's even more blatent. Over the years, female nurses have just gotten used to male compliance with their intimate care, wanted or not. They just expect access, and although they will find a male nurse if asked and one is available, they're somewhat surprised,very surprised, shocked, insulted or hurt. Some just take it in stride; others don't.
3. The recent research shows that, indeed, "Gender does matter." It's a complicated topic. There are no easy answers. Gender matters in communication styles, in attitudes, in background experiences, in power dynamics, in non verbal communication, etc. This doesn't mean men and women are more different than alike. But we must recognized those differences and not pretend that they don't exist.
3. Those in healthcare are intelligent people. I think they know the score. Maybe they're doing much more with this than I'm aware of. But, from my perspective, their communicating their concerns poorly. This topic needs to upfront -- on their websites, in their brochures, as part of patient eductation, etc. It's difficult for patients to find out how healthcare attitudes and values translate into a patient visit and exam. What exactly will happen to the patient, who will do what, who will be in the room, etc. Unless the patient pushes, they won't get these answers.
It's as much about poor communication as it is about patient modesty and the double standard for men.

Joel Sherman said...

I agree with most of what you said MER. Just a few comments. We have little information on wars prior to the Viet Nam era. I would tend to think that female nurses were around then observing physicals, but I've seen no documentation. They didn't do the exams like many do now, but they were always present. Most of the participants from that era are deceased or infirm and it’s hard to document it.
I think the push for gender equality did figure prominently in the changes that occurred though it has always been considered proper for physicians and nurses to take care of both sexes. But the role of women has certainly expanded.
As you admit, the analogy to human rights abuses and Nuremberg is overdrawn. The treatment of recruits was more or less in line with how they were treated world wide. Read up about Russian and Eastern European practices. That's not to excuse it, but you have to view it in context.
I would strongly guess that the military's changing position is solely caused by the end of the draft and the all volunteer army. They don't own your body anymore and have to accommodate recruits better, just like they have always accommodated women.
About hernias, most providers and nurses know when a patient is embarrassed or uncomfortable. They just don't see the alternative or don't want to deal with it. I believe in gender equality but I also believe in patient choice and privacy which should come first but often doesn't in American society.

Anonymous said...

In the late 60's and early 70's
it was called AFEES(Armed forces
entrance examination services).
Beginning in 1973 AFEES was changed
to MEPS. The female clerks were
civilians employed by unions.
Specifically, AFGA unions. You
won't read anything anywhere by
them. Seriously,who admits to being
a pervert! Especially violating
young men in an armed forces medical exam. As sickening as it
gets!

Joel Sherman said...

Well thanks for the details. I think the center where I had my preinduction physical was indeed called an AFEES in '68 or '69. I'm not sure there were any civilian clerks where I was. At any rate when they finally looked at my papers, they were brought in by a man, probably in uniform though I don't remember anymore.
I have no idea if any of the women working at these places were 'perverts.' Most probably thought they were patriots helping the war effort and didn't know what their roles would be when they got the job. Still and all, few apparently have ever talked about their experiences and I doubt that many are proud of their role in the draft process.

Anonymous said...

A few comments:
1-Re: the female Dr. who claims to be concerned with the schoolboys' feelings when she's examining them in the boys' locker room. Are there other boys in there changing and showering? If so, how can she claim to be concerned with their privacy & feelings, or is she performing these test after hours when everyone else has gone home and the rest of the school is closed? I can just imagine the headlines if a male Dr. took schoolgirls into the girls' locker room for physicals at any time, especially after hours! Either way, I don't see the compassion that she claims.
2-In 1970 at age 17, as an entrance requirement to CCNY, I was forced to submit to a mass physical along with hundreds of other guys, even though most of us would not participate in any phys. ed. activities. There were several females present (nurses or clerks) throughout the day unbeknownst to us before we agreed to the procedure. Of course, if we did not submit, we were refused admission & immediately subject to the military draft.
3-In 1974 I was undergoing a company physical by an old male Dr., but with a dyke nurse present. Why she had to be there, I don't know, she performed no duties whatsoever, but I was young and accustomed to obeying orders and accepted the unacceptable. While standing in front of the old man, he yanked down my briefs unexpectedly to perform the hernia exam, so I looked over to the dyke standing 3feet to my left who was facing the same direction as I was. When I did, she turned her head to look me in the eye, then directly down at my privates, then sneered & chuckled derisively! Don't tell me that health care workers are angels in white! This was a hospital in which I worked for 5 years, and many nurses used their position for power over others who were at their most vulnerable.
I had been warned about this by my best friend's mother 40 years ago; that's why many women go into this field, to feel more powerful over the helpless and/or get their sexual kicks with naked men while protected by the veil of professionalism. The website you cite mentions that very thing: how many young female clerks would volunteer to take papers into the military exam areas so that they could get a good look. Same with nurses who voluteer for that particular duty.
When in the hospital, many men would object to the females performing catherizations or pubic shavings, but the callous nurses would ridicule them with "I've seen it before, you haven't got anything special", and insist upon performing the procedure anyway.

Having been enticed with the offer of free training in exchange of several years of work, I stayed only as long as necessary in that job, but I learned much about human nature and I'm far less gullible than I used to be.

-Fred

Joel Sherman said...

Fred, I'm sure the pediatrician who posted above did everything possible to protect the boys’ privacy. I'm also sure there wasn't a regular class using the locker room then. Believe it or not many or most providers do care about these issues.
It is certainly traditional that most physicians would have taken a nurse with them to do group physicals. I think our objection to them standing there watching and embarrassing boys is relatively new and part of the purpose of blogs like this. They don’t have to be used like that.
I don't know how many nurses (or physicians) go into the field for the reasons you mention. I've never met any (but we wouldn't be likely to have discussed it). But I'm sure those that do learn how to act professionally quickly. If more men protested, the learning process would happen faster. Protecting patients’ modesty is taught to all nurses (less so physicians), but many need to be reminded every now and then.

MER said...

Joel:

Your comment: "I think our objection to them standing there watching {nurses}and embarrassing boys is relatively new and part of the purpose of blogs like this."

I don't agree. Maybe our public objection in forums like blogs is new. But then this kind of technology didn't exist back then and attitudes were different.

But I don't think male embarrassment in these situations is a "new" problem in our culture. What I think is "new" is the nurse standing there watching, the use of female med. assts. to take notes during male exams, the attitude that gender doesn't matter in our hospital culture, the former use of clerks and non medical personel during induction physicals (I hope that's not done anymore)

These things are new. To my knowledge, this kind of behavior didn't happen preWW2. It probably stared in the 1950's, picked up in the 1960's, became more prevalent in the 1970's and 1980's, and started to decline in the 1990's. That's my take on this based upon reading and research.

I think this is an imporant notion, because some ask why "all of a sudden" this concern for modesty? I don't think it's "all of a sudden." Some assume these days that those of us who are concerned with modesty are the odd ones. I suggest they are the odd ones and, if they want to resocialize people, they are the ones who need to justify their reasons for doing this -- not us.

I believe perhaps that in the past men in power have assumed that men they have power over are not concerned with modesty, or that it didn't matter even if they did, or used nakedness as a power/control tactic/humiliation e.g. some of those draft physicals we've referred to. We can demonstrate how false those assumptions are easily. No way would those military doctors and officers submit to being treated like those recruits. No way would those nurses and clerks agree to that kind of treatment either. They would feel embarrassed and humiliated. I see this issue to some degree as a power dynamic.

Men and women use different stragegies to assert themselves. Men are more physical, loud, talkative,agressive. In embarrassing situations like the ones we talking about they either clam up or use bravado, machismo, crudity, verbal agression, to cover their discomfort. Women are more subtle, psychological, even passive aggressive. That has much to do with this issue, too. But that's another topic.

Joel Sherman said...

MER, I think you know more of the history than I do. I agree it is an important point. Most outpatient exams in the past were done by solo practitioners and chaperones were unheard of. So there was no one watching anything. But female nurses have always cared for ill men and I don't think exposure was much of an issue. That's not to say men weren't embarrassed, but women were embarrassed too by male physicians. It was just accepted. And it occurred for men mainly in hospitals when they were generally too sick to care.
So I think the problem is new to the extent that it now happens in offices for non acute and non medical reasons whereas before it was mainly institutional for sick patients.

MER said...

Joel:

I think you're right on the money, especially in your last paragraph. I've always tried to separate somewhat the seriously ill and emergency room events from this issue. Not that modesty isn't a concern there, but those are much more complicated situations.
Now we're seeing this disregard for modesty more often with non acute exams and procedures.

As far as the history goes, I'm kind of shooting from the hip. There's little if anything written about this, even by the social historians and sociologists. At least I can't find it. These are conclusions I'm coming to from my research. I could be wrong.

Anonymous said...

Why are there so many privacy violations among male patients?
What is it with female nurses? Is
this behavior inherent among them?How can they call themselves professionals?

Anonymous said...

I don't think Dr. Alex (the school nurse, teachers, moms, the lady gym coach) nor any other female should ever be allowed in the boys gym locker room. This wouldn't even be up for question in the girls area. I can't help but wonder if the doctor isn't getting some sort of 'forbidden' power trip over males by holding the exams in the same room where they shower and relieve themselves.

And I don't know any guy who would feel 'less uncomfortable' having an older woman his mother's age examining his privates. This is even more degrading. And please, what legitimate reason could there ever be for female chaperones to help the female doctor and female nurses feel safe?

Vulnerable teenage males having to strip and be examined for a hernia(fondled) by an adult person of the opposite gender sounds like a form of rape to me. Visual rape anyway, when it comes to female attendees watching.

The evidence being the apparent anger and violation many men still feel 10, 20 years after those experiences. Enough trauma they take the time to seek out blogs on the subject.

Joel Sherman said...

Anonymous of 5PM today, there are enough privacy violations for all patients, both men and women.
Not surprising that a lot of violations would concern female nurses. There are not a lot of male nurses and many of them don't do general nursing.

Second anonymous, on a college or pro sports level, lots of women are allowed in the locker room. Physicians are the least of this and the most professional of them. Not clear what percentage of guys object, but many do. But I agree that one would have to conclude that given the amount of internet buzz on such topics, it has made a never forgotten impression on many guys. Some are angry, some developed fetishes, and many have just accepted it, but still have vivid memories.

Joel Sherman said...

Here's a dramatically different twist on group physicals. A Massachusetts health organization now offers group appointments to patients who want to be seen promptly and who aren't too concerned about privacy or modesty. I doubt that the idea will take off, but I'm always amazed at what some entrepreneurs come up with.

Anonymous said...

OF COURSE THE TEENAHE BOYS ARE GOING TO BE EMBARRASSED. IT does not take a brain surgeon to figure that out. The lady doctor says she sees the fear in there faces before the hernia exam. This is not about if a boy should get the hernia exam, this is about the lady doctor and the school board thinking that it is no big deal for a lady to exam young men in the beginning. The lady doctor makes a lot of extra money performing these exams and she never mentions that. She also claims this is one small town, well what would happen if that town did not have a doctor then the school board would have to get clever and come up with a plan. The lady doctor rather take her money and say after the fact that these boys look and must feel horrified, maybe she should not be there in the first place instead of saying , "do you really think they need the hernia part of the exam". I read where a lot of people ran to this doctors defense I do not see it that way at all. I read it like a person who loves animals but works for a company that makes cosmetics products (maybe a secretary) that test their products on animals. Does that new hire in that situation take the money each week or do they quit. How bad do they feel is the question and when do we do the right thing is another question?
Kevin.

Joel Sherman said...

Kevin, I think we've talked about this before.
There is no way that embarrassment can be used as an absolute criteria for determining who does physical exams. In Western medicine, gender neutral care is considered appropriate. Most teens and preteens of either sex are embarrassed by physical exams no matter the doctor's gender though for the average kid it is worse with opposite gender. This age group would never have a physical exam if embarrassment was considered a contraindication.
So physicians do what they have to do. And a majority of pediatricians nowadays are women. But you can be sure our pediatrician makes NO extra money for the exams. She says elsewhere that she works for a clinic that sees many kids on federally supported funds. She almost certainly gets paid on a salary and gets no extra money for these physicals. In fact her job could be in jeopardy if she refused these exams.

Anonymous said...

I am sorry this is my opinion as you have yours and that does not not make my opinion wrong if you do not agree with it. So you are saying she does not get paid to perform these school physicals? I fine that very hard to believe, you also talk about her doing state funded work as I have not read, unless she is a complete volunteer she gets paid. When you go to an emergency room with your child you do not stand in line waiting to see the pediatrician on duty, you see a doctor any doctor. In my school days (mid nighties) for the boys we did not have a pediatrician do our school physical, he had a general practice. The physicals we talk about our very elementary exams even a nurse or a nurse practitioner could perform, my point is someone needs to say that out loud who has something to do with this process. Criteria for whom performs the physicals should way heavier on the side of the gender who has to expose their entire body. Teenage girls do not even remove their undergarments including bra. This is just another example of the double standard men endure throughout most of their entire life's and here it is starting early. I agree with you embarrassment is not absolute criteria for choosing what gender performs these physicals. Embarrassment has nothing to do with the criteria at all when choosing a doctor.
Kevin

Anonymous said...

not quite finished here. So what you are saying if she refuses to do these physicals, she will get fired. This is freelance work and yes she does get paid. Taxes are collected in this great country of ours and yes the school districts get a large portion of that money her wages are taken out of the school districts budget. Why would she refuse to not do these physicals when she applied for this part time work outside of her having a practice. Yes, doctors can do freelance work.

MER said...

Joel:

Of course, you're essentially right in your discussion with Anonymous. But he does have a valid point or two. You write:

"There is no way that embarrassment can be used as an absolute criteria for determining who does physical exams. In Western medicine, gender neutral care is considered appropriate."

As an "absolute criteria," no -- you're right. But that's not the whole story In our current culture, "gender neutral" means that, in generaly, women get more choices in gender, especially for intimate exams and procedures. "Gender neutral" is the mantra, but there's a great double standard, otherwise we wouldn't even be talking about this and there would be no interst in this blog.

You also write:

"Most teens and preteens of either sex are embarrassed by physical exams no matter the doctor's gender though for the average kid it is worse with opposite gender. This age group would never have a physical exam if embarrassment was considered a contraindication."

When you start using words like "contraindication," it demonstratres to me that you're really trying to rationalize things. You're talking about teens and preteens in a gender neutral tone -- as if these exams apply equally to both genders. They don't. The same standards don't apply to both boys and girls. That's why you created this thread on your blog.

As far as the ethics of this and what doctors decide to do -- that's up to the doctors. But if you feel uncomfortable doing a job because you feel there's an ethical issue involved, then you need to make a decision.

I'm not going to second guess the medical profession. They understand this issue. Doctors are privileged; they have great responsibilities. It's not easy making these decisions.

Joel Sherman said...

I obviously don't know the pediatrician's financial arrangements. But if she works at a clinic it is extremely likely she's on a salary. If the school contracted with the clinic for the physicals and she did it during the day, the chances are she received no extra compensation. Money is not the main point. I assure you though, no one goes into pediatrics if money is their primary concern. It's one of the lowest paid medical fields.
It really makes no sense to refer to a double standard if the differences in the exams are medically indicated. This is very different from giving women's modesty more consideration in general. Would anyone recommend that women athletes undergo an unnecessary pelvic exam just to 'equalize' matters?
The most important question is whether the hernia exams are really needed. I'm not competent in the field to give a valid opinion, but it is certainly the standard for sports physicals.

MER said...

I can't really figure out where you're coming from on this one, Joel. No one's recommending unnecessary exams for anyone. I'm talking gender equity, not as far as what's needed for the exams. That's up to the medical profession. I'm talking about choices. It's difficult, I agree, dealing with minors in schools. How much say should they have in this area? They need guidance, but they're not just bodies needing checking. Even children should have atonomy as regards to their godies and modiesty.

I'm not concerned with the financial arrangements as was Anonymous. It's not about that, I agree. For most doctors it's not about the money.

I still say it's about communication. The schools should let students and parents know up front what's going to happen and by whom. Give them a chance to find another provider. Don't hide the gender of the doctor. Don't make believe it isn't an issue. Let parents talk with their children and see how they feel about it.

Of course, for a significant number of parents it may come down to money. The school will do the exam free or at a discount. They can't afford to pay a private doctor.

But, unless I reading it wrong, Anonymous was talking about a doctor who was uncomfortable doing a certain exam because she saw the discomfort, embarrassment, humiliation in her patients' eyes -- and that bothered her. She didn't feel right about it. And she's a good doctor, I'm sure. She's at least bringing up this subject and looking for alternatives. When anyone feels that way about what they're doing, they need to make ethical decisions about whether they should be doing it.

It's a personal decision.

Anonymous said...

Dr. Sherman
I would have to say I fall in the middle on this one. On one hand the Dr. is trained to treat males and females, the issue is not theirs, they are doing their job. That isn't the issue here, in their practice both genders will be seen with equal concern and care. Where the issue arises is the typical sports physicals require the male students to be exposed and not the females. Therefore the logical thing to minimize embaressment for all is to use a male Dr. While I agree the exam involving exposure is embaressing in general, as you state opposite gender exposure is generally more so. So for the administration to ignore this fact and hire a female Dr. is inconsiderate of the male students. No one with any common sense would suggest un needed pelvic ecams just to "even things out"....that isn't the double standard...the double standard comes into play from the fact that IF there were a need for pelvic exams, you can dang well be sure the provider would be female....that is the double standard. And while we all know in theory health care providers are suppose to be gender nuetral, in practice it is only so for the provider...not the patient. That said, I have a lot less problem with the Dr. than the admin. they hired her knowing this. It would be interesting to know the gender of the person making the hire. I understand and agree the Dr. took the job knowing it would be more difficult the boys, but the fact that she is willing to provide them a sheet to minimize and is looking for an alternative for their benefit puts her in a much better position in my mind. Its a tough question whether it is right to tell her she can't or should not do this job, because then in her mind, how does she reconcile when she has to do this in her practice. The school should have hired a male just like they would have hired a female for exposure of female students. But I only have a minor question whether the Dr. was or wasn't even a bit wrong...and the issue of the hernia is not the only issue, health will always be the most important, but how and who delivers it has to be a concern and in this case, having a male do the exam takes care of the hernia exam and addresses the modesty issue, double standard and all. Dr.'s do not have an inherent right to do these exams, they choose to do them...still not convinced that is wrong to any degree....but its not a given either. Personally I still think she is outstanding for her concern and compassion alan

Anonymous said...

Dr. you are all over the place on this. What the writer said was she has her own practice and does freelance work around it, I went back and reread that myself. Why are you pulling in some clinic? I do not think the writer is bashing Dr. Alex I just think he is stated a pretty good point but maybe not the point some want to hear or uncomfortable hearing. Years ago my sister used to work for a school district in the administration building. I called her today and asked her what she new about doctors and how the physicals worked? She said she did not know much but she knew for a fact that the doctor is hired and paid for each student seen. She says it is basically done like bidding on a contract (sometimes more then one doctor interviews or shows interest in it). She also said the school districts lawyers have a big hand in writing the contract. Dr.S. I also noticed when you read something you do not agree with you bring up a teenage girl and a pelvic exam. The bottom line is, their is a problem here and if the boys have to remove their shorts and the girls do not and your saying ethier sex is going to be embarrassed I can not imagine the girls are going to feel that awkward as compared to the boys. As discussed earlier the girls will have a chaperone and the boys might also and that chaperone is most likely going to be the same person the school nurse. As you have stated females sometimes feel better with a same sex chaperone but boys do not want a chaperone of the opposite sex and most likely that chaperone is going to be a female. The playing field here is very unbalanced from the get go, you know and so does most of the people reading this. So for you to say it is gender neutral is rather odd.

randy

Anonymous said...

I put the responsibility of school and sports physicals on the parents. They shouldn't consent until they know the details of who is doing the exam, what exactly is being done, where it is being done, who will be present, can the child's parent chaperone, can they have exam done by their own pediatrician and that's just a few questions I'd have off the top of my head. And I'd have these questions whether the child be male or female.

Parents need to take control of the situation. If things aren't as they desire they need to set the appropriate boundaries. Parents in the community can even come together in this instance if they feel proper guidelines aren't being met.

I wouldn't allow any doctor I hadn't met to lay a finger on my children especially if anything of a personal nature was being done. I suggest other parents do the same. It isn't that I think doctors are bad people but my comfort level as a parent and my child's comfort level come before that of the school and visiting doctor. If the parents sign off it is hard to blame the doctor as they are then doing what they are being paid to do. Parents need to set the standard here.

Anonymous said...

I do not think the only is question here, is it necessary for the hernia exam, I think that is the easiest question we could pull out of this. The big question in my head is how did we come to the first question in the first place. The question and the answer should be how do we have these physicals where everyone involved does not have fear in there eyes. I understand the answer might not be easy and I understand what ever the answer is some might be still embarrassed. I just think the hernia question is just avoiding some issue. What I mean is like getting prepped for abdomen surgery by the opposite sex. Then the question arises do we really need to be shaving our groin for a operation at all. That question does not deal with the question of how did we arrive that some thought it was fine for the opposite sex to shave a mans scrotum and so on is the real question for me.
Kevin.......

Anonymous said...

Let's imagine a different scenario.
Male physician travels to the junior high or high school to do
hernia exams on teenage women. Does
this happen? Why not? Women on average are prone to hernia's than
males. Who made up all this?

pt

Anonymous said...

Okay Dr. you say there is no double standard here, I disagree with you completely. Female school students would never be put in this situation of disrobing completely for a strange male doctor. Very large lawsuits protect females 95% of the time in this day and age. Do you not think for a second that most of these insurance companies demand and dedicate how far a female school student is going to disrobe for a strange doctor. Do you know how many parents would be outraged and how many peoples heads would be rolling. School districts do use legal service's and the attorney's and the insurance companies draft the parental consent form. The school district also has a small say in the parental consent form also and it is the school district job to hire and have the doctors agree on fee and to follow the outline of the parental consent form and both sign a contract. Someone said it earlier it never states the gender of the doctor. Also I agree with the same person that said parents should know the gender of the doctor going into the physical. All the parties involved know boys are less likely to complain about the gender of a doctor at that age in fear of being called inferior. My father would have said to me "your an idiot, not to want have a women hold your jewels you must be queer" It has been stated here and on Dr B blog that yes it is extremely awkward for young men to go through that with a female nurse or doctor. I have read reports on Google that middle age to older men have eased in better with the opposite sex health care workers. The same reports say teenage boys have a high percent of disliking opposite sex health care workers.
randy

Anonymous said...

The number of men posting on this
blogspot represents a very small
cross section of the population,
nonetheless gives a true representation of how big this problem really is. Just what is it
with people wanting to violate
someones privacy. Medical privacy.
Is it because its viewed as porn. Do people just get their little sexual thrills or is it about power. With male patients it seems
that this group thing is both, sexual and power. Please don't tell
me its about efficiency. I'm sick
of hearing that. I would also like
the word PERVERT to be more applied
to women. There are female perverts
as well and many women from office
clerks to nurses to female physicians are perverts. I see historically, that the young are preyed on the most. Do you see anyone wanting to do group physicals on older men! Not! The
thread on allnurses whoa inappropriate involved just that.
A crowd of female nurses and cna's
gawking at an unconscious male
patients genitals. No one on the
thread called those people perverts,I'm calling them perverts!
Period. I have copied the entire
thread from allnurses. Anyone wanting the entire thread is welcome to it! Just to prove a point! Lets start calling it as we see it!

pt

Joel Sherman said...

Well, this subject has generated enough heat. That's fine as long as the discussion is kept civil. I know the lack of civility is what has kept the pediatrician from posting more. It's fine to ask questions and argue, but it's not fine to impugn others motives on this blog.
As I've said, I don't know what her financial arrangements are and I don't care. But every school, clinic and physician makes their own arrangements. It is not standard. It would have been fine to ask the doctor why she didn't refuse to do the physicals as she knows that the boys are embarrassed. She gave some hints to the answer, but I'm sure she could have said more. I believe she indicated she was the only pediatrician in town, but you're right, these exams could be done by anyone. It is also possible that she's the only physician in the town who would agree to do them given the likely very low remuneration. We'll never know. But I do know its contra productive to uncivilly criticize the few physicians who really do care.
My comments about the lack of a double standard are only meant to apply to the fact that both genders are presumably getting the minimum exam that is needed, not to the fact that the boys’ modesty couldn't be better protected. I don't think by the way that the schools' insurance policies ever set the standard of modesty for school physicals. The situation would change if parents objected, but most parents won't because they don't want their boys considered wimps or indeed the boys don't want to complain for the same reason. Most come to group physicals because these exams are inexpensive or free for the kids and they can't afford it otherwise.

Anonymous said...

Just a note here on who actually gets the physicals at school. You need a doctor and parent sign off sheet usual from grade seven thru twelve, for each child, for each sport. I think more kids get the school physicals then most think. I have two brothers and a sister and we are all within six years of age. We were very involved in sports most of our junior and senior years of school. No exaggeration here but we all played at least two sports a year my older brother played three sports a year but I am not going to put the three into the equation. Two physicals times four children is eight physicals a year for our household for just us kids. My parents both worked full time my mother could never take that much time off and she also did not want to either. As normal kids we got sick and yes even hurt in sports and my folks where pretty busy just keeping up with those doctor visit. Not to mention I do think money was a small factor now looking back, that would have been eight more co pays a year. My parents are wonderful and did support us in sports as much as they could. For us boys we did have a male doctor perform our physicals and my sister said she always had a female doctor.

John here and thanks for reading.

Anonymous said...

randy, I have read a lot of the same posts from older men who claim to have no issue with female physicians performing their intimate exams. Many even claim to seek it out. So I tend to doubt the reasoning behind a lot of those posts. They're just frisky old guys getting their kicks having a younger woman touch them.

I had a conversation with a man in his 50s the other day about male privacy violations in general. Far from prefering a female physician, he felt angered that young males don't often have a choice. He remembered his own high school athletic experience and how the locker room after practice and game days was hardly off limits to curious female spectators and this was often terribly embarrassing for the guys. But that at least his school back then had a male physician and male chaperone for exams. In fact his coach would even lock the locker room doors on exam day once all the guys were in to ensure some sense of privacy. He remembered he and the guys felt a great relief from that.

pt, I totally agree there is such a thing as female perverts. I read an account a while back from a female who chaperoned group drug testing in the military. In other words she got to sit in a room and watch hundreds of guys peeing into a cup all day. From her comments she clearly enjoyed her vantage point immensely. What possible logic could there be to appoint females to that job? The military couldn't find a guy to sit and observe other guys giving urine samples, and lessen some of their humiliation? I don't believe a male would ever be assigned or allowed to chaperone females urinating all day. Females certainly show no remorse when they barge into a public mens restroom where male genitalia is in plain sight. There's a definite double standard in the consideration for male privacy.

Joel Sherman said...

I welcome all civil comments including personal criticism. If you disagree, that's fine and we can discuss it profitably. When it's not civil, it's counterproductive. No professional will post if there are abusive comments.
If that's what you enjoy, go to voy. I won't tolerate it on this board.

Anonymous said...

What kind of response was that, are you asking me not to post something here because I thought you did not do great job leading a discussion on something you did not care to hear but others agreed the post was valid? This is the exact behavior I have speaking of.
JCR

Anonymous said...

I am sorry but how can you presume what I enjoy and do not enjoy. You say you welcome criticism and we could discuss disagreement but instead you tell me to take a walk. Where is the discussion?

JCR

Anonymous said...

JCR I think the point you are missing is while Dr. C's intent may not have been to post to our eyes, here intent was to seek a solution to helping these young mean with their embaressment. Should she have taken the job, if they brought it to her yes she probably should have, she is trained to treat both males and females, she also did the females at the school. Now we can argue that but when you look at the efforts she went to during and after the exam to condemn her is biting the hand that is extended in help. How about this, Dr. C. did you or would you recomend to the school that they hire a male to do the boys..rather than attack her for doing them, you can ask a question or make a suggestion in different ways, one respectfully the other attack mode. At least this woman cared and was taking active steps to address it both during the exam and after as she indicated she personally was involved in trying to find male options for the students. This is her job, she is treated to treat both genders, if everyone was doing what she is....we wouldn't have the problem...I agree medical people get defensive with this issue...but attacking Dr. Sherman and Dr. C.......not sure the logic there, they are on our side folks...what do you want them to do, go into single sex practice...alan

Joel Sherman said...

JCR, if I didn't want you to post, I would delete your posts and ban your IP address. I've done neither. Your comments are negative, but are civil, and that's OK.
But I'll tell you why I defend the doctor. There have only been 2 posters to this blog who have completely identified themselves that I can recall. BOTH were women and both were quickly flamed by guys who don't identify themselves. One woman felt threatened by it all. I will ban guys who do that. You can't discuss an issue properly from only one viewpoint.

Anonymous said...

I did not directly engage in that
discussion regarding viewpoints.But
the scenaro is this. If, as a male
patient I don't feel that female medical staff oblige my privacy as
a human being, then there is only
one viewpoint. Mine. There can be no rebuttal. There can be no excuses. Don't you think we are fed up. This is why you started this site,is it not?

PT

Anonymous said...

JCR, I think the point remains, when we call Dr.'s perverts, when we go on the attack we will end up with nothing but people on our side posting. This ends up being basically a bitch session. I don't recal you calling them perverts but others did, some accuse them of doing these exams for cheap thrills. If we really want to discuss this issue we need people from both sides. If we continue to chase these people away we will never engage in costructive conversation. You can challenge someone without attacking them. The attacks go back beyond your post. Dr. C was gone long before you posted. I turely believe the Dr. tried to think of these young men, you don't we can discuss that, but wouldn't it be better if she was here to tell us what she was thinking, wouldn't it be more constructive to make suggestions and explain to her that while the efforts she took were admirable, perhaps if she requested a male to do the males and give the boys the choice, we have a female that can see you now or you can wait in line for the male....would that have not had the potential for positive results...more so than running her off.....

Joel Sherman said...

PT, this site is intended to be a discussion. All civil views are welcome, not just yours. The above anonymous poster has it right.

Joel Sherman said...

I am deleting all comments that refer to the doctor by name. Some posts were good, some were abusive, some were hers. All will be deleted.
This goes as well for any further posts.
Sorry

Joel Sherman said...

Here are I believe all of the posts I deleted with names edited.

Dr C said...
It's great to see this discussion. Some of you posting have read my blog about sports physicals. I do my best to minimize embarrassment by providing a sheet or drape for the guys to hold up and for me to work around; at least with this, the young men have something to "hide" behind, even if I have to work around it.

We also use the gym locker rooms for exams, so that there is total privacy not just for the exam, but for the preparticipation questions. Since I do practice in a small town, I really work hard at protecting patient privacy.

When we have a male physician available, as we did this year on one of the two days of mass physicals, we have the guys see him as much as possible, although unfortunately we have many more male athletes than female. We also try to have the guys see an older female physician when possible with the idea that someone their mother's age might be a little less embarrasing. Unfortunately, for those teens who come to my office for a sports physical, I'm their only choice.
OCTOBER 3, 2008 11:51 AM

Dr C said
You are exceptional, your concern for this aspect of treating male paitents, especially teens is so considerate. I personally paid for a private physical for a young employee of mine when I found out he was to shy to do the group physical at school and elected to no partcipate rather than take the group physical. While we have to a large degree hearsay for anything other than our own experience, it would seem you are also an exception. Most of the posts have indicated a near total lack of concern for this area of the patient experience. It is encouraging for us to hear about physicians like you. I was so impressed when I read your blog,,It also appears your school system recognizes the issue as well and is at least trying to address it. It would be great if you could share your thoughts on this larger issue of modesty in the medical system with us...the conversations get pretty one sided here. I and others have a million questions..do you think your concern is common among other Dr.s you seem to be far more considerate than average. Do you and your fellow Physicians ever discuss this issue of patient modesty, do you/they percieve there is a problem there, do you think patients, especially males, care about this...what is your perception of how the paitent percieves this issue. Do you think there is a double standard in how male vs female modesty is percieved or is is simply a matter of the availablity of staff...I am really excited to have someone from "your" side of this discussion involved...this is great alan
OCTOBER 3, 2008 4:58 PM

Dr C said...
Wow! I don't know where to start! This thread has definitely taken off since I checked it last week.

To start off, WJB, I will happily stop doing sports physicals on male patients. However, that leaves them with one option, a family practice doctor who is semi-retired. If he is willing and able to see every male who needs a sports physical, more power to him. I cannot refuse to see a patient because he is a male, so if they come see me in my office for their sports physical, they get a complete sports physical. For those teenagers who refuse the exam, I offer them options in other clinics, one of which is 35 miles away, the rest of which are 75 miles away. Unfortunately, not all of my patients can afford either trip with the price of gas these days.

I have undertaken the issue of recruiting a male doctor to help with the physicals myself, the school was not involved in this decision. I decided to do the exams in the locker rooms since this was the only way I could come up with to give some privacy to all the young athletes.

I would love to get creative when it comes to recruiting more male physicians for these group exams, but distances are somewhat limiting in this neck of the woods. The next closest full-time male family practice doctor is 35 miles away and has a full practice himself. But, I do like the idea of doing more to change this situation, and I will certainly look into having a male doctor present for both days of exams, even if it means having one drive up the 35 miles necessary.

As I was growing up, I went to whatever doctor my parents sent me to. It just so happens that they were all men. Yes, it was embarrassing, and I didn't complain to my mother because I didn't question her choice of doctors. Perhaps I should have. As an adult, honestly I do prefer to see a female physician if possible, but if I need healthcare, I will not put it off until I can find a female physician.

I do think it's interesting how this discussion has evolved. Some of it, I think, stems from the fact that the medical field used to be dominated by men, so male modesty was not as much of an issue. I also don't think sexuality was discussed much in those days. However, as there are more and more women in the field, especially in pediatrics which is majority women, we face new challenges; I'd definitely like us to address them. I think we should discuss these issues within the medical profession to start, but of course we need to include patient input. Honestly, in medical school, we learned about respecting a woman's modesty by giving her a gown. We never talked about male modesty, so, yes, Alan, I think there is a double standard when it comes to modesty. I guess I just think about these males as patients who deserve to have their privacy respected, so I do what I can; I don't differentiate between men and women.

This extensive discussion makes me think there is a definite need to do some research into this topic. Obviously, this is challenging since it is all subjective, but we need to start somewhere. I honestly don't think it matters who is more embarrassed, men or women, as long as we begin the necessary discussions.

Anonymous said...
Dr. Sherman,
I lost a great deal of respect for you over the events that happened on this thread over this past weekend. The great lengths you went too protect a fellow colleague and totally undermined the teenage boys who were extremely embarrassed during a school sports physical, performed by a doctor of the opposite sex.
The great lengths you went to that I am speaking of was your attack on a post on Friday, that did have merit too at least stop and think about for a moment. Instead you put on your gloves and came out of your corner with inaccurate information on Dr. C and also not realizing that doing the school physicals was not charity work. To add insult to injury the whole pelvic exam double standard comment was so off target and that is not the first time you used that comparison.
What really bothered me was your half hearted attempt with a post on Saturday that appeared to be damage control from you. You mention about other poster not being civil, except for the rant that all nurses were perverts I thought all was civil including the original post on Friday that started this. You yourself created a great deal of the heat that you mention.
This thread that you created yourself is not about Dr. C, it is about the humiliation of young men and men that may possibly endure during a school physical and military induction physicals. As we found out from another doctor yes the young men showed a great deal of embarrassment at a school sports physical performed by the opposite sex.
I do not think Dr. C blog entry was ever intended for the eyes in these threads, I believe it was for the eyes of fellow doctors. Her question on the hernia exam created more questions from other posters here and that is not wrong that thought process is natural. Questions brought forth are not about Dr C, is she a good person or a bad person, or a good doctor or a bad doctor? The questions seemed to be about is everything and I do mean everything being done to protect young men during these physicals where full nudity is required. The answer to me has to be no because the men and young men are walking away with feelings of embarrassment and humiliation.

JCR.

Hi Allen,
1) I have never written a single word about Dr. C until this morning, so I could not of attacked her or abused her in any, shape or form. As of a matter of fact I never gave my personal opinion on the subject matter of Dr. C. I think a lot of people in these rooms type before they think, when they mention someone has no logic in what they are writing.
2)My post to Dr Sherman was exactly what you were trying to say to me, he could have handled himself different when responding the way he was. Contraversary opinions do not always translate into abuse. The true bottom line here love Dr. C or dislike her there is still young men getting physicals that they show fear in.
DECEMBER 15, 2008 3:48 PM

Anonymous said...
Again to Alan.

1)You are right I did not call anyone a pervert.

2)Again I must makes this as clear to you as possible I did not give my personal opinion on the Dr. C , so please stop speaking for me.

3)I personally feel Dr. C got some wonderful support in this board and she also got some opposition in this board. A question does stick in the back of my mind, if she really wanted to help fix the situation, she would still be here. That is what I meant from saying Dr. C blog entry was never intended for our eyes. On Dr. C the first answer she got from another female doctor was yes she stop doing the hernia exam herself on the teenage boys because her hand hurt at the end of the day. That answer has nothing to do with patient modesty. I can not speak for any doctor but I could only imagine the answers/questions would be rather soft like that and not really directly dealing with patient modesty. That is exactly why some people is this thread had many more questions then is it necessary for the hernia exam.

3) Asking someone a direct question it is not wrong it just may be that the individual person is direct. Reporters ask direct questions all the time. Telling someone they do not agree with there rationalization on a certain subject is not wrong.

4) When posters mentioned they did not agree with Dr C theory of having older women doctors do the exam on the guys rather herself because she thought thought that it was easier on the guys modesty because they could relate it to their mother. In my opinion that theory I disagree with for some teenage boys their mother has not seen them nude since they were eleven years old. From eleven years old to a senior in high school you have already went through puberty and the last thing someone is going to do is think of their mother during a hernia exam. People who just said they did not agree the rationalization they were told they were attacking the doctor, most if not all were not attacking the doctor they were merely stated there opinion.

5)I never understood when Dr. C said she used a cover to hide the boys privates prior to the hernia exam. I had numerous sports physicals and they were all done standing at the end of my physicals and they were all done by different doctors. Not once do I ever remember laying down on a bed or cot. So my question which I never asked for reasons of saying I was attacking Dr. C, was how did the cover work. She admitted she had to do a visualisation of the privates and physically touch them for the hernia exam. Most boys would agree you had to drop your shorts so when and how does a cover come in to play?

6) Before you jump to the conclusion I am not calling the doctor a liar I am just curious.

JCR

Anonymous said...
Hi Allen,
1) I have never written a single word about Dr. C until this morning, so I could not of attacked her or abused her in any, shape or form. As of a matter of fact I never gave my personal opinion on the subject matter of Dr. C. I think a lot of people in these rooms type before they think, when they mention someone has no logic in what they are writing.
2)My post to Dr Sherman was exactly what you were trying to say to me, he could have handled himself different when responding the way he was. Contraversary opinions do not always translate into abuse. The true bottom line here love Dr. C or dislike her there is still young men getting physicals that they show fear in.
DECEMBER 15, 2008 3:48 PM

Anonymous said...

Dr. Sherman

You made reference to the fact that several women posting here
felt threatened. Who cares! What
about all the posts and threads that were made on allnurses or other nurse forums regarding male
patients and then removed. If the
threads made fun about male genitalia then it went on and on and on. Some joke haha. Ever notice
how most female nurses smoke like
chimneys or how obese they are!
Certainly don't set a good standard. I mean as far as poster
nurses go,forget it. I consider housekeeping the real professionals in hospitals!

PT

Anonymous said...

Not sure exactly, but it seems the blog got a little jumbled, could be my short term memory. Dr. Sherman, I thought you inidcated you were doing to delete references to the Dr. by name and her responses. I hope you don't, it is a good indication of part of the issue, we as a patient community have vastly different preferences and interpetations of right and wrong. I was one who thought the good Dr was exceptional and could have been a valuable asset to this discussion. I think this progression shows a journey that we take in this process. I probably wrote in much the same thread as PT and JCR early on Dr. B's blog. There is a lot of anger out there. I know there are stages in every emotional journey, anger seems to be in the begining of most journeys. I hope you do not delete the posts though I may be a bit late. The process could be a learning process in many ways. To a degree JCR it really doesn't matter what our intent is, if we present our side in manner that the providers find threatening or offensive and they leave the blog, we are the loosers on this. We have to decide is it more important for us to vent or discuss and share when we have that rare opportunity to attract a provider. And believe me I agree with you on a lot of your points. One of the things that reflects poorly on the allnurse site is the fact that they are so willing to terminate and or delete converstations regarding modesty, especially male modesty, on the site. When one starts up it gets heated and the moderator cuts it off. One can only assume they do not want to be confronted with the issue. Now that is a generalization as there are some nurses who really go to bat for the patient, then there are those like one Dr. and a poster who goes by WitchyRN and she definately picked the right ID. The fact that they remove these posts shows they are senistive to their side of the issue but not the patients, I was very disappointed that they would try to hide from the issue and remove the posts...cowardly in my book and it adds to the mistrust we have in them that they do try to deny or take the pedistal. But, we need to have both sides of this, and even if we do so with best intent, if we chase providers off....we do not accomplish anything other than loosing a resource. We had a provider in Dr. C that...again whether we thought she went far enought or not...was being proactive and recognized this issue. SHE took the intative to see if she could safely eliminate the exam for the sole purpose of eliminating the embaressment of the boys, SHE recruited males, SHE provided a sheet (I assume they held it infront of them as she examined them, I didn't think she said she had to visualize I thought that was someone else...or it could have been in the manner a female is draped for a pelvic exam)..regardless it was an attempt. And now we no longer have her to discuss, and we had the chance to enlighten her on our side, which she admitted during med school dealt with female, not male modesty..we could have taught her about our side and perhaps she could have shared that with other Dr.s or brought them here....so, what did we gain. Again, I am not accusing you of this, she was gone long before your post. We just need to beaware of this...I think the allnurse moderator is wrong to delete these threads, it appears all he wants (and it is a he) is stuff that reflects postively on nurses...and in doing so he damages the creditbility of the nurses, if they can't acknowledge wrong they won't correct it. SO I stick to my point which is not directed soley at you but is more of an observation or opinion...I think we need to be careful how we approach providers, if we put them on the defensive or chase them off...we loose, they are still free to do what they want, they can read these blogs, but we get nothing back from them. Vent or learn...which is the most important. Dr. Sherman, I hope you will not edit the existing posts, perhaps not post ones that are attacking other providers in the future...you seem to be able to handle the ones directed at you...but there is a learning opportunity in all of this....alan

Anonymous said...

Alan-
I agree with you 100% about not trying to run off a doctor who is trying to help, or run off any poster for that fact. I also do think there is a fine line between what is consider abusive and what is not. In this technical age we tend not to see someones expression when they are typing we do not always understand a statement, or we may assume the person is being a jerk and that may be the way they came across, they may not been the author intent. Please if a jerk wants to be a jerk that usually comes across loud and clear.
I do think any provider will have a harder time in a room like this, just in the shear volume of questions, the good, bad and the more awkward questions. How does one protect the provider but be fair to the person asking the questions? Even if all the questions where as polite as could be, it may be over whelming for that person. Does Dr.S. set up a separate question and answer threads for that person and he will approve our question? Then I think you run into a fine line with censoring peoples messages and that is not always a good thing. What I am trying to say I understand what you are saying and do agree. I do feel the poster are aloud to be as honest as they want and yes should come across as polite but that still may put someone on the defense and then you are still not going to have good dialogue.

When I said Dr.C blog entry was not intended for our eyes. I truly mean this Dr.C may not have been ran off the board? I feel she said everything she had to say at the moment. Her question was about the hernia exam, she never got a clear answer on the subject and said she was going to follow through that question. Yes others had opinion, statements and other questions. Dr. C may not of had answers for all of our question and she did give a little history in her childhood and med school and the present. Maybe she walked away to take a breathier and research the hernia question and get back to us. It is unfortunate she is not presently posting here but that does not mean she does not come in and read the post and other threads.
Allnurses.com I stay away from, someone once on Dr. B blog said they think allnurses knows they have an audience and is deliberate saying things to piss off mostly male non nursing posters. It made some sense to me, some may be true, some may not but how much stock should we put into a somewhat anonymous chat room?

JCR

Anonymous said...

JCR, great points, we really don't know why Dr C left. I got the feeling Dr. Sherman had contact with her, perhaps he could find out. And it is a tough line isn't it, if Dr. Sherman was willing he could moderate or screen but that does influence open communication....never as easy as it seems...and as you say when the questions are 100:1 even when they say please and thank-you....its easy to feel persecuted or overwhelmed....and being Dr.'s they have a pretty tough day job...she may just not feel like taking the time to be involved in this thread and who would blame her, frankly I am stunned Dr. B and Dr. Sherman have the time....I would like to know if Dr. C is reading the blog and why she stopped posting....I assumed...and we all know the saying about assuming, food for thought, thanks JCR....alan

Anonymous said...

Well, I do have to say that if I
ever run into this witchyrn I'm
sure I'll fire her on the spot.
Anyone that could be so nasty on
the inside has to be hideous on the
outside. Patient comfort is not
rocket science! These issues should
be obvious to both genders. Why
would anyone need to research this?
If you look at core values they
say " we respect our patients"
DUH, that means male patients too!
I've looked at some of the state
nursing board websites and interestingly unprofessional behavior is a broad interpretation.
Just food for thought!

PT

Joel Sherman said...

Dr C stopped posting because of anonymous antagonistic misogynist posts. PT is amongst the worst offenders. Women who have identified themselves feel particularly threatened by this in a way most of us guys don't. Though I'm sure she wouldn't be posting regularly anyway. I can do it because I'm not working full time anymore.

Anonymous said...

It's a shame that Dr.C doesn't want to post anymore. If any of these problems (topics on this site) are ever going to be taken serious, we'll need help from doctors like her. It's also helps hearing their side of things just to get a better understanding of why things are done the way they are. One thing is for sure, we aren't going to accomplish anything if we run everyone away. Jimmy

Anonymous said...

Dr Sherman

Those are strong words coming from someone far removed at a computer terminal. Calling me a
misogynist. I don't profess misogyny, I just hate female nurses! All of them! You commented
yourself that you have never experienced what most of us have. In fact, i'm certain that at one
point or another you have said that
you have never experienced any kind
of privacy violation or any kind of
unprofessional behavior by female providers. How can you therefore judge me or any of us. These are subjects that conjure up hate and anger. Truckloads of it. It mostly
boils down to mistrust and discrimination. You created this
forum. As the old saying "if you
can't handle the heat, get out of
the kitchen".

PT

Joel Sherman said...

PT, you have commented many times how you hate nurses, but despite several requests you have never told us what incidents prompted this response.
Hate is not productive and doesn’t help our discussion here, but telling your story might.
Sorry to preach. Feel free to tell us your stories under the privacy violations thread. I’m not trying to judge you, but your hate does not accomplish anything positive on this blog.

Anonymous said...

PT, I have a lot of problems with the lack of concern for modesty from the medical community. I have and will continue to debate not only the actions of some providers but the SOP procedures of the institution in general. I think issues like the requirement to be naked under those "gowns" for shoulder surgery, the stupid gowns as standard issue for people who are perfectly able to get around, etc are just practices that have come to be accepted over time by the medical community which they defend but without true logic. I have a strong problem with the double standard not only male female, but the hypocracy of some providers when they are the patient compared to what they practice on the other side of the gown. I understand your frustration. Obviously there is something in your past that takes that even beyond what many of us feel. No one here is sayin you are not justified in feeling the way you do. We might feel exactly what you do if we had walked in your shoes. The point we are trying to make here is when you show that hate it intimidates and discourages open communication. We have an opportunity to learn from each other....we don't choose to feel the way we do, it is a result of our life expereience and perhaps it is combined with our heredity to cause us to feel as we do. We don't blame you for feeling like you do, we are just trying to get some value from this thread. I personally have grown a lot from this and Dr. B's forum. I now know I am not alone and I have an absolute right to ask for what I want to make me comfortable. They have a right to say no and I have a right to go elsewhere. I have put these to practice and it has helped me...I also know that not all providers feel my requests are stupid and understand...so please understand, we are not condemning you for your feelings, we are just trying to get everyone to communicate in a manner that will get the most out of the site.....alan

Anonymous said...

Alan

You do have a right to say and
ask for whatever makes you comfortable. They do NOT have a
right to say no! Why should they!
You are the patient and YOU
are paying their salary. They are
working for YOU. We need to change the jargon. Double standard is a nice coverup definition for discrimination,which is illegal. As
a patient you have a right to choose how healthcare is delivered
to you. If you want a male nurse
for any intimate procedure,then you
should be accomodated.

Anonymous said...

I agree 100% we should be accomodated, but there are cases where they can not (no male staff), where they choose not to (do not make the effort to schedule to accomodate), and where they just don't (are available but won't due to effort or attitude). So while we can try to force them to do so, I am not so sure I want someone who has been forced to accomodate me standing over me with a sharp object or putting something in one of my orafaces....they are medical businesses, they have the right to set policies at their facility, like wise we like any consumer have the right to go to another facility and tell as many people as we choose about the reason. I run a business, when I have an unhappy customer, it is as much about the 10 people they will tell as it is about them. You can cause them just as much trouble by going to a facility that provides what you are looking for, telling everyone you know, and then telling the admin. of the violating facility exactly what you did and what you are going to continue to do. And if you have a case take it to JACHO or hire an attorney. Health care facilities are big business, they need your money, hit them where it hurts in the bank account and you'll get just as much attention as trying to force them or make a big scence. Not that I am against making your issues known, nor am I saying you should not stand your ground. But if they won't accomodate, there are those that will. I acutally saw an advertisment for "gender sensitive" care on TV from a hospital....was probably targeted for females, but if males benefit..great..alan

Anonymous said...

Sure,they are a business and due to
the type of business are licensed by state and government agencies.
It's not my fault they don't have
male staff there. Sounds even more
discriminatory if that's their excuse. Actually, makes for an even
stronger complaint when I complain
to the insurance carrier. The carrier who is paying the bill.

PT

MER said...
This comment has been removed by a blog administrator.
Joel Sherman said...

I've moved MER's long thoughtful post concerning female dominance of the nursing profession to the Equal Employment thread where it's more on topic. We have indeed wandered off Group Physicals here.

Joel Sherman said...

Here's a comment I came across on a blog which has a discussion on patient privacy. There are a few other comments by this poster, Sharon Ledbetter.

Just tuned in and think I have the idea about what is going on. I have a question. I am a NP and as one do sports' physicals. Lot's of boys get upset when I do a hernia exam and I don't blame them. I try to explain why and what and have theri partent there. but for some it is traumatic. but, hernials are traumatic. Any ideas on how to make it better? I used to have them do squats to screen kids. A doc I worked for suggested that but where I am now requires the full exam. This is not so much a bioethical issure since i do try to maintain privacy and modesty and make it just another part of the exam. But I am looking for some feedback on making it better. Fact is, I don't like embarassing the kids either.

Yes some practitioners do care.

Anonymous said...

Dr. Ledbetter means well, as did the other lady Dr. (who's name we can't mention anymore). BUT all the privacy screens and squats and shielding from other male peers in the room (etc) help nothing if the boy needs/wants privacy from the female doctor herself. There seems to be a disconnect from that basic fact.

Joel Sherman said...

I'm sure that both Ledbetter (who's a nurse practitioner not a physician) and Dr C would prefer to let males do these exams. I know that Dr C could not refuse to do them due to her clinic's federal grants and her position. The same is almost certainly true of a NP who's hired by a group or clinic. Neither are their own boss.
Recognizing the problem is half the battle though. I'm sure both these practitioners did the exams in the most private manner possible. The decision and pressure to ask for a male practitioner instead should come from the school or the parents. If these schools always use women for the girls’ physicals (and that is by no means always the case), the parents would have good grounds for making the request.

Anonymous said...

The first "clue" that people should
get is "young males". Why does this
only happen to young males. There is a reason for it and that reason
is the driving force. It's not just
for convenience. This practice is
just sick and it needs to be analyzed in the public's oponion. There and only there will people
realize the worthless value and
the true motivation behing it.

PT

Anonymous said...

I am one of those people that never played sports in Jr.high or high school because of the ridiculous hernia exam from a female doctor and the school nurse. It is one of the most unethical and unnecessary problems I've ever seen. Why is it so unheard of to have a male doctor giving boys their sports physicals?

Is it meant to be some kind of a rite of passage that every boy must endure to be a man? Do school officials enjoy humiliating young boys for something so unnecessary? I will never understand the reason why the school nurse ALWAYS has to be there to do nothing more than stare at a boy's penis. If she has no part of the examination but insists on being there to watch I consider her a pervert and a pedyphile.

I've taught my sons that if that happens to them they have my permission to immediately stop the exam and ask the nurse to leave. If she refuses they can walk out of there and I would come to the school to defend them. I just won't let that kind of unnecessary perversion traumatize them.

D

Joel Sherman said...

D, we need to keep this in perspective. Nearly all nurses who are present are there because the physician or provider wanted them there, not because they are perverts.
But I fully agree that they are not needed. They wouldn't be there if more kids and parents knew they could complain and did so.
The bottom line is that kids shouldn't be unnecessarily embarrassed. This includes giving preference to same gender examiners when dealing with kids.

Anonymous said...

As a pubescent schoolboy I had a hernia check done by a female doctor with a female nurse in attendance.
I only recall feeling slightly nervous as you do while waiting your turn because I knew what was going to happen but I was certainly not traumatized by the occassion.
If the examination had ben conducted with all my classmates naked and in the open, ie, no screens, and with a teacher in attendance as a chaperone I might then have objected.
I do tell my sons (the youngest is 15) that if they have to see a doctor to discuss an intimate problem they should remember that she (if it is a she)is a professional and will have seen it all before.
What if your son is in hospital with issues below the waist. Will you demand that the boy is only to be seen by male nurses?

Joel Sherman said...

Anonymous, I don't disagree with your comments, but there are further considerations.
First your comment that the providers have seen it all before is irrelevant to how your child feels. He's the one who could be embarrassed, not the nurse or physician. I believe that everyone needs to accept providers of both genders; it is unlikely anyone can live a full life in this country and not have to be exposed to both genders, at least without completely avoiding medical care.
But adolescents have far more problems with body image and embarrassment than adults. If there is ever a valid reason for giving preference to same gender providers it is with group physicals of youngsters. It is not always possible. But if schools make a point of providing women for the girls' physicals and some do, they should provide male examiners for the boys. Remember, girls normally retain their bra and panties for these physicals and are never even fully exposed, unlike the boys.
But all group physicals should be private to the extent that intimate exams are done behind screens with just the doctor and the kid. There is never a need for a nurse to be watching. A doctor doesn't need someone else to hand them a glove for example. Keeping observers out is important to ease the kids comfort.

Anonymous said...

I a probably missing something but I am surprised to read that in the USA it is deeemed necessary to have a medical check for every sport the child wants to participate in, the end result being that the boy or girl has to have several medicals in the same year. Surely one medical per year would be sufficient?
Is this not overkill and a licence for the doctors to print money?
I also read somewhere that a medical is required for a child to go to summer camp?
Are these examinations also quite invasive and intimate?

Anonymous said...

In the UK as far as I know school medicals have been phased out and annual checks at my doctors have also been stopped, if they ever occured.
As a father it does concern me, regardlesss of the privacy issues that nobody is looking out for the children.
Obviously it is up to the parents in the first instance but some form of organised screening is needed in my view.
On TV here they screened an educational medical series aimed at all ages and it was useful in that it debunked the myth that unless boys were 'hung' like porn stars they were abnormal and as teenage boys do look at porn it causes some to have hangups and may be one factor as to why boys do not like to be naked in the showers or during a group medical, in that they are simply worried that they do not measure up.

Joel Sherman said...

There are no universal rules in this country that apply to all schools. They all do what they want subject only to varying state laws. But I know of no schools that would require multiple sports physicals if you participate in different sports, though it may well happen somewhere, especially on a college and NCAA level.
I don't know why apparently kids are more reluctant to shower nowadays than we were. Of course I had no choice. It was mandatory and no one thought anything of it. My guess is that fear of pedophiles is a major reason, one that parents and schools reinforce. Most guys would be reassured in the shower about their size which is greatly over emphasized concern in our present culture. When I was a kid, I never heard anyone, guys or girls discuss genital size. Most guys think they are shorter than they are, partly because they look down and see their genitals in a foreshortened perspective. I was amused in Europe looking at the great statues of heroes such as Michelangelo's David, noting that all would be considered under endowed today. Size fixation is an aberration of our Hollywood oversexed culture.

Anonymous said...

Dr. Sherman
While this isn't exactly on point, do you think that fixation is part of the reason we have the issues we do with modesty. We are all so body concious that we fear being nude and judged not only infront of the opposite gender...but even our own gender. I know a young lady who plays college basketball, she mentioned in conversation that some of the girls actually shower in bathing suits....I was stunned. There was a lot of talk at one time about Barbie dolls setting unrealistic expectations for young girls. With the easy access to internet porn, I think it would be easy to make the jump that it would effect males perception of themselves....if we all thought we were amazing specimens and well endowed, I wonder if the concern we have with modesty would be so great...what do you think?......alan

Joel Sherman said...

Alan, I don't consider myself an expert on this subject. But I believe women have traditionally been concerned about their bodily image. Many women's locker rooms have completely private shower and changing areas so that women never have to be exposed to each other. My wife has said that it is highly variable how much exposure the ladies tolerate with some locker rooms very modest and others with widespread open nudity. Appearances have always been more important to women than to men and women's bodies change more prominently than men's as they age throughout life.
As you know boys/men's locker room nearly always have open showers, changing and dressing areas. But the differences are narrowing with greatly heightened bodily consciousness for boys now as well. Some boys now too are reluctant to shower in the open or wear bathing suits to do so. Two factors cause it. You can thank our Hollywood culture and the literally billions of spam emails sent out about penile enhancement. Heightened fear concerning pedophiles is also an issue that some parents and schools teach. None of this was an issue when I was a kid.
I think it is a discouraging development. Kids have enough real problems without having to be plagued by comparisons between their bodies and Barbie, Hollywood stars or porn stars. But even if we were all proud of or bodies, many would still be modest. It's not the only factor.

Anonymous said...

By far the most common reason for the students to shower in bathing suits is not body image, nor is it fear of pedophiles. It is the ubiquitousness of camera phones. It seems everyone has one, and teens will use them indiscriminately and webpost. Voila! Instant porn star.
—rsl

Joel Sherman said...

Thanks for that comment rsl. Never gave it a thought. At the YMCA I go to, cell phones are forbidden and I have never seen anyone with them near the showers. But your right that high schools and teenagers are a different matter and it is indeed a valid fear, at least for guys. My guess is most schools have private showers for the girls.

Matthew90 said...

I was reading some of the posts for group physicals and why guys would be embarrassed about being naked in front of their teammates. My school doesn't do group physicals so maybe I'm wrong about this but I don't think we would be embarrassed if we had to be naked in front of each other for them because we take showers together every day after practice. I'm sure it wouldn't bother me.

I would rather have a male doctor do my physicals but I wouldn't freak out if it was a female doing them, especially if everyone else was getting examined by the same doctor. My own doctor is a guy which is fine with me.

Last thing I picked up on was the number of physicals required. We don't have to get one for every sport, you just have to get one before school starts and it lasts for the year as far as the school is concerned. But my own doctor wants me to come in twice a year because I play sports year round so I get a physical two times each year.

Anonymous said...

Matthew90,

I also showered naked with my classmates but there is a big difference between a quick wash and being 'groped' around the genitals and maybe having someone bend you over a chair while looking up your butt (for what I never understood) and all this while your classmates look on, maybe with a teacher in attendance as a chaperone regardless of wether the boys want him (or maybe her, there, if some of the stories I have read are true).
I was never one who was comfortable enough to engage anybody in conversation in the shower. It was a necessary evil, something that had to be done, failure to do so resulting in a slap on the backside with either a cane or a gym shoe.

Anonymous said...

I was a HS student in the 70's, it was a given you were going to shower after gym or practice. While I felt a little self concious it wasn't a big deal, you were in such a hurry to get ready for the next class I don't recall it being terrible, it wasn't an option so maybe that made a difference.

Our yearly physical was always a male Dr. female nurse outside the locker room, took the vitals, etc, gave you your sheet, went into the Dr. dropped the gym shorts etc,,,next, no one standing there watching they were around the other side of the lockers...so now why would this not be available today...just curtosey.

The generational thing is interesting...Matthew and anyone else, you said you preferred a male but would not freak out with a female. On strictly a comfort level, you are more comfortable with a male than female, what would the presence of the school nurse (female) or other female in addition to the female Dr. do to the situation, how would that effect your comfort level. I understand your position, even today, but especially when I was younger, regardless of the comfort or lack there of, I would have accepted it and just dealt with it, you will find as you get older you are less willing to accept things just because....so, thoughts on a 2nd female especially one that you might see again ie school nurse...alan

Anonymous said...

That my school medical ws conducted by a female doctor and nurse did not bother me when I was 14 and it would not bother me now at 49.
If I have a full medical anytime soon and the doctor is a woman and she has a female nurse as a chaperone that will be OK. It is not a fetish thing, simply my not really giving a damn as long as the doctor is professional and competent. My only worry, and it would not cause me to lose any sleep would be that I might 'react' in a potentially embarrassing way below the waistline if she overstayed her welcome down there but my view is that I should abandon any shame when at the doctors as it is a safe place where what happens in the doctor's office stays in the doctor's office and they are there for my benefit.
I have read stories of boys 'popping a boner' in front of their mother during a medical examination. While there may be a hint of urban myth about some of these tales I think in hindsight if it had happened to me then such is my relationship with my mother I would have got over the embarrassment very quickly and we would have laughed about it and probably shared the story with the whole family. It is a natural occurence, part of growing up and nothing to get upset about.

Anonymous said...

In my mind this issue is not separate from how I see male modesty in general. Maybe it's how I was raised in a southern conservative home, but I'm not dropping my shorts if a lady is in the room. Not only for my comfort level but for hers. Doesn't matter if she's a sports physician in the locker room, or a girl in a co-ed dorm shower, or some gal who barged into the mens room while I'm mid-flow at the urinal. It's just basic good manners not to expose your privates to any female other than your wife/girlfriend. Period. That's why I have a hard time understanding guys like the previous anonymous who claims getting an erection in front of Mom would have been a source of comedy for the whole family. Not a fetish?

Anonymous said...

As you say it is the way you are raised. My mother respected our desire for privacy from a realtively young age but we could talk openly about pretty much anything.
The idea that showing a female doctor your boy bits is somehow impolite and bad manners is a bit bizarre, if I may say so.
Again, as you say, it is a question of background.
My mention of a possible erection in front of my mother at a young age is, as I suggested, initially embarrassing but nothing to get angry or upset about. Don't sweat the small stuff, as they say. I guess it has happened often over the years, and maybe the good doctor here can verify that, or not?
Maybe some of the reasons boys get upset over intimate examinations in groups or otherwise is the fear of a reaction to the doctor's touch at an age when boys are quite sensitive and trigger happy.
My view is (and I have had a few checkups over the years) I will fight it but if it happens, it happens. Either ignore it or make a joke about it. Yes, I might blush a little but I am sure I will survive.

Joel Sherman said...

We're getting somewhat off topic now. In general I want to confine the topics to medical situations.
But I had a recent experience is pertinent to the above comments.
On vacation I went into the locker room of the resort pool. A guy was there using the bathroom, but he brought his 5 to 7 year old daughter in with him. I could not feel comfortable changing in front of her for several reasons. I would not have done so in front of my own daughters when they were that age. This is not a matter of modesty, but of family custom. Secondly I am very aware that exposing myself to a girl this age would be illegal in nearly any other context (except in the family for those who practice it). I have no idea what her father would have said; he was in the bathroom stall. The potential for a hassle was best avoided.
But it's useful to ask how this scenario differs from women's customs in their locker rooms. There are children in them frequently in many areas. I don't know how most women handle it, but I do know that most women's locker rooms have private areas to change whereas that is rare in men's locker rooms. With the increasing number of men as primary caregivers, either fulltime or part time, locker room design may have to be rethought. For instance, it is now common to have baby changing areas in men’s bathrooms whereas that was a rarity 30+ years ago.

Anonymous said...

Anonymous, you started your original post by boasting that intimate exams from a female doctor/nurse didn't bother you at 14 or 49. So you sorta have to recuse yourself from any modesty discussion because coming from your standpoint you can't really understand how other many other males feel in those situations.

Likewise you don't seem able to separate a female examining you from being sexually aroused. For myself at that age (and apparently many others), an erection was the last reaction we would have had in that setting.

And your suggestion that males should just ignore it or make a joke out of it is just the old "suck it up/be a man/big boys don't cry" homophobic stuff all over again. Fact is many males still feel the humiliation of these experiences decades later. Just because you don't doesn't make it any less real.

MER said...

Joel:

Your recent locker room experience brings up what I think is an interesting question -- that you raise to some degree.

If an adult male exposes himself to a 5-7 year old girl, it's a crime. He probably becomes a registered sex offender. But, if the parent permits it, even in a public locker room, it's okay. The same would probably be true if the genders were reversed? Yes? No?
Now, it's one thing if this occured within a family setting, or in a nudist colony. But in a public locker room?
What does that say about modesty rights as they are interpreted today? I think it tells us a lot. I'll bet you'll find this happening a lot less with women taking 5-7 year old boys into the women's locker room with them? My guess is that other women will speak up and/or complain.

Joel Sherman said...

MER, laws vary from place to place, but I don't think a man could ever be seriously charged with exposing himself in the men's locker room. However nudity at home is not above the law necessarily. At least I have seen comments by nudists that if their children talk about home nudity at school the family is likely to be visited by state child protective services to investigate. The investigation would usually be dropped if they found no evidence of sexual contact or outright abuse. But who needs trouble?
Certainly any open and public place could precipitate an arrest.
Locker room customs vary greatly, and I can't speak for women's locker rooms. But I think 7 year old kids would likely raise questions most places. It's not an issue at my Y. They have a family changing area so it should never occur and I’ve never seen it there in over 30 years, which is even before they had family changing areas. But it must have occurred in the women’s locker area in years past. I’m sure there were complaints. Why else build a family changing area?

Anonymous said...

"And your suggestion that males should just ignore it or make a joke out of it"

What else can you do?

The medicals I have had both as a boy and a man have been in a private room with either just the doctor or the doctor (male) with a nurse or medical student (both female).
Not an issue.
As regards privacy I would probably make a huge noise if I found out my son had to parade naked in a group/school medical with teaching staff in attendance and no screens erected for privacy, to the point I would withdraw him from the medical. unless he personally felt comfortable with the situation.

As regards my previous point, as a boy, if my mother had followed me to the examination room I would not have protested. I would have assumed she had a right to be there. Knowing her she would have excused herself once it got a little personal. If she had not it might have become a little embarrassing briefly but again it is no big deal. I was speaking of my/our relationship and how I/we would have dealt with it.

Joel Sherman said...

These posts have been moved here from the Gender Preferences and Healthcare thread as they are mostly concerned with group military physicals.

Anonymous said...

Another analogy synonymous with
this kind of discrimination ccurred in I believe the 90's
which was called tailhook. Had
to do with sexual harrassment of
female military officers at a
party in california by military
male officers.
Interestingly, the heads of high
level brass rolled and there were
lawsuits. Yet look at the treatment
of young male soldiers being exposed to non-medical female clerks during military medical exams. Ever hear of any lawsuits,no! In fact, it
took the military over 30 years
to issue changes on rules of
observers during medical exams.
How discriminitory is that in
allowing different rules for
different genders. Female recruits
were always examined individually
in private rooms wheras males were examined together in large rooms
in front of anyone who wanted to
be there, no privacy enforcement
nothing.

PT

April 2, 2009 8:06 PM
Joel Sherman said...

I don't think the situations are analogous PT, and must also be seen in an historical perspective.
Don't remember the full details of Tailhook but some of the women were physically molested. That's not the same as a physical exam no matter how disrespectfully done.
Certainly women have always been afforded greater privacy than men in physical exams but I don't think that the military did all women physicals privately by any means. At least not by the accounts I've seen.

April 2, 2009 10:22 PM
Anonymous said...

The event occurred in Las Vegas
and essentially there were no
witnesses. It was a he said she
said. The hotel paid $400K to settle the suit.
About.military.com states that
all military medical exams on
females occur in private rooms.
As well as usmepcom.com states
that all female medical exams occur
in private rooms. Prior to 1973 the
Afees command as well stated that
all female medical exams will occur
in private rooms.

PT

April 3, 2009 12:43 AM
MER said...

Joel:

PT is correct. The following from

http://www.mepcom.army.mil/enlistment.html


"For Women Only:
The MEPS will provide a drape or gown for you during the physical examination. Your visit with the physician will be in a private room. Underclothing is required during your physical. A female attendant will accompany you when you must remove your clothing. You will also be given a pregnancy test."

No mention of how men will be trated at all -- but the inplication is clear. Especially when they write "For Women ONLY."

If they feel the need to state outright that women will be examined in a private room with all these other accommodations (drape or gown, private room, underclothing should be worn, etc.) -- the implications is that men will not necessarily be granted these accommodations.

April 3, 2009 7:18 PM
Joel Sherman said...

Thanks both of you, but I wasn't doubting what happens now. I'm sure women's exams are private now, well at least entrance exams, but probably all.
I was referring to what happened in prior wars such as Vietnam. I have seen several accounts whose veracity I can not vouch for wherein women described their military physicals as being in small groups with women doctors and some general exposure. They were not private. The armed forces have upped their standards for both men and women but the women have always gotten more privacy. I certainly wouldn't argue that they should get less. Men should also be given privacy, at least for the intimate parts whenever they are exposed, and present regs say that they are. Don't know if it's always followed, but at least all present recruits are volunteers and hopefully have some idea what they are getting themselves into. That’s a great improvement over humiliating draftees prior to sending them off to face mortal danger.

April 3, 2009 9:23 PM
Joel Sherman said...

By the way MER, I should add that another implication of the regs you quote is that the regs were put there because exams weren't always done that way. I can personally attest that women's exams were done without chaperones in the 70s because I was involved with a few. They were one on one, just me and the recruit.
Was never involved in any male exams. We did a few women because the recruiting center wasn't equipped to process women. I was in a medical reserve unit.

April 3, 2009 9:31 PM
MER said...

I agree with you, Joel. I don't want to see women get less consideration. But it is interesting in terms of what we've been discussing on this blog. Men are considered less worthy of modesty accommodatins. The military sees a need to mention these modesty accommodations for women quite publically, while they also add, quite definitively, "only."

This implies two things to me. First, that men don't require the same considerations, at least publically, as do women. Secondly, that men better not ask for these consideratins because, as they've made quite clear, they are for women "only."

April 3, 2009 9:50 PM
Joel Sherman said...

I may move some of these comments to the group physical thread as they are getting off topic here.
I would bet the military would say that men need less privacy, not that they are less worthy of it.
But in any event, no one has mentioned the factor of numbers. As there are many fewer women recruits than men, the military can afford to do them individually, but it would require immense resources to do the men that way. During war time some urban examining centers would process upwards of 500 guys a day. They couldn't possibly have been processed individually.
April 3, 2009 10:41 PM

Tony said...

Although I technically never had a MEPS physical I think I can attest to how they might have been done back in the Vietnam War era.

When I was 12 we moved to a new home which necessitated a switch in doctors. I had my first physical with the new doctor shortly before I turned 13. My father took me to the new doctor who, it turns out, was a recently retired army doctor who had gone into private practice. Prior to this he had been doing draft physicals (I didn't know this at the time but found out later).

When he came into the exam room the first thing he did was to introduce himself and shake my father's hand (not my hand). The second thing he did was to tell me to strip totally naked. This was a departure from what my previous pediatrician had done for physicals but of course I complied. My entire physical was done with me naked.

I went to this doctor until I was 24 and all physicals were done the same way. I just figured this was SOP for adult physicals, until I went to my next doctor and was allowed to keep my boxers on for most of the exam.

Joel Sherman said...

Tony, your comment certainly has some validity. No doubt army doctors are attuned to a different level of privacy and their 'patients' could never complain. That would be speaking back to an officer. At least years ago, complaining was almost never done officially.
I would point out though that there is a difference between career medical officers, one of whom you had, and MEPS exams. The latter was nearly always done by doctors serving their mandated service requirements or by paid civilians. Career military physicians got the plush jobs; MEPS assignments were nothing anyone would request. Career officers would have been used to different standards. MEPS physicians had to conform to the MEPS procedures while they were serving. They knew they couldn't use those standards in private practice.

Anonymous said...

I'd like to point out that when
recruits were getting a medical
entrance exam, they had not yet
taken the oath and swore in yet.
They therefore were still
civilians!

PT

Joel Sherman said...

I don't know the legalities PT. Most recruits had 2 exams. The first exam was full, and the second preinduction exam was usually brief. Don't know if they were technically civilians for the preinduction exam, but possibly.
But for sure, the only difference was whether a recruit who refused draft procedures would be charged under civilian or military law. They couldn't avoid service and/or confinement either way.

jean-rene said...

In most of the countries where there was a mandatory military service( or there is still for some countries as Russia, China, Greece and others), it is obvious that the modesty or the privacy was not respected for the physicals exams before military service.

In France, we had first until the middle of the 60's a physical exam in front of a draft board commission and it was a real medical exam.

All the young men over 18 age were summoned to report in front of the draft board commission. They were instructed by sergeants to strip completely as soon as they were entered in a very large room by group of more than 15 guys.
Then, they were instructed to line up in the buff and to wait their turn to be examined in plain view of everybody in the room.

The members of the draft board commission were not medical persons except one doctor, some were civilian persons, the others militarian persons and they were a dozen persons to look at the young boy when he came naked in front of them to be examined and he was standing naked face and back.

jean-rené said...

second part of my post :

In schools until about the end of the 80's, there was a mandatory physical examination handled each year by the school which was performed in the nurse office of the school or in a gym.
So each student was summoned and might be present.
It was useless to come with a medical form filled by the family doctor to avoid to the mandatory physical. We could not have our own private exam.

The PE teacher was very often present in the locker room where the students were instructed to undress in a large group of about 10 or 15 and he could even be present sometimes in the exam room, particularly when it was time for the inspection of the curvature of the spine.

For boys, it was very often handled as a group exam where the students had to undress all together, most of the time until underwears or briefs, and to wait their turn to be examined in that state of undress without talking, supervised closely by the PE teacher or a counselor.

I was a student in high school in the beguinings of the 60's and I remember very well that we hated the way in which the physicals were performed inspired by military manners but we had no possibility to escape at these exams.

The door of the exam room stayed open all the time to allow to the PE teacher to enter as he wanted and the next student was already standing like at attention at the enter of the room during the exam of the former one.

So we had no privacy even for the rupture hernia when we were instructed to pull down our underwear or sometimes to remove it.

It could also happen that we were instructed to be naked for a more specialised exam of the spine for checking scoliosis for example.I remember of two weird exam in the gym of the school when I had 14 and 16 age.

In schools, most of the time, the exams were performed by a lady doctor assisted by a female nurse but it was not that which was the most embarrassing, it was more the group exam.

I preferred the presence of a female nurse that than of a tough PE teacher.

I guess that girls were not examined in the same way but I am not sure.

The physical examination before entering a team for sports were also performed in group at that time.

All this relation shows that the respect of modesty of teenagers is a recent behaviour. When we talk about physicals exams in group, we must not forget that!

I don't try to justify these demeaning examinations who took place in a recent past, just to explain these situations and why they were accepted by the boys and their families.

At that time, there was also frequently some hazing in some great schools and universities for freshmen and most of the time, he included a time where the freshmen had to undress completely and expose their naked body to the older students. So nudity in group was not so seldom as today.

Joel Sherman said...

I have no present day direct knowledge, but to the best of my knowledge, humiliating army physicals are a thing of the past. I believe the intimate part of exams are usually now done in private or behind screens. Somewhere above I've posted present day military regs which prohibit non medical people of opposite gender being present at these physicals. Of course that doesn't exclude female nurses or medics. I have no assurance that the regs are followed 100%, but it is certainly an improvement. The military has to treat volunteers with more respect than conscripts to get them. I wouldn't be surprised though if these regs are abandoned in the event of wartime and the return of active military conscription.

jean-rené said...

You are right, the regs are different for physicals in the army when the army needs to attract volonteers but may be we would come back to the rules of the past if military service was restored one day.

As regards presence of women nurses and medics, they are now more numberous than men in the french army but I don't think that this is a real issue because privacy is more respected.

It is obvious that the regs are less respectful of modesty whre there is still draft, we have the example of the russian army to show that, I have seen documentaries about the procedure of draft and it seems that the physicals of draftees are always performed in large group and they are completely naked or semi-naked and in presence of a lot of women as medical persons because in the russian army, the great majority of medical persons are of female gender.

Anonymous said...

"The members of the draft board commission were not medical persons except one doctor, some were civilian persons, the others militarian persons and they were a dozen persons to look at the young boy"

Were the members of the draft board commission all male or were there females in the audience as well?

Joel Sherman said...

I know nothing about French customs which is what Jene-rene is referring to. The military commissions he's talking about have no counterpart in the US.
Draft boards in the US were traditionally all non-physician males, but they now have put women on as well. Don't know if they still exist now that the military is all volunteer. At any rate in this country they were never present at physical exams.

jean-rene said...

an answer to the question of "anonymous" about the draft board commission in France.

I was a draft at a time where there was only a very few women enlisted in the army as military doctors.
And these women doctors were never choosen to be members of the draft board commission.
Nevertheless, even if I have not experienced it myself when I was inducted,I kow that it could happen to be examined by a woman doctor at the first physicals after induction in barracks but it was yet seldom.
Most of the women doctors were working in the military hospitals.

It changed after in the last years of a mandatory military service but the physicals in group were not managed the same and have changed also.

But even at my time, there was yet a possibility that one or two women were in the audience of a draft board commission during a naked physical.

In that situation, these women were not medical persons but civil persons, either the mayor of a city, either an other elective person who was designed as member of the draft board commission.

I read in newspapers at that time that a few women could be members of the draft board commission among the dozen members who were mostly male persons, but it was not frequent.

Some years later, it was one of the reason which were underlined by the militaries authorities to decide that the first physical in front of the draft board commission was over!
and then, there was only physicals in a pre-induction center where only a few female military doctors, never civil women, could be present in physicals og young men.

jean-rene said...

I have made a mistake on clicking on the computer.
the point 2 is a message which has been posted in our discussion, and as I don't know what means CCNy, I wanted to ask and to have more details becaiuse I am a little skeptical as you are about this mass exam in a college.

To add to my first point about the behaviour of PE teaches or coaches, I remember to have read a post where a doctor was explaining that he was used to perform many yearly physicals or physicals for sports in high schools and so he had a great experience of the examination of the teenagers. He tried to protect the modesty of the teenagers as much and as long as he could and the exam took place in an exam room where the students were entering one by one, but to win time, they were instructed to undress until underwear before and to wait, and he noticed that sometimes a coach or a PE teacher the coach or the Pe teacher had instructed yto the students to undress completely and so they were waiting naked and they were entering in the exam room naked.
I don't know if he disagreed really or not but it seems that he did nothing, may be it was difficult to tell to a coach that it was not necessary to order to the boys to strip completely if it was its decision, the coach could have answered that he was in charge of the supervision of the boys and that did not concerned the doctor?

Joel Sherman said...

I am editing and reposting this comment to delete likely fictional references.

jean-rene said...
As regards physicals of students for sports, I think that in the past, if it happened certainly that the physicals were performed without any privacy and completely naked in group from start to finish, the lady doctor or the female nurse who was assisting the doctor were not always responsible of that disrespect of the modesty of the teenagers.

I have read one postin an other discussion about physicals of teenagers for sport in the united States where it was obviously the coach of the team who has decided that his students should be completely undressed in the locker room and waiting in line naked for the exam in the gym, it was not a decision of the doctor who was new in the school.

In one post of this discussion above in october 2008, I have read a comment who said that the teachers or coaches wanted that the boys overcome quickly their embarrassment to be nude in front of each other because they thought that it was not a fair feeling for boys.It was something common in the past for PE teachers who were used to military manners.
Nudity in group was also a mean to discipline more the boys and avoid any horseplay. Today, nobody is thinking like that but before the 80's, it was frequent.

July 7, 2009

Anonymous said...

I'm convinced that any woman on a draft board commission where the boys or men were naked was purely for perverted reasons. They took full advantage of their position to watch the naked boys and likely really enjoyed it. The word "unethical" doesn't even begin to describe how horrible those women were.

Joel Sherman said...

I posted that last comment only to clarify the misunderstanding.
In the US, draft board commissions decided who had to report for possible induction and physicals. No inductees ever appeared before them and they had no part in the physical exams. Usually they were nowhere near the places where the exams took place.
The reference you gave was from jene-rene referring to French customs. He said that women were rare and the few who were present were reportedly there because they held an official unrelated office such as being mayor of the village. Don’t know if they could have refused to attend the draft board meetings but in any case, nudity has never been as big an issue in France as it is here.

MER said...

Joel:

You write: "...in any case, nudity has never been as big an issue in France as it is here."

To talk about "nudity" in general as being or not being an issue is too general. It's much a matter of context, and how that context affects those involved. Even in places where nudity is not an issue, there are context where people can feel abused and humiliated. We look at the nudist and topless beaches in Europe and say that nudity is accepted. That's voluntary nudity. Once you get into a situation where nudity is forced, where power over you body is the controlling dynamic, attitudes can quickly change.

Joel Sherman said...

I agree with your post MER, that context is very important and that there is a huge difference between voluntary and forced nudity.
But sexual mores in France are also different. Mistresses are accepted in France; one even went to a French president's funeral standing beside his wife and family. I don't think any woman would be considered a pervert in France for wanting to watch nude guys. We don't consider men perverts if they enjoy seeing nude women say at strip shows or other legal venues.
We might say that if they only enjoyed nudity when the nudity was forced.

MER said...

D.E. Brown's book, "Human Universals" (1991) includes bodily modesty as one of those universals. Brown is an anthropologist who began to realize that anthropology's focus on the differences between cultures was going too far. He began to see that, when you got to the fundamentals, human cultures had more in common than we realize.
Now, the first reaction may be that some cultures just don't value bodily modesty, that they walk around naked and eliminate in public. But I suggest that every culture has some context in which bodily modesty and shame is a value. That context will differ, maybe even in the extreme, from culture to culture. But I'm beginning to think that forced nudity may be one of those universal concepts that has shameful and humiliating connotations in all cultures. There are certain rules that accept nudity in some cultures. But even the most liberal cultures regarding nudity and modesty have certain taboos regarding this issue. Just a theory.

B R said...

Not a group physical, unless you count the presence of his father, but this boy has obviously been shaken to the core:
http://www.youtube.com/watch?v=-eQf7kownZI

I'll understand if you don't publish this, but what's your opinion, Dr Sherman - was it really necessary for him to go through such an ordeal?

I went through a similar shock at his age and I still - a decade on -remember it as a "violation".

Joel Sherman said...

BR, assuming the video is all true which I of course cannot verify, I think it's just another example of poor communications between physician, patient, and in this case the parent who should have also warned the boy what to expect. The doctor obviously had no wayward intentions as the physical was performed in front of his father.
I don't think the exam was unusual, but the boy had probably never had a genital exam before. Both the physician and his father should have warned him before hand. Genital and hernia exams are usually included in a boy's sports physical. I could not tell you if statistics document that it is all really needed.

B R said...

Didn't mean to imply the doctor intentionally molested him, but he might as well have done given the boy's perception of the procedure as a "handjob". Gruesome.

MER said...

I watched that video and have mixed feelings about its authenticity. It sounds real, but there are certain words, certain expressions, that lead me to believe that this may be a young actor demonstrating his acting skills by doing an improv monologue with a edge that will attract attention. I can't be certain, but something about it strikes me as disingeneous. I could be wrong.

Tony said...

Also assuming that this young man's experience is true, this goes back to physical exams these days being done in a very cursory manner compared to years ago. I can NEVER remember a physical exam where the doctor did NOT examine my genitals. This started early enough in my life that having ones genitals examined was as much a part of a physical exam as having your heart listened to.

But I know that this cursory type of exam does go on because a young man that I know - now in college - apparently had his first genital exam when he was 16 and he told me about it thinking it was weird. And this was not his first physical exam because he is an athlete and would have had many physicals over the years. But for some reason previous doctors have never checked his testicles, even though testicular cancer is the number one cancer in young men his age.

Likewise, a friend of mine, who is 25, never had a testicular exam despite having had many physicals for sports as well. He had his first one this year after I informed him of the testicular cancer statistics for his age group.

So this brings up the question: why are doctors not performing genital exams on young male patients these days?

Anonymous said...

Mer- I agree with 100% about the video and having mixed feelings. The doctor explained enough about the other parts of the exam so my thought is that he probably explained the hernia exam to him prior to the hernia exam. He said the hernia/genital exam took 30 seconds that is much quicker then the average check of the male genitals area. So with his father sitting there a hand job was not what transpired. I was also a little puzzled that he was able to go home so quickly and record his experience for the whole world to watch. Everyone handles things different and I personally can not talk about poor intimate care so quickly I usually shut down at first and some experience I have shut out completely and have not been able to verbalise for twenty years.
I was also puzzled that if he and his father did expierence all of this together that they did not discuss any of it, that a hernia exam is normal for a sports physical and discuss any of the older lady in the exam room.
Last puzzling thought he seemed rather old not to of had a genital exam yet in life between the school or a yearly check up.

Daniel.............

Tony said...

Daniel (previous post) was puzzled that by his age this kid had not yet had a genital exam. I guess Daniel did no read my preceding post. I know of several young men who have not had genital exams. I mentioned my 25 year old friend who just had his first one at my urging.

I also know two young guys, brothers, also in their 20s, who as high school athletes, their doctor would just ask them "is everything ok down there", as if the kids were able to make that judgment.

I know it seems odd for those of us who are older but for whatever reason some doctors are neglecting this part of a complete physical in today's young men.

Joel Sherman said...

I have no expertise in the field of genital exams for either men or women.
But honestly, I think the most important thing is for a boy to be taught to self examine his testicles for lumps or bulges. This exam is much easier than breast self examination and takes only a few seconds. If a guy did that every month there would be very few non treatable cancers found. I believe this instruction is uncommonly given.
Of course good hygiene should also be mentioned, especially if uncircumcised. Most guys are self aware of significant hernias so I don't think that need be an annual event either.
In short if adequately instructed, I don't think any guy really needs annual genital exams if all is well. It's less important than the much more complicated annual pelvic exam that is controversial on this blog. Self instruction pamphlets are widely available for breast exams. They should be equally available for male exams.

Anonymous said...

Tony- I read your post prior to my post and I have no idea what part of the country you are in and what doctors these guys have seen and I believe what you are saying. If you read this whole blog on "group physicals" young men in this day and age are getting sports physicals in there teen age years, as early as sixth grade about age eleven and school physicals are also mentioned several times are separate then sports physicals. Very popular in this day and age is called a "well teen exam" for both girl and boys not real sure how intense they are for the girls but for the boys I have heard from my sister in law about my nephews, the doctor does the Tanner approach comparing their testicle size to fake testicles. So I would have to disagree with you about saying as a whole most young men do have genital exams in there early teen years and up. I think it would be crazy for you or I to think one of was right and one of us was wrong, we are not at every single persons physical, now are we?

Anonymous said...

DR.Sherman, I was 56 before I was shown about a self exam of privates.. after an episode of epidytimitis (sp)... I think that docotrs really ought to let guys know when they are in early teens. I only had a complete (hernia and DRE) once when I was 16.. I had heard a bit about them, but because I was a bus student and lived 20 miles away I did not do sports. No way I could practice after school. So, the one I had came as a bit of a surprise.. and some degree of embarrassment.. But the doctor waved his nurse out of the room when it came time for me to strip.. and she stayed gone...
leemac

Anonymous said...

I hate to add to the discussion but not all authorities recommend regular testicular self examination by all young males. see attached advice from the Cancer Council of Australia.
http://www.cancercouncilnt.com.au/postition%20Statements/Pos_Statement_Testicular_cancer_DEC04.pdf

Note in particular the comments in the second last para.
(Though to be fair Andrology Australia does recommend such action.)

Chris

Joel Sherman said...

Thanks for the link Chris. It is a standard argument that you can make on most screening tests. Without extensive testing and use, it is hard to know what the risk/benefit ratio of any screening test is. Just read under the women's thread the controversy about pap smears. Controversy over prostate cancer screening is even worse.
But the article is essentially contradictory. It says every guy should be 'familiar' with what his testicles feel like including any lumps or bumps. How do you do that if you don't feel them regularly? In fact most guys feel them every time they take a shower. Self examination is not the same as a large public health campaign which would undoubtedly scare many people. But nowhere does it say that a doctor shouldn't tell his patients to become familiar with the feel of their testicles and report any changes. You shouldn't rely on an annual physical for that.

Anonymous said...

Hi Joel,

Chris again. Not that I want to engage in what is essentially a pedantic argument, but the point I was responding to was the notion that doctors should be telling young men to check their tersticles every day in structured manner.
The sentence that you quoted on being familiar with testicles is followed by:
"Men with a family history of testicular cancer (father or brother) or a personal history of absent or undescended testicles in particular should regularly check for lumps or swellings on the surface of the testicles."

And the sentence on public campaign is put in context by the following:
"Further to this, telling men to check their testicles regularly would be encouraging them to do an examination that has no evidence of benefit, and could have the potential to create an unnecessary level of anxiety and fear."

I think what they are saying that the majority of young men are familar with their testicles, you mentioned the shower )and one no doubt could think of other ways),that a structured approch to self checking is not necessary. I think that is what they are trying to say.

Chris

Tony said...

Let me also try not to be pedantic but offer a reflection based on someone who works with high school youth. We are asking middle school and high school boys to take the responsibility of examining their testicles on a regular basis. Yes, we can ask, and teach them how to do it, and encourage them. But let's not forget that these are the same young men who can't remember to bring a notebook to class.

Given that it takes all of about 30 seconds, and costs no more than a pair of gloves, to do a testicular exam, it would seem to me that this should be a part of every physical exam, and an opportunity for the doctor to remind the patient of the importance of checking themselves every once in while.

Joel Sherman said...

Its obvious I hope that I am not against annual genital checks for boys and men. If you see a doctor regularly, there's no reason why it shouldn't be done.
But the best way to avoid the admittedly small risk of testicular cancer is to be self aware and report any abnormalities promptly to your doctor.
I have no idea of what percentage of adolescents can be trusted to do this.

Anonymous said...

The person posting on this board calling themselves "jean rene" also posted similar things on voy.com as "jean-the-frenchie". He/She has a fetish for older women performing physicals on boys and men. "jean" claims this was common procedure in schools he attended...stories such as two adult women would be in a room where one male student was sent in at a time and had his genitals examined by the two women.
"jean" likes to criticize any male who finds this appalling. He asserts that males should "prefer the presence of a female nurse than that of a tough male PE teacher." etc. I believe his stories are false and pure fetish and should be removed.

Joel Sherman said...

I don't know, anonymous, and have chosen to leave them as I edited. I believe jene-rene is more likely gullible and repeating some probable fetish stories he's read rather than making them up. Just as I cannot reliably evaluate French stories, he cannot evaluate American stories.
But there is no doubt that in earlier wars women, sometimes non medical personnel, were present at some, not all, mass army physicals when guys were nude.
I do not post comments that I believe to be clearly fetish and I do get occasional comments like that.

Joel Sherman said...

Here is a thorough review of sports physicals from a medical standpoint. Elsewhere I have found the statement that the American Academy of Pediatricians does not recommend preparticipation group physicals as individual physicals are more thorough. Of course they are also less cost effective and I recognize that the recommendation is also self serving if you think they are trying to drum up business.
Of interest to many readers here is this statement:

Genitalia: The need for a genital examination is an area of controversy among sports medicine physicians. This examination can be used for Tanner staging in adolescents to classify athletes by maturity; thus, developmental delays can be detected. The genital examination can also be used to assess males for the presence of a single testicle and to evaluate for the presence of hernias. Some sports physicians omit the genital examination unless the history indicates a single testicle or inguinal or scrotal swelling; the medical history may be adequate for finding these problems. Furthermore, unless hernias are incarcerated, sports participation may not be prohibited.

Certainly that gives credence to the philosophy that there is no justification to embarrassing kids in mass physicals.

MER said...

That's a very comprehensive review of the sports physical. Notice that they've divided it into three basic parts: "The main athletic assessment issues can be classified into 3 categories: administrative, coaching/athletic, and medical."

It's interesting, not surprising, that they don't address a third category, or include it more specifically within the administrative area. That's the issue of privacy or modesty. You'd think they at least consider this since we're dealing with young men and women, some of them minors. The fact that this isn't even addressed, even just a paragraph, does demonstrate how the system doesn't even see this as an issue -- or, has decided that it is best left undiscussed.
This document would be a model if it only included something about the ethics or privacy for these young athletes.

Joel Sherman said...

MER, this is the only statement the article makes about privacy:

This multistation approach requires a coordinated effort of many more personnel. These types of evaluations are often performed in gymnasiums, locker rooms, or auditoriums; thus, privacy for the patient is lost.

But having noted it, this and no article I've ever seen makes recommendations to preserve privacy, such as all participants be in shorts or underwear except for any required intimate exams which should be done individually behind privacy screens. That doesn't seem like it's asking too much. Any facility can provide a corner with a privacy screen.

MER said...

"...thus, privacy for the patient is lost."

I just want to comment on the importance of language. Note that this independent clause is in the passive voice. The subject is privacy. The linking verb, "is." The predicate nominative, "lost."
How does privacy get lost? Does it lose itself? Does someone lose it? Who is responsible for this loss of privacy?
Even if we change the sentence around and put it in the active voice, it comes out, "The patient loses his/her privacy." How does a patient lose something like that? Is it misplaced? Is it the patient's fault?
See how we use language, not to really communicate, but to shed ourselves of any responsibility. Orwell wrote much about the misuse of language
In the case of the kinds of group physicals described in this document, patient privacy is eliminated by those responsible for conducing the exam. They are the responsible ones -- the institution or agency, the doctors, the nurses, all others involved. The patient him/herself doesn't lose privacy. It's taken away, in some cases by either intimidation or force (e.g. If you don't go along with this you won't play the sport, or get the job, or we'll just plain make your life miserable.)

We need to look out for this kind of misuse of language, language used not to communicate but to hide information, such as who is really responsible for a certain action.

BR said...

On your earlier point about the foreskin and checking for "hygiene"...

Perhaps it's hard for those who're circumcised to understand how instrusive it is when someone other than oneself or a lover retracts the foreskin.

"Cuts" mightn't realise how sensitive the glans can be when not keratinized by years of Calvin Klein abrasion.

Doctors are hugely insensitive when it comes to this part of the exam, and if they must look under the hood, they should ask the patient to retract his own foreskin.

jean-rene said...

I have seen many years ago the movie "Hair " in which there was a scene of a physical of draftees naked in front of a draft board commission in New York.

Of course, it was not a real scene since there was never such a physical in your country but the director, "Milos Forman" had lived when he was a young man in an eastern country, "Tchecoslovaquia"

And it explains why this director had shooten the scene like that rather than a physical in a pre-induction center to respect more the reality which is genereally the purpose for such a scene.

it was because when he was himself a draftee, he was living in a country where there was a physical examination in front of a draft board commission, so he knew that situation and he found it normal for him to show that scene, it seemed real for him, even if all the following procedure of the physical was of course pure fantasy and with the purpose to make spectators laugh with a very amusing song by women outside because it was partly a musical movie.

jean-rene said...

sorry for all the grammar mistakes of my first previous post that I have noticed only after reading it again.
so I adress you the same post without all or most of the grammar mistakes.
I don't know if the first post edited before correction can be delete.
here is the post after correction.

I am coming back home after holidays and when I read the new posts on this discussion, I am surprised of the comments on the post of "anonymous" on july 28 which was a little agressive towards me.

I think that it is not fair because I have only related my own experiences in France in the army or in high school which took place a long time ago in the 60's or beguinning of the 70's.

I know perfectly that the prcedures are different today.

As regards the post of an other person that I was referring for a PE teacher behaviour, I have not made my relation up.
If "anonymous" is skeptical, he must read all the posts in this discussion since the beguinning.

what is the subject? privacy in group physicals! if there was no issue at all, I don't think that you have opened a discussion on that subject.

may be it was rather an issue in the past than now but it was an issue at that time!

I don't see what relation in my post can be a fetish story ?

when I was questioned about the presence of women, I have answered honestly that I have not experienced that myself in physicals for military service, so why is "anonymous" so skeptical about what I said?

About the draft board commission, I know that there was never a physical examination in front of this commission in the United States but as I said (and it is easy to check it on internet) the custom was different in France (and in many other western countries which had adopted the same procedure than France).
at least since the middle of the 60's until a physical in a pre-induction center was subtituted to the physicals in front of the draft board commission as it was in your country.

Anonymous said...

jean-rene do you go by "jean the frenchie" at the Voy boards? I think that's what anonymous was refering to.

jean-rene said...

yes but what is the problem?
I have the right to post messages in different discussions about this issue.
I give only my opinion as it is normal in a forum, other persons may think differently of course.

It is right that in the yahoo group, I don't approve those who are always complaining about the presence of lady doctors and women nurses when they had physicals in schools. It was common in the past in France, I had myself experienced it several years and I don't think that it was really a big deal because these women were adults and medical persons, and this situation was not a surprise it was expected by us.
And even a shy or a very modest teenager can or must overcome his embarrassment to face this situation.

I don't belive that the nurses were pervert women as some postmen said, they did their job and even if the presence of the woman nurse was not always really necessary, we must understand that the lady doctor was glad that the nurse was here to fill the medical forms and also to talk with her because it could be boring to examin a lot of teenagers one after one during all a morning.

if the physical examination could be embarrassing, it was not because of the presence of two adults women, but because of the lack of privacy if it was scheduled to be a group physical with undressing in group in a locker room first and then being examined sometimes in group in a gym for example or if several boys were examined at the same time in a room with the door opened on the locker room
and the presence of men adults could be sometimes also embarrassing, may be more if it was that of a tough PE teacher who yelled all the time after us.

It is mostly what I have posted answered in this forum on this subject

Anonymous said...

I thank God I wasn't young in France because I could NEVER think the same way you do jean. Though it's just your opinion I don't understand how you could possibly think that way. To me they are unnecessary perverts and I NEVER would have taken their orders. I guess it's because I'm not an exhibitionist and I DO have some self esteem and high morals.

FR

Anonymous said...

I see that jean-the-frenchie has revealed himself here at last:
"if the physical examination could be embarrassing, it was not because of the presence of two adults women..." - Joel, ofcourse that's a fetish: CFNM (Clothed Female-Nude Male)!
-Jean likes to excuse abusive behavior by females: "we must understand that the lady doctor was glad that the nurse was here to fill the medical forms and also to talk with her because it could be boring to examin a lot of teenagers one after one during all a morning."
-And blames other males for causing the humiliation:
"if several boys were examined at the same time in a room with the door opened on the locker room
and the presence of men adults could be sometimes also embarrassing, may be more if it was that of a tough PE teacher..." On Voy forums it was much more graphic and disturbing because jean claimed the two adult females examined the genitals of every 12-year-old boy in the school to make sure he was developing correctly. Ugh.

Joel Sherman said...

I will post no further comments which are directed at a given individual, either for or against.
Lets discuss ideas not personalities.
But all ideas are up for discussion. You may or may not agree with jene-rene, but his thoughts on the appropriateness of opposite gender examiners are certainly not uncommon and can be brought up. For example, what's the appropriate age for a child to be examined alone without a parent being present? Or should an opposite gender parent just leave when their child is exposed? There is no simple answer, but I'm sure we could find guidelines.

Anonymous said...

Joel, apparently "There is no simple answer" according to you only when the child being examined is a boy. No 12-year-old girl would be taken into a room and given a gynecological exam by two adult men, followed by all of her female classmates during a school day. And her father would never stay in the room to watch such an exam. Yet you seem to think the same treatment of boys is still an "idea" up for debate.

jean-rené said...

I answer also to the second "anonymous post of the 20th of august" : I don't understand your comments because you are always trying to misrepresent what I said in this discussion or in others like "voyforum".

When I say that I think that an exam of the genitals of a twelve years boys is useful in a physical examination, if I speak of two women for that exam, a lady doctor and a lady nurse, it is because it is the most common situation I have known, but my statement is also valuable of course for a man doctor and a nurse man and the gender of the doctor who performed that exam has no importance for me as long as it is a good doctor who explains the reason of the examination.
As I said, for me, when you are in a medical situation, particularly when you are young, if there is an issue, it is not a question of gender because I consider that it is the same job when medical persons, women or men, had to perform an examination.
I would like that you do not make me tell what I have not told.

And yes I think that the humiliation in physicals of boys can be caused by male adults.

If you are not much shocked by physicals exams performed in group in school or for sport or for military service without any privacy, even if there was only men present (I talk of a taugh PE teacher because it was my experience and I think that I am not the only one to have known such teachers but it could be also an autoritarian doctor with military manners ...), it is right that we disagree on that point which was the real subject of this discussion.

I would also recall that each time that I express an opinion about situations, I try to consider the time when they happened, we cannot judge some situations of the past with the opinion of today, it would be an historical mistake.

As I have said previously, never physicals examination could be performed on draftees today like they were in the past at least in France but it is a real fact that they were performed without any respect of privacy and that nobody was really complaining about that (not the draftees,nor their families) or at least that no authorities wanted to change the rules of examination since it lasted a very long time.

it is only an example but
We cannot ignore some facts and think like if they had never existed.

Joel Sherman said...

Anonymous of today, I of course did not refer to specific situations. No 12 year old girl ever routinely needs a pelvic exam. And in this day and age there are significant numbers of families with only fathers around. These dads would take their daughters to the doctor and would stay in the room up to a age which differs for every family and physicians office.

Anonymous said...

From what I've heard and read there isn't much use for a hernia exam either but they're ALWAYS given. In all my years growing up I have NEVER known anyone with a hernia. I'm convinced that most of the time hernia exams aren't given because someone's worried about the boys actually having a hernia. I think it's more of a rite of passage. It's also a way of teaching young boys humility, and show them who's in charge (the school nurse). Many fathers of those poor boys have the attitude that "I had to do it so you do too". Disgusting.

I'm very lucky to be living in a very conservative community where morals are considered important. In school my father always had a male doctor and no nurse, I had only a male doctor and no nurse and now my nephew has had only a male doctor and no nurse. My father was an Orderly at the local hospital and intimate care was completely segregated by gender. Today about 35 percent of the nurses there are men and gender requests are almost always honored.

I've discussed this blog with many people here and almost all are disgusted to hear some of the things I read on this blog. Opposite gender doctors and nurses for sports physicals, catheter inserts by women, female ultrasound techs for testicular sonograms and other similar things are really looked down on. Even by medical professionals.

Recently President Obama stated that he wishes healthcare around the country were more like how it is in Salt Lake City.

GR

Joel Sherman said...

This was posted today by anonymous. I have edited out some sections:

Most of us who are NORMAL prefer to only have our nudity exposed around the SAME gender in non-sexual situations such as medical exams, dressing rooms and restrooms. A girl is naturally more comfortable having her first pelvic exam by a female doctor/nurse because they are both female, so the girl isn't feeling objectified like she would by a man. Likewise it is exactly the same for a boy's first hernia exam, he naturally feels more comfortable with a male doctor/nurse. Of course there are rare exceptions to the rule, and we are all free to seek opposite gender caregivers once we reach adulthood. But an adolescent doesn't have the choice during such mandatory physicals.
Sorry Joel, but I don't believe any single-Dad would stay inside the exam room once his daughter has removed her underwear. The girl would be humiliated in front of her dad. The father would trust the female gynecologist/nurse to
take care of his daughter. If he's the sole custodial parent then I'm sure the girl's grandmother, aunt, godmother, big sister, etc would be happy to accompany her in the exam room. Why is there a different expectation for a boy?
I would have been mortified to remove my underwear in front of my mother at puberty, and I feel pretty safe in assuming a majority of males felt the same. In fact I would have refused until my Mom, the nurse and all females had cleared the room. However contrary to given individual's skewed reality, I would not have been embarrassed in the least having my dad, grandfather, godfather, uncle, big brother, or my tough male P.E. teacher present!


I'm happy to present differing viewpoints despite the fact that I don't substantially agree with either of them. But I won't continue personal confrontations with the two posters involved.

Anonymous said...

To that last anonymous poster - I agree 100%. I don't even need to expand my answer, you said it all.

DG

jean-rene said...

I will respect the will of Joel Sherman to avoid too personal discussions between two persons on this forum but it is sometimes necessary to illustrate some ideas by personal experiences or facts.

I agree with the statement that mostof the young men or teenagers prefer to only have their nudity exposed around the SAME gender in non-sexual situations such as medical exams. Even if I am not convinced that it is always absolutely right because I am thinking that it is not so simple and not so obvious.
It may depend on the behaviour of the doctor or male supervisors as I have said. Some boys or teenagers and may be not only a very few ones may be as much embarrassed to be nude or semi-nude in front of men than in front of women in medical situations.
And if it is the case for a teenager, he is not less normal than the other ones.

In my opinion and according to my own experiences, sometimes, it was less embarrassing to be examined by a female person which is rather having maternal manners face to you than by a man with military manners who was too tough with you.
But I agree that it is not a general rule, and also that some women are not nice but autoritarian and some men are not tough guys. So it is why I said that it is not only a question of gender but also of behaviour.

As regards dressing rooms and restrooms, I don't think that it is the same issue, these rooms or places are not mixed fortunately.

And yes, I think that in the past there was a different feelings of parents towards the modesty and privacy for boys and girls.

May be it is finished today but I am not sure of that.

And as I have said, It will be good if each person in this discussion did the effort of thinking how it was in the past and not how it is today.

In the past, if a boy was instructed to undress for a physical, he did what he was said more over if it was in an institutional field such as school physicals or military physicals.
He had not the choice to refuse because he was embarrassed by the presence of a woman as some seem to think, It is completelu naive to think like that, it was a time where boys were required to obey what they were told to do in some situations without complaining.

and it is the subject of our discussion: group physicals.supliesu

jean-rene said...

To come back to the subject, group physicals, some questions need an answer :
- are group physicals still performed today, in what circumstances?
-in that case, are they performed like in the past with less concern to the modesty of boys and teenagers or young men or with more respect of privacy and modesty as it is likely?
- are girls also submitted to group physicals or only boys?
-are the group physicals of girls performed in the same way as for boys?
- if not, why?
- in the past, why were the physicals performed without privacy, why the adults were generally so less concerned by the modesty of boys?
-how can we explain that now?
why there were so less complaints?
-was it known by parents? what did they think about these physicals? why they did not intervene towards school or sport authorities to obtain a change in the rules of exams?

and so on ...

Joel Sherman said...

I have no real data to answer your questions Jene-rene. My belief is that group sports physicals are still common in high schools and colleges but uncommon for other purposes. There are many fewer female athletes than male, but they could have group physicals as well, almost certainly with less exposure than males.
There is no standardized way to conduct group physicals in terms of privacy so the procedure is likely different in every school.

Anonymous said...

jean-rene

I'm just not concerned about how things were done in the past, only what happens to me and my children.

I think in many cases the way it was done in the past was barbaric and I'm just happy society is improving today.

Joel Sherman said...

Copied from the women's thread:

Anonymous said...

I'm a male. Back when I was in high school (in America) I never played school sports because I refused to have my genitals examined by a woman with a female nurse at her side gawking at me (and I love sports).

September 8, 2009 8:21 PM

Joel Sherman said...

I wish there were some statistics available as to what percentage of guys are like the above poster. I have seen only anecdotal information on it. It seems to be a very poorly recognized situation.
The female pediatrician who posted early recognized it, and I have seen other comments from guys who also refused to take part in sports because of it. It can be very similar to the humiliation recruits often underwent with induction physicals. But unlike them, these physicals are avoidable by simply opting out of sports. A sad situation.
If anyone comes across any further references to this, please post them.

Joel Sherman said...

Here's a reference about sports physicals. I may have posted something from this group before, but this is recent.
It is from a male nurse practitioner (a rare species) giving recommendations for sports physicals. He recommends against doing this in groups saying a better exam can be done individually. He copies that recommendation from the Amer. Acad. of Pediatrics although it is in part self serving for both of them. He certainly doesn't mention that greater privacy and respect enter into the equation.

Joel Sherman said...

Don't know if any of you have seen this short thread on a health forum but it is quite pertinent to this topic. There are some thoughtful comments on it concerning group sports physicals on guys, especially concerning the hernia exam.

Anonymous said...

Here is a link to the California Interscholastic Federation, the governing body for all high school sports in California. For the PPE, not only do they specify a Genitourinary exam for males only, they recommend that a third party be there for it!

http://www.cifstate.org/health_safety/pdf/Sports%20Med%20Handbook%20August%202007.pdf

Joel Sherman said...

Thanks for the link Anon. It's relatively standard stuff.
A few points: The article is about sports physicals in general and doesn't mention group vs. individual exams. The recommendation to have a chaperone present for genital exams is part of an asterisk, almost as if they don't think it's important, but want to cover all bases legally.
I have written responses to these guidelines which ask that they consider mentioning privacy protection though I've never gotten a response. I won't bother objecting to this one as they're not referring to group physicals specifically. But yes I object to a recommendation for using chaperones without reference to a patient’s wishes. See my chaperone thread for more details.

Anonymous said...

Thanks Dr Sherman, I realize being a group physical changes things versus a private exam . Many have felt a hernia check was unnecessary but at least in California now its been replaced with a genitourinary exam. How's that for progress? Oh and a newer version dated 2009 doesn't exclude females.

http://www.cifstate.org/health_safety/pdf/Sports%20Med%20Handbook%20August%202009.PDF

Joel Sherman said...

Anon, the fact that they now don't exclude women from the recommendation for a genital exam just goes to prove that their major reasoning is legal, that is fear of missing anything no matter how remote. It's really hard to come up with a female GU problem that could compromise a women's ability or safety in playing sports. They might as well require a pregnancy test.
In part it's a matter of philosophy, do what's most practical or cost effective vs. do everything as completely as possible.
I will have to start a part 2 of this thread shortly.

Joel Sherman said...

I note that the Army regulations for physical exams have been updated since I last gave this link and are now current to Oct. 2009. They have been made even stronger:
2-7. Presence of individuals of opposite gender during medical examinations
a. Only authorized MEPS medical personnel immediately involved in conducting medical examinations are allowed in an examination area with applicants in a state of undress. Members of the opposite sex (except examining practitioner) are not allowed in these areas while applicants are present. Under NO circumstances will recruiters or Service liaison personnel be present in the examination area for any reason.
b. MEPS must provide a chaperone during the medical examination if the examining practitioner is of the opposite sex.
c. MEPS will provide a chaperone if the applicant and examining practitioner are of the same sex, if requested by the applicant or practitioner.

Anonymous said...

b. MEPS must provide a chaperone during the medical examination if the examining practitioner is of the opposite sex.

Once again we have that pesky detail of whether the chaperone will be of the same sex as the applicant. Of course, we know that will be true for female applicants, but what about men? The only thing men can be assured of is that at least the chaperone won't be an administrator--unless the female doc owes someone a favor.
--rsl

Joel Sherman said...

THIS THREAD HAS REACHED CAPACITY AND IS NOW CLOSED. PLEASE CONTINUE ON PART 2.

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