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Monday, March 2, 2009

Gender Preferences in Healthcare

What are they? Do men and women differ? This topic pervades the blog, but I'd like to consolidate it under one heading. This topic will concentrate solely on patient preferences and not with how they affect employment of health care workers like the prior thread.  A summary article can be found on my companion blog.  The summary article has also been picked for publication on KevinMD, a widely read medical blog.

199 comments:

Joel Sherman said...

In other threads I have articles on patient preferences for same gender care. A
military study
documented women’s preferences for same gender gynecologic care.
52% of the ladies preferred women, 4% preferred men, and the rest didn’t care. An analogous study for men gave strikingly similar results for genital/rectal exams.
Half of men preferred male providers and the rest didn’t care.
I believe it’s fair to say that neither study is definitive by itself and others have gotten somewhat differing results. But the main conclusions are quite valid, about half of both men and men prefer same gender care for intimate care and procedures. Yet American medicine basically operates under the pretense that care should be gender neutral, i.e. it makes no difference whether the providers and nurses taking care of you are male or female. Having said that there is clearly a difference as to how male and female patients are treated. For instance it is uncommon that a male nurse would place a urinary catheter in a woman (though it happens), but men are catheterized by women nurses routinely nowadays though that wasn’t the custom 30 years ago.
It is very true that most patients accept opposite gender intimate care without complaining, but that does not mean that they aren’t embarrassed. Most men in particular feel inhibited from asking for same gender care. The bigger question is how many patients, both men and women, avoid medical care completely because of issues like this. The answer is not known to my knowledge but my guess is that it affects more men than women. I have seen publicity for prostate cancer screenings which are run by nurse practitioners, all women. Does that make any sense? Have you ever seen a women’s health center where even one man worked in a clinical role? Yet men are expected just to accept it. How many men won’t go because of embarrassment? Men routinely avoid health care more than woman yet questions such as this are not routinely asked. An expert in men’s health concerns, Catherine Dube Ed.D, posted in this blog under the chaperone thread. Yet she never raised the question of whether same gender care would make more men feel comfortable. The issue is certainly raised for women frequently.
There are other issues and special concerns in gender preferences. Important among them are: 1). the age of the patient with adolescents being especially embarrassed by opposite gender care. This used to affect girls immensely, but now with the increasing predominance of female pediatricians, it probably affects boys more. 2). The age of the provider. Most people feel there is a difference in discomfort in being bathed for example by a middle aged CNA vs. a girl just out of high school. 3.) The degree of exposure required. Obviously few people care about the gender of their ophthalmologist vs. their urologist or gynecologist. General practitioners are intermediate and vary as to how much exposure they require. 4.) The problems to be discussed, even if no exposure is required. For instance, it may be harder for a man to talk about impotence with a woman and ladies may not want to talk about venereal disease with a man.

How do we bring these issues to the fore in medicine?

Anonymous said...

Joel, I have a sister-in-law who is a nurse at the proctology department of our local hospital. I assumed that the male patients would prefer male nurses. However, she has told me that many of her male patients prefer female nurses because they are hugely homophobic. I think with female patients, if they are given female providers they are going to be pretty much universally happy. But male patients are all different, so it is hard to predict which gender they prefer.
Also you say that men routinely avoid health care more than women. I would say that because usually need to visit the doctor for birth control, we are forced to visit the doctor usually once a year. Otherwise I think you would find women are just as likely to want to avoid health care.

Joel Sherman said...

Anonymous, the statement is frequently made that many men are homophobic and prefer female nurses. There is indeed some truth to that, but I have never seen it quantified. Please ask your sister-in-law if they actually ask any patient what gender nurse they would prefer, and do they do so in a neutral setting where they can refuse the ladies? I ask only because it is rare to ask and to have sufficient male help available to satisfy those who prefer men. I wonder whether some nurses say that to justify the lack of choice they offer male patients. But again, I have no data. If you do pin your sister in law down, please let us know what she says or encourage her to comment on the blog herself. The data I've seen do suggest that a few men refuse male nurses, but it is not common. But I have no idea what number would prefer female nurses for intimate care if given a choice.
But my post refers to physicians or primary providers, not nurses and there is a big difference in terms of how patients view the two. Nursing is not a macho profession and many patients tend to think of male nurses as either effeminate or gay. Homophobic guys may well reject male nurses but prefer male physicians for intimate care. How many guys would feel more comfortable discussing their erectile dysfunction with a lady? If you looked at the study I gave, it certainly does not support your conclusion when it comes to physicians. Half preferred men and the rest didn't care. If men are so homophobic for intimate care, why for instance are there so few female urologists? There doesn't seem to be a great demand for them except to take care of women patients though clearly a few men do prefer them.

MER said...

I'd have to agree with Joel on this, but as he says, we have very little data. But the data he has presented does give us a good indication.

As Joel said, if nurses don't ask men, they're doing a lot of assuming. I'm not convinced their assumptions are correct. How many men are homophobic? Some men may prefer female nurse for other reasons, too. One man I interviewed told me he prefered male nurses for intimate procedures, but otherwise prefered female nurses. He said: "A female touch is soothing." I asked him to elaborate and he went on to say that it was just more comforting for him to have a female taking care of him in these non intimate ways. This man was not homophobic.

It's when intimate care enters the picture that we may get a preference. Now, unless you can interview patients in a neutral, non threatening environment, you'll not get a reliable answer. I've found one of the best ways to get reliable answers from men is to talk with men who have had procedures and exams in awkward situations -- that is, men who have actually had the experience. Then ask them over coffee or beer if they had had a choice, what would their choice have been. Almost all the men I have asked this questions to have said they would have prefered a male nurse. A few few said it really didn't matter.

As I've stated in other posts, to ask people with little or no hospital experience with intimate procedures how they would react is almost worthless. Reaistically, they don't know. They may think they do, but from interviews I've done, it's clear to me that those with little experience have their eyes opened wide once they enter the hospital and get a dose of reality. That's when they come face to face with how they actually feel about this issue.

I can think of two cases where men I know who had little hospital experience, went to the hospital and then changed their whole attitude about this topic. Before hand they thought this whole discussion was worthless. After their experience, they were very leary about going back into the hospital now that they knew what they did.

I have interviewed several nurses. Most have told me that they're so busy, so task oriented, that most of the time they don't even think about gender issues when dealing with men. It's just get on with the job. I don't think many female nurses are in touch with men's feelings about this. They work in a culture that embeds gender neutrality, gender doesn't matter. Because most men won't ask for male nurses or complain, female nurses have become bold in their assumptions that it doesn't matter and they act accordingly.

I'm not saying this applies to all female nurses. I would say many.

And I think we need to make sure we expand our descriptions to include CNA's and medical assistants. Frankly, most of the intimate work these days isn't done by nurses. It's done by nurse assistants. And these assistants have limited training and mostly in procedures and tasks. Very little training in the psychological or sociological aspects of nursing.

My point? I'd like more info on how the above studies were done. And, for future studies, we need to be careful. Depending upon where the reseachers are coming from on this issue, too much ideology can be embedded with in the methodology. I've got to the point where I want to know exactly how the study was done and the specific questions asked.

I'd also like to talk with the researrcher and ask specifically why they conducted their study. What was the purpose? Answers to these quesions will tell us much about the results.

Anonymous said...

Joel,
I agree with you that some men may refuse a male nurse. I do not think it is many. I believe when men are rarely giving an option of caregiver, so in this day of no orderlies and the almost non existence of male nurses , who is being refused? I believe many guys say during a procedure ( I am glad a lady is doing this and not a guy) of course a male patience will say this to act macho. I grew up with a male pediatrician it was no big deal to me to have male checking for a hernia. I had several operations in the early nineties and I was never given an option of a male care giver. First operation was quite a shock I was just a teenager the ones that followed, you know it is most likely coming (nudity). I also believe age is a factor starting with male teenagers I think most are very uncomfortable with opposite sex caregivers. As we go through life I think most males are more relaxed and having a female professional care giver is fine with some of us. I am thirty five and I am sure when I am seventy I will be just happy having any caregiver. Having a preference does not always mean refusal. I bet if a guy walked into a male patients room for a surgical prep and the patient had a roommate, the male patient would give the male nurse a hard time. If you take the same scenario and take out the roommate part I bet the male patient would not say a word to the male nurse about his surgery prep. I think most men are striving to be treated with respect and to be given an option.
Daniel.

Anonymous said...

I don't know how or when this stigma pertaining to male nurses
actually started in regards to
homosexuality. I have known many
male nurses over the years and
I must say that perhaps only two
were gay.
Every male nurse I've known were
very very professional! I have seen
that there tends to be more homo
sexuals among female nurses than
there are male nurses and quite
understandable considering the higher female to male ratio
in nursing.
It would be sad for male patients
to disregard a male nurse on the
assumption that he might be gay.


PT

Joel Sherman said...

I agree PT. Most of the male nurses I know, indeed male healthcare workers in general, seem to be as happily married as anyone else. And I personally only judge them on their nursing capabilities. I'd have no problem being under their care.
But homophobic guys would certainly be more wary of guys in female dominated professions.

Anonymous said...

I've never understood the male's reluctance to speak up concerning gender preferences. I guess I'm too young to know how society in general thought about masculinity 30 or 40 years ago when a man of any age was too embarrassed to speak up because he would be considered a "sissy". I know it's very similar today but nearly everyone I hear or read says it was much worse back then.

To me, a man who stands up for himself and won't be pushed around by women or give in to the power a women tries to hold over them is more masculine. It just seems strange that men will go through what they describe later as being one of the most humiliating experiences of his life and consider himself "a MAN" for doing so.

It seems to me like all they're doing is giving in to the female's power as if she were an Army drill sargent and are too afraid to say "no". They allow women to do the most demeaning and humiliating things to them, treat them like children and let them do intimate things to them when they know that same women would NEVER allow a male of any occupation to do to the same to her. It sounds like the women are in the driver's seat and the men are buckled into their carseat in the back. How could that possibly make men feel more masculine?
DG

MER said...

I've wondered at that, too, DG, but when you study male psychology it becomes clearer.
1. Men generally have less experience within the health care system that do women. Men are often surprised, or "ambushed." One strategy nurses use for embarrassing intimate tasks is to work quickly to get it done. That's supposed to help with embarrassment for both parties (See "Behind the Screens" by Jocelyn Lawler).

2. Patients are naked, vulnerable, and confronted with a person in a "uniform" and with authority. Don't underestimate the power of the "uniform." (See "Sociology as Applied to Nursing & Health Care" by Mary Birchenall, et. al., specifically, Chapter 8: "Nursing, Clients, and Power" by Martin Johnson.)There have been significant psychological studies, disturbing ones, that show people doing all kinds of things they wouldn't normally do when confronted with orders from an authority.

3. Men are still taught by society that real men don't cry. That you don't complain. That you just put up with uncomfortable situations like these. Otherwise, you're not a "man." That's still part of the masculine identity.

4. For many men, maybe the older ones, being a "gentleman" is still a powerful cultural rule. I know that sounds silly within the context of what we're talking about. But several men have used that word to me when describing why they didn't speak up. That was their ratiional. They thought just going along would be gentlemanly -like. Of course, later they had second thoughts about what they did and were angry with themselves.

5. Nurses and doctors have problems getting used to dealing with embarrassing situations, too. But as they get used to it, it becomes routine and they don't even think much about what they do. They sometimes approach the intimate task or procedure with authority and boldness. Some become bolder as years go by because they're never challenged or confronted. This boldness can be really intimidating when you're naked and vulnerable and frightened and unsure of what's going on.

6. I've read men's stories, and have had them tell me in person that -- even knowing all that I've written above, they still hesitated to stand up for themselves in situations where they felt their modesty wasn't being respected. Of course, they felt terrible about it later. But you can't discount how intimidated patients can be within an alien hospital culture that sometimes can seem more interested in efficiency and body parts than in whole human beings.

7. All this applies to women, too. Read their stories. Their modesty is also violated. This isn't or shouldn't be a gender war. My research and experience has convinced me that doctors and nurses who are really conscious of and sensative to patient modesty issues, apply it to both genders. Those doctors and nurses who are oblivous or hostile to it, also deal the same way with both genders.

Just curious, DG -- have you had experiences in hospitals or clinics where you were confronted with this issue? If so, did you speak up? What was the response, and the attitude of the response?

Anonymous said...

MER raised some great points regarding male psychology in not standing up for sexual privacy. Number 3 in particular—number 4 to a lesser extent—is especially valid both in and outside a medical context. It is by far the most powerful dynamic in that it involves attitudes males are taught from infancy. (Many mothers consciously resist picking up a crying male infant to "teach" him that he can't get what he wants through complaining.) I would further venture that, among other emotional lessons, most mothers discourage modesty in their sons while strictly enforcing it in their daughters to an extent that would be considered child abuse if the sexes were reversed and fathers taught the "lesson." This concept is as heretical as any Freud put forth...but far more obvious.

Which psychologically leads to the disclaimer in number 7. Women suffer modesty violations also but, like loss of child custody, as an anomaly not as a matter of wholesale gender double standard. Doctors and nurses who are oblivious or hostile to patient modesty are primarily hostile to the privacy of MALE patients. (The need to include the violations of women patients is a classic result of item #4)

PT & DG have made outstanding points, the upshot of which is that if men were treated like women are in the medical establishment—even with the occasional intrusion on modesty—there would be no need for this and Dr. Bernstein's website. But we aren't.

—rsl

Anonymous said...

MER I think there is another one that plays into this. A man runs the risk of making the conern known, and if the facility can or will not accomodate, now they have drawn attention to it. Pretending it doesn't matter gives one the feeling that it won't matter as much to the provider, acknowledge it now it is center stage with the light on it....that is why it would be really beneficial of providers would address this early on before everything starts...alan

MER said...

Alan:

That's just it. Men need to go into these situations with their eyes wide open, realizing what the perceptions are in medicine.

"Runs the risk of drawing attention to..." -- you write.

You bet. If you run into resistance or ridicule -- Draw attention to it. Don't be embarrassed. Don't apologize. Don't feel shame. Don't be uncomfortable.

Be polite, firm, knowledgeable, and clear about your values and preferences.

What you'll end up doing is drawing attention to the double standard, to the myth of gender neutrality within medicine. Don't think medical professionals are unaware of this double standard. They know about it. They just don't want to talk about it or have anyone call attention to it.

Let them be the embarrassed ones, the uncomfortable ones. But men have to feel comfortable enough with their values to stand up and do this without flinching.

Anonymous said...

Thank you MER & rsl. I've only had a couple of experiences where I wasn't comfortable with the situation. I guess my parents taught me at a very young age to stick up for myself when I don't like what's happening around me (not to say that anyone is a coward for not doing so, I have just been more stubborn than most).

I always refused to get a physical from the school doctors and nurses (all women of course - that I will never understand) and so to play sports I went to a doctor at the hospital my father worked at (as a liason for the Fed. Gov), sometimes for free (and no women). To make myself clear, I've never had a problem with female medical workers as long as my shorts stay on (similar to many I've seen here). When the shorts come off, any female of any occupation is out the door and the door is locked. Surprisingly there really haven't been many problems for me.

The first confrontation I had was when I was about 12 and needed surgery to fix a broken nose and have my adenoids taken out. Neither I nor my parents had any experience with that type of surgery so none of us knew what to expect. When a nurse came in and told me to get completely naked and put on the gown my parents and I were dumbfounded. Why should I need to get completely naked for a nose surgery? I didn't understand. I can't remember now what I said exactly but basically it was "no way!" After a few minutes they agreed to let me wear scrub pants and that was OK with me. Then when the nurse came in to give me the initial shot in the behind I wouldn't let her until she promised to only lower the scrubs about an inch on one hip (I was only 12, stubborn but immature). Whether she did what she said she would do I don't know. If this experience sounds familiar I might have discussed it here a while back.

Anyway, the only thing that bothered me was when I later woke up the scrubs were very loose on me and pulled over to one side. I still wonder today if they took them off after I was out and put them back on afterwords.

Only one other time I had an uncomfortable experience. At 19 I needed a full physical for work and they sent in a woman. I politely asked for a male doctor (knowing what I was in for) and after a roll of the eyes she left and a man came in a few minutes later. No problems.

The only other hospital experiences I've had were two knee surgeries and both times they recommended I wear some loose shorts. No problem.

So MER, what I figure my problem is with being so stubborn is I have practically no hospital experience and have never been forced to do anything I wasn't comfortable with in my life. I still admire my parents for not making me go through anything I consider unethical, but at times I think that is the reason I refuse to be forced into anything today.

But many of the points you made about male psychology do make a lot of sense to me MER. Sorry to give you guys my entire autobiography. I've enjoyed reading your posts MER and Joel and many other guys here. This blog has taught me more than you'll ever know.

DG

Joel Sherman said...

The first post of this thread gives a link to an abstract of male preferences for genital exams. I thank MER for the link. The basic message was that near 50% of men prefer males for a genital exam and the rest had no preference.
I have since gotten the full article and have a few more comments. The study took place in a small rural setting in Michigan. The study did not include adolescents for which the results would likely differ. Interestingly there was a difference according to the age of the patient with more middle aged and older men clearly preferring same gender than younger men. The reason for this was unclear. Are younger men more used to women doctors or more attuned to gender neutral medicine? Unstated and not asked was if any of the guys got turned on or embarrassed by the exams. In a somewhat different questionnaire, the authors stated that 2% of men preferred women physicians. I would expect more than that, at least 5-10%. But the study sample was just over 100 and relatively small.
So in summary, age is clearly a major factor and a complex one. Adolescents prefer same gender as well as older men, but younger men are neutral. This study didn't include women, but other studies make clear that younger women greatly prefer same gender, whereas older women are generally comfortable with either. That's likely due to the fact that older women had little choice and are used to male physicians. The fact that the Michigan study of men was likely an all Caucasian sample of rural men also affects the results as an inner city sample would likely differ as suggested under the religion and race thread.

Anonymous said...

In regards to this study I suspect
that the preferences that older men
requesting same gender are most likely due to the appreciation of
the double standard. With age comes
wisdom.


PT

Joel Sherman said...

It's an interesting question why older men should have a higher preference for same gender care. I doubt that wisdom has much to do with it. Older men were raised in a more Puritanical time and are perhaps less comfortable with exposure. Alternatively, they probably care less about the potential sexual arousal of opposite gender care which can be a significant factor for younger guys preferring it.
I don't know the answer. I doubt anyone is going to study the issue.

Joel Sherman said...

I note the references that MER has given on Bernstein including the bill in Alaska concerning same gender preferences in mental hospitals.
It seems the case law is pretty consistent. We all have a right to the privacy of our body (apart from prisoners) SUBJECT to feasibility. But feasibility is not defined anywhere, so how meaningful is it? It would take sanctions for hospitals and other institutions to decide that it is suddenly feasible. That happened for instance with Title 19, granting women equality in sports, as federal funding was made contingent on it. If Medicare payments were made contingent on granting bodily privacy, it would quickly be found feasible. It's not going to happen though as not enough people care about this issue in my estimation.

Anonymous said...

Enough people care, they're just afraid to admit it. This has been an important issue for me for years and I've talked to many men and boys about it over the years, mostly friends and family members. The vast majority, including my father and brothers say they hate going to female doctors and nurses, but not one of them has ever complained or even asked for a male nurse, doctor or tech.

The studies can't possibly represent what men really think. All they tell us is what men will admit, not what they really prefer. If the men that participate in those studies will tell the truth and not worry about their friends thinking they are sissies or homosexuals I think we would have a much higher percentage of men that prefer same gender care.

MER said...

Joel:

Although we don't have solid data as to how many men or women prefer same gender intimate care, the courts seem to assume that most people DO care about this. Look at these two cases:

The first is from Local 567 American Federation of State, County & Municipal Employees v. Michigan Council 25, American Federation of State, Country & Municipal Employees, 635 F. Supp. 1010, 1013-14 (E.D. Mich. 1986 footnote omitted.)

"Obviously most people would find it a greater intrusion of their dignity and privacy to have their naked bodies viewed (or any number of personal services performed) by a member of the opposite sex. Although there will be a certain reliquishment of privacy by necessity when anyone is admitted to a hospital or mental health facility, this is not to say that a patient has forfeited all rights to privacy."

This is from 1986. Note the use of the word "obviously." The court assumes that "most people" would be bothered by a member of the opposite gender taking care of them intimately. The court also assumes that this is obvious.

The second cases is from Lee v. Downs, 641 F.2d 1117, 1119 (4th Cir. 1981):

"Most people, however, have a special sense of privacy in their genitals, and involuntary exposure of them in the presence of people of the other sex may be especially demeaning and humiliating. When not reasonably mecessary, that sort of degradation is not to be visited upon those confined to our prisons."

This from 1981. Although the court says that this involuntary exposure only "may be" demeaning and humiliating -- it still says that "Most people" have this special sense of privacy connected with their genitals. I think it's significant that the court uses words, like "demeaning," "humiliating," and "degradation."

Three points I get from this. The court seems to say that it is just common sense, obvious, that most people have modesty in this area. Secondly, the court belives that these rights need to be protected, with in reason. Third, the court seems to say that, rather than "assume" gender neutrality, places like hospitals should "assume" the opposite, since this is "obviously" how "most people" feel about this.

Thus, it appears to me that the burdon of proof doesn't lay with those of us who support the right to same gender care, but rather with those who assume it is not needed because it isn't an issue.

Anonymous said...

It would be sad for male patients
to disregard a male nurse on the
assumption that he might be gay.


So what if a male nurse is gay as long as he's professional when giving care to his (male) patients? Isn't it identical to a female "straight" nurse doing the same thing?

Joel Sherman said...

MER, I agree with your court cases that most of us intuitively feel that we are more comfortable with same gender exposure. However as you know court cases are not definitive unless it is the US Supreme Court.
Don't know the details of the second case, but there have been a lot of cases that disagree with their statement when it comes to prisoners’ rights, subjugating them to equal employment rights of women. So in prisons women have won in most states.
In healthcare as you know the situation is not all that clear. But I agree that there is enough evidence to know that same gender care should be an option for those that want it, clearly a significant percentage.

MER said...

Joel:

I do realize that this is a controversial issue. There are more than two sides. But I thought it was interesting how the cases I quoted make it quite clear, really assume, that intimate care from the opposite gender would be, if not unacceptable, at least not desired by most people. We've been looking for some hard data. Although these don't represent Surpreme Court decisions, they are still significant opinions of cultural mores from high level courts.

But they also leave much to be defined. I'm beginning to think that, within some of the specific areas we're discussing, the courts have not been required to define certain privacy limitations. Cases specific to what we're discussing, the double standard for men in intimate care, perhaps haven't been brought to court yet. If they have, there are probably very few, and the issues of those cases may go beyond mere modesty and privacy into malpractice or other issues.

I really don't know. In Dr. Bernstein's blog I asked the lawyer who responded to my post with these cases to give us some specific case law that backed up what he said -- that the courts have said hospital patients have to give up a "great deal" of privacy. I'd really like to see what the courts have said, if indeed they have spoken on this issue. And if patients do have to give up a "great deal" of privacy, as this lawyer asserts, how does the double standard fit into this? Do both genders have to give up the same amount of privacy, or doesn one gender have more opportunity of being accommodated?

I'm not sure about the status of women guards in prisons. I would suspect that these women just don't do certain activities anymore. With so many lawyers around, the liability is just too great.

I know of one nearby large men's prison where there are two or three male nurses on staff. That's not, I think, only to protect male privacy. It's also to protect female nurses from some of these prisoners who would enjoy occasinal female examining them naked and harrass these women. So it's difficult to compare privacy rights of the the general population to those of prisoners and mentally ill patients. Some mentally ill may have a perversity for wanting a certain gender to see them naked for their own pleasure -- so these cases need to be judged on an individula basis by the experts on staff.

Joel Sherman said...

MER, a comment about prisons about which I've read considerably, though have no personal experience.
Obviously as prisoners have limited rights, it is not applicable to healthcare.
Every state and every prison differs in policy. But cross gender monitoring which includes showers and cells with open toilets is common in both male and female prisons. Some allow for privacy screens. Actual strip searches are often limited to same gender though in some jurisdictions, women monitor male strip searches. The reverse never routinely happens.

MER said...

Here's a relatively recent study from the Journal of Advanced Nursing Volume 28 Issue 4, Pages 809 - 817 --

"An anthropological interpretation of nurses' and patients' perceptions of the use of space and touch" by Susan Christine Edwards. The author is a
lecturer in Physiotherapy, School of Health Sciences, Morris House, University of Birmingham, Edgbaston, Birmingham B15 2TH, England.

The abstract is as follows:

"An anthropological interpretation of nurses' and patients' perceptions of the use of space and touch The use of touch and space by nursing staff is critical in all aspects of patient care. How patients and nurses perceive the use and possible abuse of these encounters is the subject of this research. Data were collected through participant observation and semi-structured interviews with staff and patients. Interpretation of data was inherently from an anthropological perspective. There were some similarities between staff and patients' perceptions of space/touch interactions, for example what constituted personal space, but also some differences, which may have implications for clinical practice, namely gender and age of both staff and patients during intimate tasks. The construction of the ward environment was identified as being crucial in developing a 'new reality', within which altered expectations emerged as to what was considered to be acceptable or unacceptable behaviour. The conflict between primary and professional socialization is an issue which may need to be examined further in educational institutions."

Note the reference to the fact that the gender and age of both the nurse and the patient were factors in attitudes.

I couldn't get access to the whole article. Joel -- maybe you can get it through one of your medical libraries. I found it at thus URL:

http://www3.interscience.wiley.com/journal/119123311/abstract

Anonymous said...

MER
The conflict between primary and professional socialization is an issue that may.......that is something that say alot as well. Perhaps the greatest issue of all is we the patients approach it from a primary socialization perspective and providers are approaching it from a professional point. In that paticular setting where providers spend long hours in the setting and identify it mainly from the professional view, it would be easy for them to gradually place less and less value on those primary aspects that the patient walks into the building with. Perhaps that explains why some providers may actually think "we are professionals" has value to the patient and why when providers assume the role of patient they have a different view...they are viewing it from a primary socialization perspective....interesting statement. Hopefully we will have an opportunity to read more on this...thanks for the post...alan

Joel Sherman said...

I have now read MER's interesting reference.
Amazingly the entire study is based on interviewing 6 elderly patients, all over 75, four women and 2 men.
Susan Edwards', the author from the UK, conclusion is that both men and women prefer intimate care from female nurses. She could be right but it's incredible that anyone can come to a conclusion based on 2 men's opinion. I hope that's not what 'Advanced Nursing' research is all about. Don't see how this paper could have been published.
Having said that though, the paper does make some interesting observations about how patients relate to nurses. It confirms what I alluded to above that many (or at least 2 or 3 people) think of nursing as a nurturing mothering role and can only visualize women doing it. She confirms that physicians are not seen in the same light.
Details of the methodology are not given. Obviously it also makes a difference whether this was a neutral questionnaire being filled out in a neutral setting or, more likely, a woman asking pointed questions one on one. Does anyone doubt that a man asking the question would get different answers?
The study is over 10 years old though and since then society has evolved with a continually increasing percentage of men nurturing their children. So maybe attitudes will change decades from now. I talked to a nurse who manages a hospital based high school program introducing the kids to medical careers. Numbers vary, but this rotation 3 of the 10 students are guys.

MER said...

Joel:

This is the kind of shoddy research that results in the creation of stereotypes -- e.g. women are nurturers, men are not and most if not all men prefer female caregivers for intimate care.

I agree with you. I can't believe that a study with such a small and narrow sample could be published, unless there was an conscious or unconscious agenda. I must say, I've read many articles from this journal, and most represent solid research.

Anonymous said...

If you go into a study looking for an answer you can usually get it. Given all of the patients were elderly, one has to wonder if it was at nursing home where care is much different than say a urology office. If they went to a urology office and interviewed 10 sixteen year old males, 10 twenty-one, 10 30 etc. would they get different ratio's. Unfortunately I think this is often the case, providers often look for and use studies to validate what they are doing..a female uses such a obviously flawed study to make a sweeping comment. There is an interesting blog by Lisa Horne, she is a female reporter who goes into the locker room of the USC football team...she makes a comment along the line "I went in and they didn't care, I thought if they didn't care why should I"....so out of 70 some guys, not one of them cared, did she ask every on or did she just make that observation. It is interesting that there are a lot of common behaviors on this issue with providers and reporters. As soon as she starts getting challenged, would she allow her modesty to be violated like this, why doesn't she challenge the double standard that female athelte locker rooms are closed to reporters, etc. she employs the same tactic they do on all nurse when the patients right for modesty challenges the providers...they shut down the thread. Providers as a whole do not want to be challenged on this, they take it as a personal attack, they put their rights over the patients, etc. Fortunately, there are people like Dr. Sherman that are opening this issue up and empowering people to make those calls themself. I don't want to turn this into a male vs female thing. No doubt women face some of the same challenges, but there is a difference in how it is viewed. While it is getting better, if a male prefers a male provider they are more likely to be seen as troublesome, odd, or sexist than a woman preferring a female. I don't know that I have ever seen a study, even a ridiculously flawed study like this, Dr. Sherman pointed out, it is ridiculous that someone would claim any reliable conclusion from such a small sample study and such a narrow age range...I still have never seen anyone even try to suggest females prefer male providers...I have never seen anyone suggest it is sexist to not let male reporters in female locker rooms....there is a bias in thinking and agenda, and when you start from that point, you will have a good chance of getting the results you are looking for...alan

Joel Sherman said...

Alan, thanks for this post too. The female sports reporter column that you referred to can be found here. I found the most interesting thing about the column was that her position here, that all the athletes are fine with her presence was a complete reversal from an earlier post elsewhere wherein she talked about violating the athletes privacy and admitted that some cared. That column was deleted in a day or less making me wonder if she had violated the female reporters' sacred creed that men don't care. She admitted the column, but didn't really comment on her change of mind. At any rate the locker room situation is not the fault of the reporters who have little choice, it's the fault of the leagues for putting publicity ahead of privacy. And to be clear, the leagues don't have to admit reporters to the locker rooms. They can control them anyway they want. They just have to treat male and female reporters the same.

Anonymous said...

I will gladly post what I have done here. I find it interesting that sports writers (which I think mirror some of the issues posted here about medical care) only see the double standard as it applies to them, not when they are the perpatrators of it. They jump all over someone who says members of the opposite sex should not be in locker rooms, they point at and scream discrimination loudly, but say nothing of the obvious discrimination and double standard which the athletes are subjected to. When a college allows reporters, male and female in male locker rooms, but closes female locker rooms...can there be any clearer and more blatant discrimination that that. Yet the very people who screamed for equal treatment are a part of the discrimination and say nothing. I agree, it is the instututions, colleges, etc that are truely responsible for this, where i fault the reporters (and in this case providers) is they join right in and do not challenge it. It obviously is about their rights...not equal rights. There is a web site something like the federation of female sports writers...that is really interesting to read. They discuss issues and instances like how when a woman reporter exited through the showers where a couple of men were showering naked...some laughed and how sexist they were to violate her like that....are you kidding, if a male exited through females showering it wouldn't be a laughing matter it would be a legal matter. The press crucified Reggie White (player and minister) when he spoke out against women in the locker room. Didn't mean to take this post to sports, but i think there are some similarities. When a providers sees a request for same gender intimate care as a violation of thier rights and as being sexist....a little self centered and self serving in my book....alan

Joel Sherman said...

I have moved a series of posts concerning military entrance exams to the group physical thread as they have become off topic here. This was done today.

Joel Sherman said...

I have moved another post from here to the male modesty thread.

Joel Sherman said...

I have moved this post here from the 'your privacy rights' thread

LN said...
It is my view that when women are given a choice, the majority prefer a female doctor. (particularly for anything invasive)
There are women who will accept a male doctor, embarrassed to make a fuss, but that is very different to preferring or not minding a male doctor.
In Australia, roughly 65% of women attending a Sexual Health Clinic specifically asked for a female doctor and many of those refused to see a male doctor. (if a female was unavailable)...
Many women were happy to wait or even return...(our Clinic the figure was 72%)
Of the remaining 28% who didn't specifically ask, we wondered whether indeed they had a preference, but were too shy to ask....
We specifically asked these women on return visits whether they'd prefer a male or female Dr - they only needed to tick their preference - almost all preferred a female with a handful not minding either way - whoever was available next...
I therefore believe that women prefer female medical providers (part. for certain things) but that some will "accept" a male due to an inability to make their preferences known (feeling silly, immature, embarrassed, expecting to be fobbed off)...and the minority don't have a gender preference. (Based on our survey/study)
I wonder whether a urology clinic would find similar results with their male patients.
I think these figures were quite definite because of the type of medical service they were seeking...
I suspect gender may not be such a big factor for general medical care.
http://www.reuters.com/article/lifestyleMolt/idUSSP30365420070823

April 8, 2009 1:48 AM

Joel Sherman said...

LN, to a large degree it is age dependent, at least in the USA. I've seen estimates that nearly 90% of young women prefer female gynecologic care though the percentage is much less for older women who have nearly all seen men for similar care at some point. Most adolescents, both women and men care more about the gender of their doctor than they will later on in life. Your article didn't discuss age, so I don't know the breakdown there. My wife tried female gynecological care for the first time and wasn't happy with the doctor though not because of her gender. She switched back to a male gynecologist.
Obviously also a male genital exam is far less invasive than a woman's and over in a minute. Most young guys don't get rectal exams. So it does indeed make less difference. But male urologists are over 90%, so there's not much demand for female urologic care by male patients.
All these statistics are soft however. If you read above you'll find studies saying that about half of both men and women prefer same gender.
LN. If you read the chaperone thread you'll find out more than you want to know about patient preferences for chaperones. Thanks for your input.

MER said...

If LN's still on here, I'd like to ask a question.

That was an interesting study. Did you do the same study asking men about their preferences? If so, what were the results. If not, why didn't you do a similar study regarding men's preferences?

MER said...

I read the link to the study and see that men were involved. Again, I have to question the study.
-- Who did the study?
-- Why was it done?
-- What were the protocals?
-- Could we see a copy of the questions asked?
-- Were the questions about just genital exams or about everthying?
-- Joel mentions that gential exams for men are less invasive and take less time than those for females. Although true, I don't that that's the larger factor here regarding whether people want same gender care.

How about invasive urological procesures done on men? Were men asked about that? Were they explained the details of specific invasive male genital procedures and then asked their preference?

I belive studies like this one that seem so lop-sided may have a problem somewhere. And let's then assume, for the sake of argument, that these statistics are true. True for what specifically? True for any kind of medical contact for men? And, again, if even that is true, we're still talking about 30 percent of men who prefer male care. What do we do with them? Accommodate or ignore them.

ESF said...

This may be slightly off topic, but....

Congressman James Murphy, along with Congressman Barron Hill, have introduced the "Men and Families Health Care Act of 2009" - the bill that would finally give equal rights to men by creating a comparable Office of Men's Health. Sadly, previous legislation has languished in Congress. Let's hope it goes through this time! Here's the link on Congressman Murphy's web site:

http://murphy.house.gov/News/DocumentSingle.aspx?DocumentID=124615

I'm going to write him to congratulate him for this move!!

Joel Sherman said...

Great find ESF.
I'll post the link on DailyStrength as well.
I'd urge all of you to write your own Congressman to support this. I already have.

Anonymous said...

A related discussion is going on regarding male nurses in labor delivery:

http://www.boston.com/community/moms/blogs/moms_are_talking_about/2009/06/very_intersting_conversation_g.html

--rsl

Joel Sherman said...

Nice reference rsl. The range of comments are well worth reading as well.
Many women do indeed see beyond the hypocrisy of the double standard in healthcare.
Unfortunately it only takes a few complaints for hospitals to avoid the issue by not putting men in 'sensitive' areas. It is distressing how many male nursing students are told to get lost in L&D though it is not a universal experience. A man telling a female nurse to get lost during a urologic procedure might be treated as a sexist harasser instead.

Anonymous said...

I just wanted to add a comment about men preferring female care because they're homophobic.
I also know a man who was assualted as a boy by a male teacher. He can only see female doctors or he has a panic attack.
The comment was also made if women didn't need to see the doctor once a year for birth control, they would avoid the doctor like many men.
I'm that woman.
I specifically researched what methods I could use that did not require a script.
I avoid doctors.
I had a frightening experience in a hospital as a child and feel anxious around doctors. I hate hospitals.
Fortunately, I'm in good health.
I don't have any routine things.
I would only agree to anything intimate if I were in pain or discomfort and then only with a female doctor of my choice.
I would have to feel in control and comfortable.
Some of the stories on this site frighten the life out of me.
Natalie D

Joel Sherman said...

Reposted from the cancer thread.

Jill said...

Shocking...
I'll definitely be reading the book.
I understand there are people who don't mind opposite gender care.
I do feel concerned though about the young, very shy and uneducated.
Not everyone feels able to speak up in a medical setting.
I saw an interesting article in the newspaper a few months ago.
A high % of women requested female doctors at a sexual health clinic...a smaller % of men asked for male doctors.
When patients could simply tick a box nominating choice of Dr...the overwhelming majority of women ticked a preference for a female Dr and a slightly higher % of men asked for a male doctor.
When the patients were interviewed, some admitted feeling stressed and reluctant to see opposite gender doctors, but felt uncomfortable making that request or had been fobbed off previously or made to feel immature or silly.
Some just felt intimidated by the medical/Clinic environment and didn't want to make waves or lacked the confidence to make the request.
Many said they'd see a Dr more often or more promptly, if they were guaranteed the doctor of their choice.
Some patients said the exam became a negative experience when they didn't have a Dr of their choice.
I suppose that's why with very intimate procedures and maximum exposure, I think the option of same sex should be offered.
I understand that was the reasoning behind BreastScreen...make it as user friendly as possible and women are more likely to have their screening.
Of course, we're all free to consult the Dr of our choosing, this applies more to settings where we have less control...free clinics, hospitals and medical diagnostic centres.
Just my thoughts...

July 15, 2009 12:15 AM

AL said...

In Sweden women are now unable to request a female doctor at public health clinics.
Male doctors claimed it was discrimination.
The only women able to make such a request are women who have sexually assault in their history or where it is forbidden in their religion.
Many women now choose not to go to the Clinic.
A history of sexual assault is often difficult to discuss and may not even be something the woman has dealt with mentally.
This new rule is unacceptable to many women.
In other countries it has been decided in another way and a request for a female doctor is an exception to the discrimination laws.

Joel Sherman said...

AL, women's health is in transition. My bet is that in the future 90% of practitioners will be women and the problem will naturally resolve. 90% of urologists are men. Until then, women should have the choice to wait for an available woman provider if she wants.

MER said...

Joel writes: "My bet is that in the future 90% of practitioners will be women and the problem will naturally resolve."

I'm not sure I understand your comment. What problem will be resolved? A very specific problem regardng women's health. But if 90 percent of doctors are women, will that not potentially create more problems for men in healthcare?

Joel Sherman said...

MER,
I was referring to the fact the ob-gynes in training are now 90% women in this country. My thinking was that women who prefer female physicians for intimate exams will then have little trouble finding a woman to do one. It is a diminishing problem in this country.
Of course, in Sweden I really don't know if we are referring to ob-gyne clinics or general medical clinics so it's possible my comment doesn't apply to Sweden if the clinics are staffed by GP's only. I wonder if men have been given any gender choice in these Swedish clinics.

Gail said...

I'm so grateful that I live in a time where there are female doctors.
If I develop an embarrassing problem, there are female doctors out there to help me.
My Nan bled for 18 months in her forties.
She was too embarrassed to see a doctor...all male.
She probably needed a D&C.
I understand this happens to some women going through menopause.
She's said to me many times not to take for granted all the choices we have today...including female doctors.
Nan said many women just endured embarrassing problems rather than see male doctors.

Brandon said...

Hello everyone. This is my first comment for this blog. Here's my opinion.

Intimate cross-gender care is one of the biggest flaws of modern society, and of many years past. Outside of a medical setting, is it acceptable for a married man or woman to get naked for a person of the opposite sex other than his/her significant other? Absolutely not, and it never has been! Where along the timeline did our society decide that because a person has medical training, they should be given a free pass from this law?

I will forever hold a grudge against the medical industry, and here is why. The arrogance and disregard for the physical intimacy and exclusiveness of a couple. There are still those out there that believe that only one person of the opposite sex should ever see them in the nude, and that is their spouse. I'm one of them.

I realize that things are moving in the right direction, but we still have a long way to go. Many years ago, when the medical industry decided that females could not practice medicine, they spit in the face of the belief that I just stated above. If my mother had problems in her intimate areas, she was forced to not seek treatment, or go and disrobe for a man other than my father. I respect our previous generations for many reasons, but this is the area where I feel like they have flat-out let me down.

We preach for our daughters to dress modestly so they aren't viewed as an object by men, then we send them to a male gynecologist to get their breasts rubbed, and their bodies penetrated by a man. Please tell me. Why do we have this hypocrisy in our society? Why are doctors given a free pass as though they are robotic, and are immune to normal human feeling? The number of sexual misconduct cases in the news tells us that doctors are as human as anyone else. I've also read many admissions from physicians on the web of being aroused during exams, as well as one male doctor that I see occasionally. Why does the world look the other way on this issue? Why is it that when something is done in the name of health or in a medical setting, it is exempt from the laws of modern society? Women should work on women parts and men should work on men parts. Period.

Brandon

Anonymous said...

Well Brandon don't forget our sons
as currently 93% of nurses are
female!

PT

Jackie M said...

Brandon,
I see female doctors and would only allow a female nurse to shower me or carry out intimate procedures.
I know some male doctors end up before the Medical Board.
It goes further than that for me...its a question of my comfort and making the exam more tolerable.
My discomfort with a male doctor for an intimate procedure or a male nurse showering me would be so great...I'd simply refuse and find another doctor or nurse.
It really frightens me to think how I would have managed in years gone by...
Probably just avoid doctors as far as possible and like my grandmother, use a midwife to deliver any children.
I don't see it as a big problem for me, as there are so many females in medicine today and I would always insist that my preference is respected.
I find increasingly my preference is unnecessary...Breast Screen for example only use female staff.
The vaginal ultrasound unit in the local diagnostic centre is staffed entirely by women.
This seems to be happening more and more...
I think men should also be offered same sex technicians for scrotal ultrasounds.
I have private health insurance and so always have my choice of Dr.

I think all of the preventative exams women have in the States makes privacy and dignity a big concern.
Women in other countries don't have that many intimate exams.
I've never had a pelvic exam and I'm 35...they're just not done in other countries.
My Dr does not recommed breast exams before 40...
I think about 60% of women have pap smears every 2 years, other low risk women choose 3 or 5 yearly testing and others choose no testing at all.
It's a voluntary testing program.
Contraception is readily available with a blood pressure test.

No woman needs to see a male doctor or use a male nurse these days, if it matters to her.
Some women don't think ahead and are then suddenly confronted with a male doctor, or don't request a female at the outset...also, without private health insurance you may end up with a male doctor in labour and delivery or surgery.
If you REALLY want same sex care, I think its fairly easy to exclude men from your health care these days.

I do think we need more male nurses. There are more appearing every year...so hopefully, all men will soon have the option of a male nurse in future.
I know some men and women don't care about the sex of their doctor or nurse...that's their business, their choice.
We're all different...
It's an issue for me and many other men and women.
My husband regards my choice of Doctor as my decision and he's free to make his own decisions.
We both choose however, to have same sex medical care.

Anonymous said...

Right on, Jackie M and Brandon.

GL

Elise A said...

"Also you say that men routinely avoid health care more than women. I would say that because usually need to visit the doctor for birth control, we are forced to visit the doctor usually once a year. Otherwise I think you would find women are just as likely to want to avoid health care." (Quote:Anon)

I think this is true.
I have never relied on doctors for birth control because of their unreasonable demands.
I saw my friends blackmailed into distressing and unnecessary exams to get birth control.
Several felt they had to sell their bodies for birth control.
It caused all sorts of very negative emotions....bitterness, resentment, anger, unhappiness, disgust and depression.
It even broke up one relationship after my friend couldn't cope with any more personal intrusions after a demeaning, terrifying and painful cervical biopsy.

I explained to my boyfriend (at the time, now my husband of 18 years) what I'd be put through to get BC.
We both did our reading and emailed several medical societies overseas and found out very quickly their demands were totally unnecessary.

The routine gyn exam is totally unnecessary and screening is a matter for the woman...it can never be demanded was the message loud and clear from all the medical people we contacted around the world.
I'm a happy, healthy woman.
Most of my friends have had various and deeply distressing biopsies of numerous varieties and face these exams every year OR no BC.

I see a doctor now and then for general things....when you don't need them for BC, their power disappears.

I think there is a huge difference between having exams and procedures that are actually needed when you're unwell or YOU choose to have AND all sorts of extra things DEMANDED of you...many of which CAUSE health problems.
Whenever our doctors come out with further demands, I check the requirements overseas and usually find the opposite view or a greatly modified recommendation.
Our excessive and demanding approach is harmful.

One of my friends has just had her birth control held back until she has a mammogram. She's just turned 40...
There is now great concern about the risks of mammograms and in many countries that offer them from 50 (once again our doctors go over the top and make it 40 which greatly increases the risks)
only about 50-55% of women accept their invitation to screen.
How dare our doctors take away our right to consider the facts and risks and make up our own minds whether we wish to screen?
Who gives them the right to demand us to put our health on the line? The medical evidence is easy to find and very clear...the rest of the world's doctors have got the point...NOT before 50.
More and more doctors in England are warning women about the risks of mammograms at ANY age.
Surely, DEMANDING a mammogram OR you don't get BC, is unlawful.

Her doctor has simply said, no mammogram, no pills...so today she's going to Planned Parenthood to use their HOPE option.
Her doctor just lost a patient.
I had hoped she'd consult an attorney.
About ten years ago a pre-employment medical check called for a gyn exam.
I spoke to an attorney who sent a letter setting out the odds of a woman getting cervical or breast cancer and the odds of having biopsies for a false positive and the health risks.
Several references were attached.
It ended by saying, I would have the exam and test in exchange for their written confirmation that they would fully compensate me for any harm that may result from the exam. (In fact, I would have gone looking for another job if they'd insisted)
I was excused from that part of the physical (including the breast exam) and just had a general exam.

I hope more women refuse to be stood over like this and find ways of protecting their health, bodies and rights.
We must protect ourselves from the excesses and harmful demands of the medical profession in this country.

Annette said...

I think doctors have worked out that women are fairly easy to manipulate and control.
I know many women who've bought the propaganda and submit every year.
I think if you challenge a doctor EVERY time they make unethical/unnecessary demands, things would change.
Doctors are not stupid...they KNOW they can't demand you have a mammogram and refuse you birth control until you do so....but if you allow them to do that...they got away with it and will keep doing it.
Doctors must be forced to obey the law and ethical codes of conduct.
I reported a doctor recently for refusing migraine medication until I had a pap smear.
I decided many years ago that all of this preventative medicine was not for me.
That is my choice...I prefer not to live like that and will take my chances with not just cervical and breast cancer...but every cancer.
I'm not having my brain scanned every year either although the focus for women has always been our reproductive organs.
The brain wouldn't interest them...the next thing will probably be mandatory vaginal ultrasound for ovarian cancer starting from age 16 or something equally nasty, extreme and unnecessary.
I take a novel approach and respond to symptoms.
The doctor was spoken to...but I get the impression these arrogant and bullying attitudes go straight to the top.
I think it will take legal action and media attention to stop the bullies that call themselves doctors.
I got my migraine medication...but the delay was inexcusable.
It's very poor that we have to go to these lengths to get the medication we need for REAL health problems.
I doubt this sort of thing would ever happen to a man.
Does it?
Are you refused Viagra or migraine medication until you have a digital rectal exam or a testicular exam?

Wendy H, Sydney said...

I was once told by an American doctor that he wouldn't want to be an American woman...that women suffer badly at the hands of the medical profession.
He said that if you have a health problem and have insurance, you'll receive the best medical care in the world.
Look at the world renowned Sloan-Kettering Centre for Cancer.
He did say that unfortunately healthy people get the same level of surveillance and intervention and he felt that had lots of negative outcomes and probably should be addressed.
He said that healthy people needed to monitor the advice they received and refuse any test or exam until they were satisfied of its benefits.
He did not approve of doctors requiring cancer screening before prescribing the Pill. He thought that practice was unethical and an abuse of the power vested in doctors.
He had never followed that practice, even though his colleagues felt he was putting his neck on the legal chopping block.
His view was that these exams and test are not needed for birth control and are supposed to be an option for the woman, but that doctors "imposing" these restrictions had now made them fearful of doing the right thing...and following the medical practice around the world and the recommendations of numerous medical bodies. He said those requirements were doctor-made at the Clinic level and were not recommendations from above...so doctors were "imposing" these exams and test against the recommendations and creating possible liability due to usual practice evidence.
In other words they'd created an unethical rod for their own backs.
He said when unnecessary exams and cancer screening that should be no more than an option become mandated...it's unfair on the patients and makes it difficult for doctors who want to do the ethical thing.
He didn't feel you could say these exams and tests were for the good of all women...in fact, they led to over-treatment in a high number of cases.
He felt testing virgins, very young women and every year showed common sense and balance had been forgotten in favour of blanket over-screening and over-treatment.
He thought it was a juggernaut that wouldn't easily be stopped with powerful drug companies, insurance companies, politics, pressure groups and lawyers all playing a part...
We met this Dr on an African safari in 2008.
I well remember our conversations about the US healthcare system.
I have an interest in women's health and used his comments at one of our meetings on cancer screening and informed consent.
Great blog...interesting reading!

Joel Sherman said...

I have copied several of these last posts to the women's thread where I think they are more on topic than here.

Nicole said...

"It is distressing how many male nursing students are told to get lost in L&D though it is not a universal experience. A man telling a female nurse to get lost during a urologic procedure might be treated as a sexist harasser instead."

I would never accept a male nurse or midwife during L&D no matter how distressing it was to them.
I have a right to concentrate on the birth and feel as comfortable as possible in a frightening situation.
I can't see an issue...it seems like common sense and basic courtesy to me.
We don't stop being human beings with feelings and insecurities when we enter a medical environment.
My mother faced the same problem years ago...there simply were no available female doctors...the few female obgyn's were snowed under...
Men will find things easing over the years with more men entering nursing.
Unfortunately, male nurses seem to find their way into areas that upset us.
The system is so insensitive or sloppy they end up in L&D or gyn or being sent to shower a female patient.
My sister refused a male midwife during her L&D.
She knows that three other women also refused his care.
Even one who had a male doctor - she knew and trusted the male doctor, but didn't want a unknown man in the room while she was delivering.
Hopefully, the system will finally "get it" if we all keep refusing cross gender care...if the male midwife is sitting around and the female nurse in urology is refused...they'll have to make some changes, take extra care to accommodate patient preference rather than face last minute hassles.
I think the greatest challenge for women is L&D and gyn surgery.
I have private health insurance so I can choose my female obgyn. I met her once at a University dinner and was so impressed...
I know she's covered by two great female doctors. She understood many women sought her out because they wanted a woman to care for them...so having male doctors covering her was unacceptable.
You really have to plan ahead to avoid a very difficult and uncomfortable situation.
One of my friends got pregnant last year, an unplanned pregnancy...because she wasn't on the books of a female gyn she really struggled and was becoming quite frantic and upset.
I called the female gyn that impressed me so much in the hope she'd remember me...we had chatted for over an hour.
She did and agreed to see my friend at 7am the following morning...whew!
Healthy baby boy born privately with two women in attendance...my friend said she felt calm, focused and in control which made her L&D easier.
(her partner faints at the sight of blood and chose to stay outsde until it was over)
Gyn surgery is challenging as well...like urology...you have to query exactly who will be present and ask for same sex care. In a private hospital, there is usually no problem....you're the boss in the private sector.
In public hospitals, it's another matter.
At the very least, they could prep and drape you privately...I don't think many of us would mind if we're draped, unless it's very intimate surgery like urology or gyn.

MER said...

Some of you may know, Garrison Keillor recently had a stroke. He writes about it in today's newspaper column. He drove himself to the emergency room, was treated, had many tests, and later then to the Mayo. He writes:
"The nurses, of course, are fabulous. Like many nice 67-year-old men, I am even more awake and alert around attractive young women (though I try to be appropriate). A tall dark-haried beauty named Sarah brings me a hypodermic to coach men on self-administered shots of heparin, and without hesitation I plunge it into my belly fat. No man is a coward in the presence of women."
What he next writes about nurses is not an uncommon perspective. I would say it's quite common:
"Nurse are smart and brisk and utterly capable. They bring some humor to the situation ("Care for some jewelry?" she says as she puts the wristband on me). And women have the caring gene that most men don't. Men push you down the hall in a gurney as if you're a cadaver, but whenever I was in contact with a woman, I felt that she knew me as a brother. The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity."
I'm sure he doesn't intend it, but Keillor does a real injustice to male nurses here. His thoughts are clear. Men are just not meant to be nurses. Who knows? Keillor may just prefer female nurses. Some men do. And we need to note the he's being treated in St. Paul, his home ground where he is well known, loved and respected. How his treatment differed because of his fame we can only surmise.
He also relates this interesting perspective:
"It's powerful in a hospital. Instead of a nice linin jacket and cool jeans and black T., you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath" and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin."
You need to read all this in the context of a man who is extremely glad to be alive -- to have survived the stroke. I don't thin his is an uncommon perspective.

Joel Sherman said...

No of course it's not an uncommon perspective. Most of us are fine with a little mothering when we're sick.
Doesn't sound like he had any significant intimate care which makes it easier, though it's hard to know exactly what he meant by support when urinating. I've been the recipient of similar situations.
Of course you can be sure he had super service from all being a local celebrity. He might not have found the staff quite as supportive if he had been a wino off the street.

Anonymous said...

I agree gyno care is a very difficult situation and male intimate care should never be involved. But at least 20 times the amount of bad situations involving opposite gender intimate "care" happen to males than females.

Anonymous said...

I think the contention that men just aren't capable of being nurses is like any other stereotype, women can drive or be authority figures...women cops, firemen are men.......the trouble is...very few people seem to care when the transgression is directed toward male nurses....for some reason it seems more acceptable, less damaging when it is directed toward male nurses....alan

Amy said...

Male nurses are great...lots work at our local private hospital.
They take care of the male patients when exposure is required...they do general things as well.
My sister was in this hospital recently...not once was a male nurse sent to her for anything embarrassing. (she needed help in the shower for a day or so)
A male nurse took her temperature and BP a couple of times.
The male patients got the same treatment.
I should mention this is a private Catholic hospital...they may have greater sensitivity to patients needs and feelings.
I cannot imagine a female nurse removing a man's catheter or showering him...I doubt that would ever happen. (in this hospital)
If this hospital can manage it, it can't be too difficult...just requires a commitment on the hospital's part.
Can you imagine walking into Myer to try on a dress and being told you'll have to try it in the men's changing rooms, we're short staffed...it would never happen because they KNOW it's unacceptable.
Why should it be any different in the medical world?
I would have thought the need is greater.

Joel Sherman said...

Here's another study based on a military hospital survey (Obstetrics Gynecology Apr 2005, Vol 105, #4, p 747-750) of women to determine their gender preferences for ob-gyne care. The study was large including questionnaires sent to over 1500 women. All ages and races were represented. The results were very similar to what I quoted at the beginning of this thread, 60% said they had no preference or preferred males. Surprising to me, age was not a big determinant. The study also gave references to 6 other studies with numbers ranging from 34 to 61% for the same question.
In other words, 40-70% of women in various studies had a strong preference for female providers.
I will track down the other studies, but I guess male ob-gynes still have a role to fill.

MER said...

In today's paper, if you get or read the Amy Dickinson advice column, you'll read about a woman who resents being called "Mom" by her dentist and the assistant (both women) when she brings her children in for exams. She also resented being called "Mom" by a nurse when she was in labor. She says she finds it "condescending and just lazy."
Here's how Amy Dickinson responds:
"I completely agree with you that this is annoying. Thinking about this, I realized that every technician and worker at my local veterinarian's office somehow manages to address me by name during animal examinations (where they also refer to my pets by their names. If some health care workers can manage this, then why not others? Granted, family practitioners and their staffs are very busy, and their attention is properly focused on the children when they come in for an exam. It is also fair to assume that people don't know if they should address you as "Monica," "Mrs. Smith," "Ms. Smith.," Ms. Your-childhood-surname" or "Dr. Smith."
Okay -- now pay attention to her last two sentences:

"This is why health care professionals should ask you how you would like to be addressed, and then make a note on your or your child's chart. You can help this cause along the next time you encounter it by saying 'Oh, please call me Monica. Usually only my kids call me Mom.'"

A few points:
1. Note again, we're dealing with assumptions and lack of communication on the part of both parties.
2. Note that Amy Dickinson suggests that the patient step up and become more proactive.
3. Finally and most important, note that Amy Dickinson places the
primary responsibility of asking how a patient would like to be addressed upon the medical professional. And she suggests they make a note in the patient's chart. See where I'm going with this?
4. How we wish to be addressed is important. Yet how we wish to be seen and handled undressed is even more important. If we can "assume" that it's a good idea for medical professionals to take the lead in issues how to address their patients, how much more important it is that they should take the lead in modesty issues.
5. What's so hard about providing a form asking patients how they wish to be address -- as well as a question about their privacy and modesty preferences.

Joel Sherman said...

MER, how you should address patients is perhaps more complicated than you're aware of. Many offices follow a protocol of calling patients by their first names in the waiting room because HIPAA requires that patients not be identified in public. Other offices pay no atention.
I've found that most patients prefer to be addressed by their first name, but there is no inviolable rule. Older people tend to be more formal. But for long time patients, I usually use their first name. I suppose I could ask what they prefer to be called, but even that minor bit of formality would put off some patients.

MER said...

I can see your point, Joel. I can also see you saying the exact same thing to a patient -- exactly as you've written it. Nice way to open a discussion with a patient and explain that the issue is more complicated that one thinks. My point is that, yes, doctors and nurses should ask, even at the risk of annoying some patients. I think most patients would appreciate it and, especially older patients, consider it a sign of respect.

Anonymous said...

Dr. Sherman is right. You call all patients in the waiting room by their first name due to HIPAA. We also continue that policy in general areas where we take blood, collect urine samples, etc. We can then use their last names once in the actual exam room but not before entering a private area.

MER said...

I'm not an attorney, but it would seem relatively simple to have a form that asks people how they want to be addressed. This form could also explain that, if they chose to be called by Mrs. Smith or Mrs. Jones or Mr. Johnson -- they are waiving their rghts and certain protections under HIPAA. This is called true informed consent. How we're called by others up to us, not others. Our names like our bodies belong to us and we have control. Some patients my feel protected by being called by their first name. Others may not feel the need for any protection. This is up to them -- not to some bureaucrat or legislature crafting laws. We can always waive certain "rights" if we desire. I often hear the phrase "The patient is in charge." Granted, the patient can't be in charge of everything -- but one would think they they could at least be in charge of how they are to be addressed.

MER said...

Over several threads, I've claimed that accommodation is out there if you only ask. Over several threads, allnurses.com has been criticized.

I call your attention to the thread on allnurses that I'll place at the bottom of my post. It's about how much accommodation should be done for religious or cultural reasons. Right now it's 3 pages. The overwhelming opinion is that you should accommodate, that it's about the patient, about patient comfort. It's not about changing how people feel or what they believe. Most of the thread is about racism and sexism. But at on page 3 a discussion begins about requesting same gender care. So far, the response is to accommodate.
So, if some bloggers here are going to claim that the wierd threads on allnurses are representative of all nurses -- you need also to accept my contention, that is -- This thread is representative of what's going on in most hospitals in this country -- accommodation whenever possible.
I'm not saying that complete ignorance of male (and female) modest never happens. It does. I believe most of the anecdotes on this blog. But the main problem as I see it is that men don't ask, and some women don't either.
At the risk of repeating myself over and over again -- it's as much or more about good communication as it is about anything else. Here's the URL to this thread on allnurses.com

http://allnurses.com/general-nursing-discussion/when-draw-line-430154.html

Joel Sherman said...

Nice thread MER.
Yes I agree. The majority of staff will try to accommodate patients. That includes gender preferences when asked when possible.
Male nurses are usually accustomed to that request, and accede to it graciously. It happens less to female nurses so they may react with surprise or worse. You'll note on that thread that no one has even mentioned men asking for a male nurse, only the opposite, i.e. men refusing a male nurse. That illustrates that even for the men who do care, even fewer are willing to say anything.

As far as your other thoughts on names MER, in principle a question as to how the patient wants to be addressed is appropriate. But I believe most patients are already tired of paper work and formalities.

MER said...

Another one of those subjects we don't really know much about -- although I'd bet there are studies or at least surveys that give some indication.
It seems that older people in general are not really comfortable with a young receptionist or caregiver, within let's say a hospital situation, calling them by their first name. At least until they get to know them better. That may happen with a nurse or other caregiver after a few days or a lengthy hospitalization. There is a notion of decorum which, though pretty much lost in much of our culture today, is still remembered by our older citizens. In formal, professional contexts, a young person just doesn't call an older person by his or her first name until some kind of relationship has been established.
Maybe I'm just old fashioned.
But the reason I even brought this subject was that advice columns like the one I quoted are indicators of what's acceptable and unacceptable in our culture. This columnist clearly places the responsibility of finding out how people want to be addressed on the medical profession. Right or wrong, that seems to be the cultural expectation. My point was that, if something seemingly as simple as a person's name needs to be considered by medical professionals, how much more important are modesty issues.
That was my point.

Joel Sherman said...

As promised above I have read 2 more articles concerning women’s gender preferences for obstetric and gynecologic care:
Howell, Eliz et al. Obstet Gynecol 99: #6, 2002, 1031-1035.
Plunkett, Beth et al. Amer J Obstet Gynecol, 186: #3, 2002, 926-928
Both studies polled near 150 women either post partum or post operative. Majority were post partum. The results were basically similar to what I have above. Approximately 50% of women preferred female physicians for ob-gyne care, 5-10% preferred men, and the rest didn’t care. No other factors such as age or race were significant. Significantly 25% said gender was the primary factor in choosing a doctor whereas near 50% said their personal connection with the physician or their bedside manner was most important.
Although patient age wasn’t a factor in their choices, I suspect young women or adolescents would more strongly prefer women providers, especially for their first exam. One study asked about male nurses who not surprising fared worse than male physicians but still near a third were fine with them.
Unfortunately the amount of data available for men undergoing intimate exams is much less though the study I quoted early in this thread was similar to these studies with about half preferring same gender.

MER said...

This whole modesty issue is connected directly to a much bigger picture. Please indulge me here. This may sound off topic, but it's not.
In the LA Times, I've been following a story about how the Cedars-Sinai Medical Center gave radiation overdoses (8 times stronger)during CT scans to 206 patients. The hospital learned about their mistake in August -- yet it's only recently that patients learned about this error -- and many of them learned about it from recent newspaper reports.
Four patients said they were called by the hospital last month and "questioned." But no error was acknowledged and nothing explained to them. The hospital said they called patients to learn if they were experiencing any side effects. Didn't want to alarm them.
POINT ONE -- The attitude: We know what's best for our patients. Patients can't handle the truth.
George Annas, an ethicist and lawyer at Boston University said that, from an ethical standpoint, the hospital should have informed patients of the error: "This is part of a trend in patient safety. Whenever you make an error, you tell the patient."
POINT TWO -- This is a new trend? Telling the truth to patients about errors? What's that saying about the standard operating procedure? The SOP is secrecy.
The LA Times interviewed some patients who had been called by the hospital -- one of the five they interviewed said she had been told of the overdose. The others had not. Basically, patients were asked if they had had any side effects. That's all. One patient said his call from the hospital sounded like an "investigation." But he was never told the truth.
By the way, this is the same hospital that, in 2007, did not tell actor Dennis Quaid and his wife that their newborn twins had been overdosed with a blood thinner. Quaid said that he and his wife learned of the problem the day after it happened when they arrived at the hospital and were met by risk managers.
POINT THREE: Risk Managers? This clearly shows that the hospital is primarily interested in protecting itself rather than it is in open and honest communication.
Does anyone see a trend or pattern here?
How common are these errors. It's estimated that up to 100,000 people die every year due to medical errors. That would be as if we had a commercial plane crash (full plane) every day of the year. How do hospitals deal with communication regarding these errors? Are they up front, open and honest with patients?
POINT FOUR: This is the culture of secrecy that patients are dealing with within American medicine. In fairness, many good doctors and nurses are trying to change this. But secrecy is extremely embedded, and has been historically, within medical culture. Medical knowledge is like Gnosticism -- secret knowledge necessary for salvation, and only the professionals have it and they know what's best for everyone.
If the medical culture deals with errors like the ones I've summarized by practicing secrecy and and extremely poor communication skills, how do you think they deal with such a small issue (to them) as patient modesty? For many, patient modesty, specifically gender choices for patients, isn't even on the table. It's off the radar.
This is the battle patients face.

Joel Sherman said...

MER, in that regard hospitals are no different than any other institution or business. Examples of this behavior abound in religious institutions and industry. Think priest scandals and contamination by industrial waste. A major lawsuit involving a hundred patients could easily put a hospital out of business. Many are self insured.
Obviously it would be better if they were upfront with all patients. But first they have to figure out what happened and the likely consequences. Wouldn't help to call patients and say that something is wrong but they're not sure what that means. It's understandable that they don't want to panic people, but at some point that turns into a cover up.
It would help if this country had a reasonable malpractice system, perhaps modeled after workers compensation programs. It's not even being considered.

MER said...

Joel:

I can see your points. But the fact that other institutions handle errors this way neither makes it ethical nor good business. Imagine being a patient and learning about this mistake by reading the newspaper. This kind of behavior erodes trust. It encourages more suspicion and may result in even more lawsuits and higher penalties. Regardless of the merit of some of your arguments, hospitals must find a better more ethical way to communicate honestly with patients about these kinds of errors.
As far as being like other institutions, perhaps structurally or following a business model. But, and we've talked about this before, the medical community is granted by society special privileges and rights regarding their ability to operate "behind the screens" in dealing with patient privacy and modesty. The caregiver-patient relationship may be one of the closest among relative strangers that exists, next to that of priest/minister-parishioner.
And from what I've read, states that have enacted tort reform regarding malpractice awards, have seen neither a reduction the cost of malpractice insurance, nor a reduction in the cost of medical care. This is still being studied. But it doesn't look good. I'm all for discouraging lawsuits with no merit -- but those patients who are harmed significantly and will need money to take care of them for many years, are being limited in what they can get by the courts. There's got to be some middle ground.

MER said...

A side note to the Cedars-Sinai Medical Center incident. In today's LA times, the CEO of the hospital said he regretted the "circumstances" subjected 206 patients to radiation overdoses. The entire statement wasn't published, but apparently there was no "apology," just "regret" for these particular "circumstances."
This is the kind of legal language that will continue to erode trust. Refer to Art Stump's comment on the letter he received from the hospital he had trouble with.
Now, I understand the legal implications. But to me, and I think others, the issue isn't the mistake the hospital made. We all make mistakes. Of course, the stakes are much higher in hospitals. And the medical community must do bette and work to lessen the number of mistakes they make. No, the issue isn't the mistakes.
The issue is communication and trust. What's the protocol once the mistake has been made and discovered? What do you do? Who's running the show, the medical professionals or the risk managers and lawyers?
As I see it, that's what this issue is really about.

Joel Sherman said...

I agree with all your points MER. It would be better if hospitals always dealt upfront with people.
My only point is that it's not likely the bureaucratic mind is going to deal with it any better in hospitals than they do anywhere else in our society, especially when big bucks may be at stake.

MER said...

Check out this "Caregiver Preference Guidelines" from the University Health Network at Toronto General Hospital. It clearly makes a distinction, that is often missed on other blogs, between patients who openly discriminate because they just don't respect people of a certain sex or race, and those who feel uncomfortable or embarassed.
Joel -- do you know any American hospitals that have guidelines as detailed and specific as this regarding caregiver choice? This is a model that should be adopted by all hospitals. It seems pretty realistic. They make no promises, but they recognize the issue and try to deal with it. This is part of what some hospitals call patient-centered care.
Here's the URL:
http://www.uhn.ca/About_UHN/corporate_info/reports_statements/docs/Caregiver%20Preference%20Guidelines.pdf

Joel Sherman said...

Thanks MER. That's an excellent guideline for a hospital to use. I think it gets it exactly right. It accedes to requests whenever possible, but when the reason for the request is clearly prejudice, it explains to the patient that it is against hospital policy. But they will still try and grant the request if the patient insists.
No I know of no American hospital with similar guidelines. Most ignore situations that are not outright bigotry such as rejecting a provider because of their race. Anything short of that, the staff is left to fend on their own. I would think those guidelines are an excellent model for the group trying to organize for patient privacy to be able to forward to hospitals as an example.

Anonymous said...

I agree that this is an example of a hospital in trying to cater for patient requests. But to me it is far from adequate. My readinig is that they try and do all they can to get the patient to change their mind. Look at the complicated process in the flow chart. Whilst in the text at the end they do say that patients may have a reason such as prefering same sex provider given the nature of the treatment, or history of abuse etc. BUT its all about in my reading of supporting the staff member involved. Why? I know that its a real issue to them in some cases where the patient expresses a preference based on racial prejudice or similar, but where do you draw the line? What about a nurse who has a patient of the opposite gender refuse her/his services? Would the patient be put through the same process? It seems so. That being the case, I think that this policy is far from adequate. I express a view for same gender care, that should be it. No meeting with senior staff to try and "talk me out of my views" and certainly no need to provide any special support for the staff member involved. After all it is patient centered care, not medical staff centered care.

Chris

MER said...

Good points, Chris. This can be a tough issue when dealing with blatant sexism or racism. My take is that most staff will opt out of dealing with patients who are overtly racist or sexist toward them. Who would want to deal with something like that? Life is too short. The opt out probably takes place most of the time. As a supervisor, I would seriously question a staff member who wants to challenge a racist or sexist patient. What would be the value? Teach them a lesson? You're not going to change them. Treat them and move on.
It's not perfect, but the fact that this hospital has such a detailed policy highlights the fact that they recognize this modesty issue and are willing to at least discuss it and face it openly. That's a very positive attitude.
I would recommend some of us send this policy to hospitals in our area and get their reaction. Do they have a written policy about this? If not, why not? What do they think of this policy? Would the consider articulating the way they handle these situations? (No question that they deal with this. Most just hide it as part of their underground culture.)I think it's good form to begin with a credible sample of what we think is right. That puts the ball in their court.

MER said...

I want to amend my last post. In situations where patients are overtly racist or sexist, sometimes they need to be told to find other providers. It's not as simple as treat them and move on. This is a question of judgment, with many variables. In a case where a patient would not allow a black nurse or doctor into the operating room because of racism? I could see the hospital telling them to find another hospital. That would be true of a sexist woman or man who refused to allow a member of the opposite sex into an operating room because of racist attitudes. I'm not saying this is an automatic refusal. Judgment is involved. And, as you can see from the guidelines I posted, the hospital does attempt to explain to people with racist/sexist attitudes why they can't accommodate them.
Having said this -- what I've said rests upon the premise that the caregivers clearly understand the difference between racism and sexism, and comfort levels and embarrassment. I think they do most of the time.

Joel Sherman said...

I don't want to reiterate, but I think Toronto Hospital got the guidelines mostly right. You have to challenge patients when overt prejudice is involved. In fact if you don't, your own employees could potentially sue you.
The guidelines did not say that gender preferences were prejudice. Of course they could be. It depends what the patient says. There is a difference between requesting same gender care due to your own comfort guidelines versus saying that all male doctors or female nurses for example are perverts. Most people can tell the difference between those positions.

MER said...

Earlier, I posted a link to a Toronto hospital stating clear polices about how to deal with specific care requests. It seemed to be based mostly on racist sexist requests, but it did include a statement acknowledging that some some patients may just feel uncomfortable with opposite gender care and that needs to be respected.
Here's an even better policy statement from a hospital in the UK. What's interesting is that if a patient requests specific gender care and it's not available, that needs to be recorded. Thus some stats are created that can indicate staffing needs. I doubt very much whether these kinds of stats are kept anywhere in the US. If they are, they're certainly not reported.

We're always talking about what we should do on this blog. Well, here's something we can do. Read these polices I've posted and send them to local hospitals asking if they have such written polices. Make sure you make it clear you're looking for "written" policies. It's so easy for them to just say, oh, yes, we do this or that. Is it in writing? If the hospitals don't have such policies, why not? Ask them to justify their decision.
Now, I know someone stated that these hospitals in Canada and the UK don't always live up to the policies. But at least they're in writing. If a patient files a written complaint, and the complaint is reviewed, these polices are bound to pop up as part of that review. In fact, the complaint can even ask if such polices exist which will force them to the surface. The same isn't true, I believe, in American hospitals. The written polices don't exist, so during the review of a complaint the hospital isn't required to fall back upon specific standards.
I again post the question: Why is it that I'm finding all these policies in the UK and Canada? I've never found anything like this from an American hospital.
Here's the URL to this UK policy document:

http://extranet.somerset-health.org.uk/area15/policies/CaringForPatientsOfTheOppositeGenderJul06.pdf

Joel Sherman said...

Thanks for that link, MER. I too have never seen anything similar in an American Hospital. I think the guidelines are excellent except that they are unusually legalistic, especially for a British institution. I'm surprised that it recommends that chaperones be present for opposite gender care whenever possible. Chaperones should be offered but not made mandatory. The majority of patients don't want them. Also it makes it much harder to employ male nurses or aides if a female always has to be present.
But I think your idea of sending the guidelines to local hospitals is a good one. The real coup would be to get JCAHO to accept them. Try sending them there as well.

MER said...

How nurse respond to gender preference requests can be influenced by, among other things, the subject of my comments below:

Marjorie writes: "I've said on another blog (and I apologize to Dr. Bernstein) that I feel the medical community is unethical, disgraceful and harmful.

I need to both distance myself from what Marjorie writes above. I don't believe it's a "community" problem. Every profession has it's bad apples. In medicine the stakes are so high that it's especially disheartening to see ethical breaches.

But I do agree with some of what Marjorie says. Verbal and physical abuse indeed works its way down. Nursing and elementary school teaching (both historically dominated by women)are examples of how those at the bottom of the power hierarchy at times take their frustrations out on each other and sometimes even on their clients. On their clients, not necessarily actively but through passive aggression.
Here's an interesting thread on allnurses that talks about how nurses, so often the victims all kinds of abuses, take it out on each other. I read recently of a nursing convention where one of the main topics was bullying in the work place. We know that those who are sexually abused, often sexually abuse others. Verbal abuse and humiliation also follows that route. Here's the URL which is titled "LATERAL Violence. How Nurses treat Nurses!"

http://allnurses.com/general-nursing-discussion/latera

Joel Sherman said...

Thanks MER.
Here's a corrected link that works.
I'll read it through soon.

MER said...

Relative to that last link about problems in nursing, another related link was posted on Bernstein's blog by PT. It's also quite disturbing.
http://www.aboutmytalk.com/t69397/s&job.html

Also, this blog was posted on Bernstein (by NP)and, I think, demonstrates the kind of medical blogs that may cross the line as far as appropriateness. Medical professionals will always relate experiences and anecdotes among themselves and some will be inappropriate -- but they're not publishing them on the web. It's not so much that I find the stories on this blog offensive (whether they're offensive is a matter of opinion). It's the tone that bothers me. I read it as a tone of patient as object, patient as basically dumb, etc. And the tone seems to grant no recognition that non medical people, patients, might be reading these and have a reaction that is quite different than is intended. Here's the URL
http://stanford.wellsphere.com/life-as-a-doc-article/the-gynecology-room-redux/561184

Having said all this, we need to be careful about regarding these kinds of posts as representative. They may be. But they also may not be. I do think they are indicators of problems that exist in the profession.

Joel Sherman said...

Here's a very interesting thread on allnurses concerning male nursing students on obstetrics.
I haven't finished going through it yet but it gives some very interesting observations and thoughts on the acceptability of male nurses to various patients. I think there is a huge variation in hospital to hospital and patient to patient.

MER said...

Part 1

I’m beginning to think that the idea of female nurses attending to the intimate care of male patients – although presented on the surface in hospital culture today as completely appropriate and acceptable and normal for both patient and nurse – is much more controversial. You won’t find much in print, especially in this country, perhaps because the idea that it might be inappropriate or unwelcome for some men is not politically correct, nor does it fit into the scheduling, hiring and economic culture of large hospitals.
It’s extremely difficult to research attitudes. You can, of course, interview people and take polls. But you’ll often get what people think they think, rather, necessarily, what their true attitudes. You really need to study the surrounding culture, popular ads and media, letters, journals, etc. We can learn much about these modesty issues, I think, from review medical publications rarely read by the general public. The old journals, especially, can give us insight into some of these controversial issues.
Take, for example, two 1907 issues of The American Journal of Nursing (AJN) (March and May). The topics? Catheterization of male patients by female nurses. It was an open, discussed controversial subject back then.
Annie L. Williamson, R.N., Superintendent of Oswego Hospital in New York, wrote in the March issue that what's often overlooked when discussing this subject is “...the moral effect on the patient, and his mental attitude towards such treatment and the nurses who are obliged to give it.” In other words, the danger is what the male will think of the nurse who does this job. Williamson goes on to comment on the unsavory moral status of the patients “who fill the male wards in our hospitals,” which is “too well known to need comment.” (p. 495)
What's she talking about? What's too well known that we don't even need to discuss it? Even back in 1907, most wealthy people didn't go to hospitals unless they had to. The hospitals or doctors came to them. If they did go to hospitals, they went to private hospitals or to special wards and were accommodated as a special private patient. Even cultured, educated men who were not wealthy may have gotten special treatment.
So who are these men with unsavory morals? They are the poor, the working class, the uneducated, the uncultured. According to Williamson, it was particularly dangerous for a female nurse to do this kind of intimate work on this kind of man “without lowering herself in his eyes, and establishing, from his standpoint, a relation much to be deplored...” The average {male} patient, she writes, “cannot be expected to look at the subject in a purely impersonal and professional light.” (p. 495)

MER said...

Part 2

So – what's going on here? Are we stereotyping men? Keep in mind – the concern here is not about the man's embarrassment or possible humiliation. Indeed, it's suggested that, rather than being embarrassed, the man is more likely to presume that much more is going on than a mere medical procedure, and that the nurse doing it is not worthy of his respect. Is there any basis for a man feeling that way?
Remember, the history of modern nursing is a history of early nurses who did not come from the upper classes. Indeed, as the Industrial Revolution progressed and as young women from the farms moved to the cities, and as the medical profession grew – nursing became a viable option for these young women as an alternative to less dignified occupations such as factor work. In fact the early reformers saw nursing as an alternative for some of these girls falling into prostitution. Early nurses, before nursing schools (the 1870’s in this country) and professionalization (about the WW1 era), had to be closely monitored and supervised by matrons who where usually from the upper classes or upper middle classes and considered to be more morally stable.
Williamson says that any nurse doing this kind of intimate procedure on men must “exercise...great dignity and discretion, to prevent the patient presuming.” Notice again that the concern here isn't really for the male patient, especially those with questionable if not degenerate moral character – the lower, uncultured classes.
Williamson does talk about the other kind of patient, the man of “upright character.” What would be the effect of a female catheterizing him? It would, she says, violate “all his ideas of propriety, not to say decency,” and it would be a “severe shock to his moral sense.” This would be especially so in the “case of young men and boys.” But again, the focus isn't so much on the patient as it is on the nurse and the profession. “Their reverence for women, and especially for nurses, is apt to be sadly shaken,” Williamson writes.
I need to emphasize again that the major focus here is on the effect this intimate activity will have on the image of women in general and nurses in particular.
How about doing the procedure under sheets so the nurse can't see anything? “What of the touch?” Williamson writes. The contact of the nurse’s hands on the man's genitals is “as likely to have an evil effect on the patient.” Of course, “evil effect” in this context was an Edwardian euphemism for an erection.
Williamson goes on to argue against the idea that nurses should be taught only to do this procedure on unconscious patients. She tells a story of a nurse who did that, but the patient wasn't really unconscious, remembered it, and “afterwards related, to a choice circle of friends, no doubt with embellishments, what had taken place during the time that he was profoundly unconscious.” It still isn't about the man's feelings as much as it's about the man retelling the story in such a way as to lower the moral character of the nurse.
Williamson isn't suggesting that nurses not be taught this procedure. They should, and they should be willing to do it in an emergency. That would be their duty. She claimed that any nurse who could do the procedure on a woman could easily learn to do it on a man.

MER said...

Part 3

In the same March 1907 issue of AJN, a writer, R.C., a female medical student, weighs in on the issue. She complains about the difference between the textbooks used by doctors and nurses, the nursing student text being inferior because “The human body was everywhere expurgated as were the lectures.” She called attitudes like Williamson's “superficiality and prudery,” and added, “Is it justice to the nurse to say that her morals are tainted by this necessary work?” She then adds: “Would anyone dare make this assertion of our celebrated gynaecologists, who examine thousands of patients? – women.”
R.C. makes the issue clear. This issue is really about the strength of moral character of the female nurses. Are their characters and morals strong enough to do this kind of intimate work on men? R.C. says yes.
In the May 1907 issue of AJN, May Alzada Mott writes: “...I do not think in a hospital where there are interns and male nurses that a female nurse should catheterize a male patient, especially the class of young men and boys one is apt to meet in the wards and who cannot understand why a nurse is a nurse and what it means.” If this attitude appears to be condescending, perhaps it is. Men of these classes are not considered intelligent or sophisticated enough to understand what's going on between nurse and patient. There must be sexual motives, this argument goes, associated with any women who would perform such a procedure on any man – at least that’s what this “class” of men would just normally assume. Was or is there any truth to that, or is it just a rationalization?
R.C goes on: “It is true there are some nurses from whom the act of catheterizing a male would detract nothing – she would still be the same dignified, discreet, womanly nurse, but there are some others who have not enough stability of character, and would be better out of a male ward.” R.C. recognizes that, even if we consider this activity appropriate, it isn’t appropriate for all nurses. She also states, as does Williamson, that nurses should learn to do the procedure and be prepared in emergencies.
But note again that the big danger here is the dignity of the nurse, not the comfort of the patient. It's implied that most male patients, especially of the uncultured, uneducated lower classes, will misinterpret the interaction and presume too much. There is more concern for the better class of men and older boys. Their moral sense would be shocked with the result that they would lose their reverence for women – again, the concern for the female sensibility and image more than for male modesty.
So – what does all this mean for us today? I’m not sure. But I do believe that attitude we read here from 1907 is still alive. To what extent? I don’t know. But from the research I’ve done, I think a significant number of female nurses would just rather not do this kind of intimate procedure on a male. Why? Could be for many reasons. Perhaps they feel uncomfortable. Now, I’m not saying they won’t do it. It’s their job, so they’ll do it if required. I believe there is a struggle in the profession that doesn’t get expressed in public – the conflict between the gender neutral culture of the hospital vs. the importance of gender boundaries in the general culture.

MER said...

Part 4

This issue is not dead. Consider the following articles:
“Male catheterization and the extended role of the female nurse” in Community
Nurse, 2000, Feb; 5(2): 81-6.
“Male catheterization and the female nurse: still a controversy” in Community Nurse, 2000, June; (5):23-24. The abstract states: “Custom and tradition decreed that male catheterization was carried out by male nurses and doctors. Myth, misunderstanding and misbelieve can perpetuate the notion that it is inappropriate for a female nurse to catheterize a male patient.” Articles like this are attempting, it seems, to justify this change from the old “custom” and “tradition.” But the fact that articles like this need to be written suggest that there is resistance to this change.
“Male catheterization and the extended role of the female nurse” in Community Nurse, 2000, Feb; 5(2): 81-86.
“Male catheterization by female nurses: a small-scale survey” in British Journal of Nursing, Vol. 7, Issue 13, 23 Jul 1998, pp. 757-764. The results of this survey indicated that “while most nurses agree that it is acceptable for females to catheterize male patients, most female nurses do not undertake the procedure” because they thought there were polices against “patients being catheterized by nurses of the opposite sex.” Although rarely discussed in print, it may also be that a significant number of female nurses don’t feel comfortable doing this.

Joel Sherman said...

MER, can you find the exact references of those articles, including the page numbers. They might be obtainable through the library. Were you able to get the entire 100 year old journals?
The attitude you describe doesn't surprise me. Morally upright women were supposed to be shocked by adult male nudity. That attitude is still around, but less prevalent except in criminal law where men can be charged with exhibitionism but it is usually laughed off for women. Women are supposed to be offended by male nudity but never the other way around.
Of course note that nurses did not catheterize men then routinely except in emergencies. All your quotes seem to say that. So the issue didn't often come up. I'm more interested in how the tradition of male orderlies doing the catheterizations disappeared as it is routinely done by nurses now. I can speculate, but I don't really know the answer.

maria said...

I was moved to tears by Brandon´s comment and do not understand why medical personnel claim the higher ground, yet intend to be considered just as human as anybody else. I am desesperate because my husband really wants to refuse cross-gender intimate care but is brainwashed and believes he will have no choice, but I've done my reaserch and he probably will be accomodated ....It is indeed one of the biggest flaws of our past and modern society... But we have more problems than that.... My problem is that I really won´t want to have sex with him for months (or even years if he tolerates intimate care by any female nurse (I don´t care if she´s young and pretty, altough that wouldn´t certainly help, or if there is really no sexual intent on his or her part). dooes she really think she is different form any other woman in the street just because she wears scrubs????I don´t think so, and if he goes along with that while having real choices, (especially if they both take great pains to hide it form me in the name of "patient privacy" he may well really contemplate having sex with her for the rest of his like because I won´t!!!!!

MER said...

I think one point that is rarely discussed, a point I've heard from a few men I've interviewed -- is this:
Although most reasonable people know that female nurses and cna's do not intend to sexual arouse the men they treat intimately -- that doesn't mean that the men don't feel sexual arousal sometimes. And the fact that they do, doesn't mean they're doing it on purpose or enjoying it. It happens. So, regardless of caregiver intent, some men feel sexually aroused. It's part of the male psyche. Some caregivers misinterpret any arousal the man demonstrates. And, frankly, some men, to cover their embarrassment, shrug it off or even brag or otherwise make statements or comments that suggest to the nurse she is being sexually harassed.
I've heard men tell me that as long as they don't find the female nurse attractive, things will usually go fine. One man said, "As long as she doesn't turn me on..."
A few nurses have told me, and I've read it on some blogs, that it isn't uncommon to send in an older nurse to deal with some men needing intimate care, knowing that it will make a difference in the man's eyes.
These attitudes are generally part of the underground structure of what's going on between patient and caregiver, especially in opposite gender intimate care situations with male patients.
I can't speak for how women may react to male doctors or nurses in these situations.

MER said...

An item in today's L.A. Times. The Journal of Epidemiology and Community Health reports a study that claims that "Walking away or letting things pass may be an unhealthy way to deal with unfair treatment on the job. This study of 2755 men comes out of Sweden. Men who reported these "covert" strategies so many were more than twice as likely to have a heart attack or die from heart disease over the next 10 years.
We've talked about how men don't complain, but are ambushed or just let intimate care situations happen to them in hospital or clinic settings. Now, imagine a man who has a heart condition under the stress of not wanting opposite gender intimate care but being unwilling to ask for same gender care. In a situation like this, the system itself that isn't proactive could be putting the man in more danger than it realizes.
I realize this sounds like a stretch to some. But let's be honest -- medicine knows how important factors like stress and psychological well-being play in patient care and ultimate success. Although we can't always quantify it, it's no mystery.

Joel Sherman said...

MER, I have no idea what percentage of men feel sexual arousal when exposed to cross gender intimate care. Of course there are many variables such as how sick the patient is at the time. It's more likely to happen in an office setting I would guess. The amount of handling also makes a difference.
Embarrassment may just be a mask for arousal. Although only the fetishists may look forward to it, I'm sure it can happen to a lot more men under the right circumstances. It clearly is a problem for far more men than women. It certainly is an argument for the availability of same gender care.

MER said...

I don't think it's a matter of what percentage of men, Joel. I think it's very contextual, and in the right circumstances almost any man might have that happen to him. Of course, as you said, we're talking about very specific kinds of care and procedures, those that are not necessarily so uncomfortable or painful that would discourage arousal. But this is one of those subject well know to nurses and cna's who deal with this everyday -- but a subject that is rarely talked about clinically, at least publicly, though you sometimes see it discussed on allnurses in both professional and nonprofessional ways.

MER said...

Here's a interesting blog run by an ER nurse. This particular URL will take you to a little essay called "buff tuesdays." Read the reader comments after the essay. These comments could demonstrate many things:
-- The sensitivity of an ER staff about nudity, and/or
-- Their lack of sensitivity about nudity, and/or
-- Their dark humor, and/or
-- all of the above.

It's an interesting blog, although I don't always agree with his point of view -- as a patient. But it does give you great insight into the minds of those who work in an ER.

http://www.impactednurse.com/?p=255

Joel Sherman said...

That's a cute spoof MER, though I'm not sure it sheds any light on the issue. It certainly does tell you that the nursing staff is aware of the embarrassment issue though.
It's worth noting that the blogger is an Australian male nurse. In this country I don't think administration would take very kindly to a picture like that posed on their premises and then published. Might get you fired.

Anonymous said...

I think Brandon really hit the point....Healthcare workers, especially nurses, claim the high ground and then expect to be treated as "human" just like everyone else....Cross-gender intimate care in one of the flaws of modern society and I won´t put up with it, and I am trying to talk my partner out of it...I really would have difficulty in feeling aroused by him if his parts had been rubbed by a female before!!!!!

Anonymous said...

Exactly my feelings Anonymous, but from the male side.

Anonymous said...

Maria..Anon.:

My husband reluctantly allowed a female nurse to perform intimate care on him. I could not get over his letting her or her believing it was her right to fondle my husband like that.
We are no longer intimate. If we stay together remains to be seen.
Please someone needs to stop letting them ruin our morals and marriages!
I hope it can change before others suffer and it is not too late like me.

Matty G

MER said...

A point that I've made off and on throughout this blog is this:
On either end of the spectrum are the two extremes -- people who completely refuse to be treated intimately by the opposite gender, and people who insist on being treated by the opposite gender. Most patients, I'm convinced, are somewhere in between, and could go either way, depending upon the entire context of the situation, how safe and comfortable we feel, whether we feel our dignity is being respected, how we're initially approached.
I found a recent study in an Australian journal that may indirectly support this position. See below:

"Undermining self-efficacy: the consequence of nurse unfriendliness on client wellbeing"
Collegian: Journal of the Royal College of Nursing Australia, Volume 12, Issue 4, Pages 9-14
R. Geanellos

ABSTRACT

"Although unfriendly nurse behaviours are noted in research findings, no study names these behaviours as such, nor investigates the impact of nurse unfriendliness on clients. Because the present findings reveal the phenomenon of nurse unfriendliness, they allow both the phenomenon and its consequences to be understood. These findings were developed through secondary data analysis of a text where participants discussed their encounters, during hospitalisation/s in 2002-2003, with friendly and unfriendly nurses. Findings reveal nurse unfriendliness is characterised by frostiness, officiousness and apathy. It results in thoughtless and inept nursing and in a hostile environment where clients feel unsafe, unwelcome and unaided. Unfriendly nurses create barriers – they are disrespectful, cheerless, unresponsive and domineering so clients feel belittled, disheartened, unprotected and distressed. When clients are placed in this position, their self-efficacy is undermined. By revealing the consequences of nurse unfriendliness on client wellbeing, findings from this study advance nursing knowledge."

Now, the paradox may be that what the patient perceives as nurse unfriendliness isn't necessarily conscious unfriendliness on the part of the nurse. It may be the nurse trying to distance her/himself, protecting her/himself emotionally, not getting too involved. (By the way, this applies to all medical personal, not just nurses). But we're talking about distinct situations
-- Nurses who may not realize the persona they're projecting.
-- Patients who misinterpret nurse behavior.
-- Really unfriendly nurses who actually demonstrate frostiness, officiousness and apathy.
-- Patients who are just pains in rear end who create a situation where good nurses become unfriendly.

But I think this is one key to this issue. The majority of patients in the middle of the spectrum on this modesty issue, may refuse opposite gender treatment if they perceive the nurse as uncaring and unfriendly.

I haven't been able to find a link to the article. If anyone can find it, please post it. I'd like to read it.

Joel Sherman said...

I agree with you MER that the blogs, in particular Bernstein's, have become bogged down with extreme views on either end of the spectrum. That of course does not mean that an attempt to accommodate these views shouldn't be made. But patients who put their views in a moral framework are far less likely to be accommodated than those who can compromise with a system that doesn't see it in a moral framework at all.
I'll see if I can get the article to you.

Anonymous said...

What has happened to morals in America? We seemed to be leading the world in ethics and morals yet in our medical system it's a free-for-all chaotic mess. In the outside world including politics we like to think of ourselves as progressive and politically correct. But inside hospitals we act like we're back in the dark ages, only this time all men are slaves and women have complete control of what happens to everyone's body. When will the medical world catch up with the rest of society?

MER said...

Anonymous: When you start saying things like "all men are slaves and women have complete control of what happens to everyone's body" you lose your credibility. Sweeping generalizations like this push you so far to an extreme that it's hardly worth debating with you. We can recognize a double standard problem without taking an extreme stance like that. My experience has been, as has others on this and other blogs, that accommodation can be achieved if you're willing to communicate civilly and rationally, and, if refused, find another provider. In an idea world, you wouldn't have to fight for the accommodation. In this world, you may have to. But if you believe strongly enough in what you say, you'll fight. But if you argue the way you write here, you risk tagging yourself as a fanatic, which gives you little or no credibility.

If you actually believe what you said -- then we're so far apart that we just need to agree to disagree.

Anonymous said...

WOW. MER must have been in a bad mood when he wrote that. Cheer up and stop taking people so literally. He was obviously abused in some way and those were his thoughts at the time. Many things he said sounded familiar. He was probably just venting after going through hell with nurses and now he's getting critisized here. Lay off a little and try to imagine what he has just been through.

Joel Sherman said...

Posted by MER:

Anonymous: These are called discussion boards, not venting boards. Okay, vent. But venting like that leaves little or no room for discussion. Perhaps he should describe the experience he went through so we know where the venting is coming from. We owe it to each other here to try to explain not only what we believe or feel, but why we believe or feel as we do. People who have had bad experiences have valid reasons to be suspicious, and need to keep their eyes wide open when they go for treatment. But, as I've said before, we need to go into these situations not only looking out for ourselves but also with high expectations, not expecting the worst of everybody. If you believe that "all" nurses are perverts, as so do, then you're setting extremely low expectations for the whole system. Some people with attitudes like the one we're talking about, go into the system looking for a fight -- and when we do that, we can almost always find a fight. Either that, or they go into the system and freeze up and allow things to happen to them that they later resent, and then vent about it.
Either way, in my opinion, these are unhealthy approaches to life. But maybe you're right. It may be best just to ignore venting like that.

swf said...

I have to admit, I find the extremes interesting. Perhaps it's the motivation, passion, and reasons behind them. Or maybe it's the idea of seeing if there is any form of mitigation for them.
But something I learned recently from a respected poster: participating in the emotional conversations for whatever motivation could lead to losing you own credibility.
So lesson learned and taking my que from those wiser: I will be approaching extremes more cautiously.

Anonymous said...

Finally, finally -- some acknowledgement of this modesty issue in a major publication by a renowned doctor and writer. And – although the word “modesty” isn’t used, the meaning is clear (to me, at least). In the December 17, 2009 issue of The New York Review, there’s an interview with Dr. Jerome Groopman. He wrote the recent book, How Doctor’s Think, which I highly recommend. He’s asked about the importance of the “symbolism and meaning attached to a patient’s illness.” Here’s what he says:
“I think it’s important that a physician try to understand the experience of illness as best as he or she can. It’s clear in certain necessary but difficult and disfiguring surgeries like mastectomy. There are patients who experience gastrointestinal disease, colitis, inflammatory bowel disease. And these are sensitive and often highly symbolic parts of our bodies. It’s incumbent upon a doctor who cares for patients dealing with maladies that affect these organs that have resonance with us on a symbolic level to probe and try to understand the experience of the patient.
“And it varies. Some patients may see malfunction in such parts of the body in a highly charged way, and others may not. And in making decisions in trying to help the person make choices that potentially could be live-saving, you want to be sure that you have as much insight as you can into how the person thinks about his or her body and how those thoughts and feelings factor into their preferences.
“It’s a lot more than what you would find in some algorithm or guideline that says, well, if you have this tumor, this is what you do. If you have this inflammation in the bowel, this is what you do. That’s not enough.”
What insightful and wonderful thoughts. What part of the body could much more symbolic that the genitals? Groopman is saying that doctors need to understand how patients feel about where the disease is, what part of their body is being treated, and what that represents symbolically to the patient. He says just what we’ve been saying. How patients react varies. Some see these body parts as “highly charged.” Others don’t. He then talks about choices patients need to make, life-saving choices, and how the patients’ preferences factor into the doctor’s treatment plan. Sound familiar?
What I find especially interesting – Groopman doesn’t use the words privacy, dignity, modesty. Why not? They’re embedded within his comments. Is there a tendency in medicine to shy away from these particular words. I wonder if most doctors interpret Groopman’s words as I do, or whether they see what he’s saying as something entirely different.
-- MER

Joel Sherman said...

MER, Groopman's comments are always interesting. He's talking about old style internists from a time when they could be real academicians and philosophers. -From a time when a physician could take the time to sit and talk with patients to find out what their illnesses meant to them and how they were affected by their illnesses. Would be great if every physician could do that, but time pressures just don't permit for most doctors.
Outcome centered medicine with guidelines does seem to result in appropriate therapy being given to more patients than haphazard planning. Maybe it means that the average doctor will never be on a par with Groopman.
It is difficult to tell from the article whether he had modesty and gender issues in mind when he was interviewed. I'd be surprised if he was thinking of gender issues in care. He probably sees little of it in his practice as a gastroenterologist.

maria said...

I need to write to a person in this blog, MER: I am one of the women (not the only one, it seems), whose ideas are deemed extreme because she doesen´t want female nurses doing certain procedures on my husband. One of the most infuriating things about the situation is that many times they even say thing like "you don´t know anything about MY patient because you are married to him!!!! Seriously. I know him well enough to know that if intimate procedures involve half of what I know they entail, the guy would find it very difficult not only to stop himself from showing considerable arousal, but even making nasty comments, and also being very angry afterwards about it, too. (I mean angry about letting that happen, of course, not making nasty comments)....
One of the reasons I abhor some female nurses with a passion is that I have been subjected to their disrespect myself. The teenage ones, especialy if under 18, make me shiver. "Coincidentally", I am the same woman who was bathed in a toilet with open door by one of these younger "nurses", no, she´s not a "professional" just at the time another male CNA was coming at the GYN ward (no joke, folks)! Obviously, the whole thing had been planned, because she held a grudge against me (she had had the guts to ask me if I had had an induced abortion and I sent her to hell). I beg, implore, MER think about it: tey are many times mean,inmature and petty. Why else, they disrespect people they have had personal fights with? They are not touching me again. EVER. You cannot claim the high moral ground yet let yourself be carried away by you personal arrogance....

Anonymous said...

Maria -- How husbands and wives want to approach this modesty question is a personal matter. It's up to them. But it should be an agreement. What I find a problem with is one, the husband or the wife, who has a problem with opposite gender care while the other doesn't -- and the one who has the problem with it intimidating or forcing the other to go along. I do agree that if one spouse loves and respects the other, and knows that opposite gender care upsets him or her, it would be appropriate for that spouse to compromise and seek the kind of care that makes the other spouse more comfortable.
But, as you've suggested, I am thinking about it, and I am beginning to see your point of view more clearly.
I do respect that you've had negative experiences, especially with the younger female cna's and some nurses. I've mentioned this in past posts -- cna's have little training compared with doctor and nurses, and they cannot claim the same professional status as doctors and nurses. Yet the health care culture seems to want to consider them professionals just like everybody else. I don't agree with that position. And, the health care community is increasingly giving cna's and nurse assistants more and more of the responsibilities that were typically carried out by the more experienced and trained nurses.

Nurses with B.A's or B.S's (or M.A's) do have more training in the psychosocial aspects of what they do. They should understand human psychology and sexuality on a much different level. But remember, what we learn in class is the academic curriculum. The hidden curriculum, what we learn and are socialized into on the job, can be much more powerful that the academic curriculum. Most cna's do not, especially the younger ones right out of high school. They're completely task oriented -- as are, unfortunately -- some nurses.
People are different. The medical culture needs to acknowledge that and respect that. They need to design their clinics and hospitals around it. But that will never happen until patients insist on the kind of care they feel most comfortable with, the kind of care that augments their value system.
But I'm beginning to research more about how doctors, nurses and cna's are socialized into their culture. Much of what they really learn about modesty issues isn't learned in the classroom. It's learned on the job, by their mentors and colleagues. If they have good mentors and colleagues, and if their workplace advances ethical practices, they are socialized into a healthy and respectful attitude toward patient autonomy, including modesty. If they have a bad mentor and indifferent colleagues, and their workplace is unhealthy, they learn to dismiss patient autonomy as a value. I'll be writing more about this in future posts.
Perhaps we agree more that we disagree, Maria.
MER

Anonymous said...

Part 1 of 2

My recent research into silence and denial, has led me to some theories about what’s going on sociologically within hospital settings. I believe it’s important that patients understand this. Inexperienced patients, especially, who enter this alien medical culture need to appreciate where their caregivers are coming from and the kinds of strategies these caregivers use to get patients to cooperate with hospital policy and values.
First – this is about how we see socially and culturally. Medical professionals have been socialized to focus on certain things and not focus on other things. Though they may physically see nakedness and modesty problems, they have been trained to regard them as irrelevant to their job at hand. They have been socialized and trained to regard their gender as irrelevant to their relationship with the patient.
We can add to this various other factors: the prevalence of female nurses; the politics of medicine; the business and money factor; male/female staffing imbalances, double standards (against women, too) etc. And, we can’t ignore the whole issue of power. What we are allowed to see and acknowledge and regard as relevant is often controlled in situations where one group has power over another group. This also means that what we’re allowed not to see, acknowledge, talk about, or regard as relevant is also controlled by the group in power.
So – what does this mean for the patient entering a hospital culture and his or her modesty concerns specific to gender? Patients enter into this world bringing with them various perspectives and backgrounds:
1. The gender of my caregiver doesn’t matter to me. I’m comfortable with any kind of same or opposite gender care.
2. I have no idea what’s going to happen to me. I don’t know what to expect. I guess I’ll find out one way or the other.
3. I have definite feelings about this and I want same gender care for any kinds of intimate procedures.
4. I demand opposite gender care for my own reasons.

Add to these three basic positions whether the patient has had any experience with hospitalization and whether those experiences were positive or negative. This will definitely influence where the patient will reside on this continuum.
Now – what happens when caregivers face one of these three positions? Regardless of your position, you may get an introduction something like this: “Hi, my name is Sharon or Jane or Bill. This is my colleague, Carol or Ann or Dave. We’ll be working with you today.” They may or may not be wearing name tags. They may or may not describe their positions as nurses, cna’s or medical assistants. They may or may not describe exactly what “working with you” means. If you’ve done your research or have hospital experience, you’ll know what “working with you” means. If haven’t had any experience and don’t ask, you may be surprised.
By the way, that strategy – “We’ll be working with you today,“ is a popular one. It doesn’t’ give you a choice. It doesn’t’ ask a question. It just states what’s going to happen. It leaves it up to you to protest, which caregivers know most patients won’t do. It’s a conscious strategy to get you to go along with the program. So – how does this apply to the different positions above?
Continued...
MER

Anonymous said...

Part 2 of 2


POSITION 1 – Your values and expectations will match the gender neutral values of the hospital and your stay has the potential go just go smoothly, depending upon whether you consider your treatment to be respectful and dignified.

POSITION 2 – You’ll be moved along quickly through the system and, unless you express concerns, you’ll get what you get.
If you find opposite gender care acceptable, you move to Position 1
If you find that it does bother you and you don‘t express any concern, you’ll get what you get.
If you find that it bothers you and you express concern or ask for same gender care, you most likely run into caregiver strategies that try to resocialize you “not to see” gender as relevant. You may get responses like these:
“We’re all professionals here.” Translation: Gender doesn’t matter.
“I’ve done this many times.” Translation: Gender doesn’t matter.
“There’s nothing you’ve got that I haven’t seen.” Translation: Gender doesn’t matter.
You may get what you want. If so, fine. If not, at this point, you need to decide whether to just accept what’s available move to position 3 below.

POSITIION 3 – This could be the most dangerous position. Or, if staffing is available and you’re in a hospital that consciously tries to accommodate, things may work out just fine. But the fact is that these unwritten social rules in our culture – the things we don’t talk about but that rest beneath the surface of our everyday activities – these elephants in the room – have tremendous power because of their secrecy. Bring them into the open and they lose their power, but their openness may cause embarrassment, resentment and/or hostility. Those who ignore these hidden rules can be considered social deviants and suffer social sanctions or be stigmatized.
If you select this position, you may create a conflict between two differing social norms – that of the hospital, and yours and that of society in general. I’ll call this the “Socialization Wars.” The hospital culture is trying to resocialize you into what they consider their world. How do you react? What patients need to do is engage – begin to resocialize the hospital culture into your world. Remind them that “their” world isn’t really “their” world. It’s “your” world, too.
You must confront them politely, intelligently, tactfully, firmly, confidently and with respect. But you must not back down. This means you must be prepared. You must do your homework. Know the arguments. Prepare lines of reasoning. Don’t let them control the agenda – which will most likely happen when they try to switch from your needs and values to their and the institutional needs and values.
This battle will not be easy. Physically, you’re on their turf and under their control But the principle of patient autonomy, dignity and respect are also parts of the hospital culture, though in some cases those words have become “lip service.” Use those words.
But if you go into this battle, go in with your eyes wide open and be prepared. In avoiding your embarrassment, you may cause your caregivers embarrassment, and that could affect any future relationship you have with them during your hospital stay. But unless patients start resocializing the medical profession, we’ll make little progress. In our current medical culture, we can’t depend upon this being taught in medical school, unfortunately – despite the great efforts by doctors like Dr. Bernstein and Dr. Sherman.

A FEW SOURCES

Enright, D. J. “The Uses of Euphemism” (1985)

Gawande,Atul. “A Surgeon’s Notes on an Imperfect Science.” (2002
)
Goffman, Erving. “The Presentation of Self in Every Life” (1959)

Goleman, Daniel. “The Psychology of Self-Deception.” (1986)

Katz, Jay. “The Silent World of Doctor and Patient” (1984)

Zerubavel, Eviatar. “The Elephant in the Room” (2006)

-- MER

Joel Sherman said...

MER, nice exposition. I think you can also talk about how the acuity and state of consciousness modifies the expectations. Your alternatives only apply to more or less elective situations.
There is also a group of patients who do care but are too sick to effectively make their preferences known. Some of them later develop what's akin to a post traumatic stress syndrome. This is a situation that you can't plan ahead for unless you have family who are present and know your wishes,

Anonymous said...

Excellent comment Dr Sherman. No matter how much we prepare, most of the time we don't have the mental capacity to follow through with our plans in hospital situations.

Maria, I think exactly the same as you. I'm single at the moment but when I get married opposite-gender medical nudity will be a topic we discuss in detail. I feel that if a female nurse sees me naked and touches certain areas of my body I would be cheating on my wife.

S

Anonymous said...

The January 2010 issue of the American Medical Assn. Journal of Ethics is focused on nursing. There are several very interesting articles. One of the most interesting is "The Medical Team Model, the Feminization of Medicine, and the Nurse’s Role" by Lisa Rowen, DNSc, RN.
Although this doesn't address the modesty issue, it does underscore the importance of gender in our culture, even in the hospital culture. This article focuses mostly how gender affects doctor-nurse relationships.
Medicine seems to recognize more readily the importance of gender when it comes to relationships within the system, e.g. doctor-nurse; doctor-doctor; nurse-nurse. They seem to be less aware or concerned with gender issues between doctor/nurse-patient. Maurice, you must have some contacts at that journal? How about an issue dedicated to gender issues as they relate to patients?
Here's the link to this article, and the link to the entire journal online:

http://virtualmentor.ama-assn.org/2010/01/oped1-1001.html

http://virtualmentor.ama-assn.org/2010/01/pdf/vm-1001.pdf
MER

Joel Sherman said...

I've read the first article MER. I'm not sure if the lady author has it completely right, though some points are certainly valid. I think the 'feminization' of medicine is no different from what is seen in our society has a whole, certainly applicable to much more than medicine as women make large inroads into traditionally male areas without I may add, a complimentary increase of men in traditional female areas. But it's questionable if the democratization she talks about is a result of more women in medicine. I think it reflects the greater informality of our society as a whole. As a resident, it wasn't only the nurses who stood when an attending physician walked in decades ago, all of us did. Society was very different then.
The author believes that women physicians are more nurturing than men. Maybe it's true, but if you look at the women's thread on this blog, you won't see any difference. Both male and female physicians are accused of arrogance, telling their patients what to do without adequate discussion. Their gender doesn't seem to make a large difference in their attitude towards patients.
I wouldn't know if nurses treat women doctors differently than men. If so, it is certainly an evolving attitude as women have only been present in medicine in large numbers in recent decades. But nurses are more informal now with men too. Where I attend, the nurses call many male doctors by their first names, especially the younger ones.

Anonymous said...

Another article in the January 2010 issue of the American Medical Assn. Journal of Ethics is "Gender Diversity and Nurse-Physician Relationships" by Beth Ulrich, EdD, RN. Although this article, again, focuses on how gender affects relationships within the system, it does suggest how gender diversity within the system is necessary for a gender diverse society. Hidden beneath the covers are many patient-related gender issues, including modesty. The article also does address percentages of males and females in medicine in different fields, as well as other professions. Here's a link to this article:

http://virtualmentor.ama-assn.org/2010/01/msoc1-1001.html
MER

Anonymous said...

In today's New York Times: "Doctors report that about one in six patients is “difficult.” The study focused on 113 doctors in a larger group, the ones who most frequently reported these “difficult encounters.” Those doctors were more likely to be younger and female.
Now -- first -- I'm interested in all kinds of gender issues, especially in medicine. I'm not interested in gender wars. I say this because, after I post something like this, some post inevitably interprets my intentions as somehow bashing women or female doctors. I'm not.
There may be some gender reasons for this statistic. Or, it's more likely that the controlling factor here is the youth of the doctor, lack of experience.

An editorial with the article suggested that doctors need better training to cope with the psychological challenges of caring for patients. I would agree -- but I'd say the real training needed is in communication skills. The editorial also suggested that doctors should focus on identifying a patient’s expectations at the beginning of a visit. But that requires more time and, again, better communication skills. The editorial also reminds us that dealing with difficulty signifies mastery rather than weakness. I would agree, and that applies to all occupations and professions.
But I would add this. I believe doctors need to reexamine their definition of "difficult patient," perhaps in terms of what might be considered normal human behavior in some kinds of doctor-patient encounters. To the doctor, these encounters are normal, everyday, routine work. To the patient, they may be unique, threatening, embarrassing, humiliating and/or stressful. I think there may be a serious doctor-patient disconnect when it comes to the concept of "routine." Doctors need to understand, not just intellectually, but emotionally as well -- how "routine" for them isn't necessarily "routine" for the patient. To a large extent, that's empathy. I don't know how you can teach empathy. That most likely comes life experiences, and fits better into some personality types than others. Here's the link to the article:
http://well.blogs.nytimes.com/2009/02/26/annoying-patient-or-difficult-doctor/
MER

Joel Sherman said...

Sounds like an interesting study MER. I'll look up the original in the Archives of IM and report back. I haven't seen many studies looking at why women drop out of medicine which I believe they do in greater proportionate numbers than men. Much is likely related to greater domestic responsibilities and pressures. But I've always wondered why some women drop out of general practice to specialize in 'women's health.' Maybe it will shed some light on the issues.

Joel Sherman said...

Just looked at MER's second post from virtual mentor looking at gender diversity in medical personnel. It's a good article exploring the subject though it doesn't go in depth about how to improve gender diversity in nursing personnel where it is still lacking. I'll also post the article in the equal employment thread where it is even more relevant.

Anonymous said...

"But I've always wondered why some women drop out of general practice to specialize in 'women's health.'"

Maybe they get a conscience. Maybe more men are finally starting to stick up for their rights.

Anonymous said...

“In a predominantly clothed society, there is a shared, if tacit, recognition that clothes carry something not only of personality but also of humanness itself.” So writes Ruth Barcan in her 2004 book Nudity: A Cultural Anatomy.
There are few occupations or profession in our society that require people or bodies to get naked. Police, prison guards, airport security, funeral directors, doctors, nurses, and other medical personal. Note I said “require.” Some of this nudity may be forced as with police and prisons. Other kinds of nudity imply some kind of informed consent. But when it comes to the kinds of potential modesty violations we’ve discussed on this blog, what really constitutes “informed consent?”
“In our societies,” Barcan writes, “clothing records and symbolizes both an individual life history and sociality (and therefore humanness) itself. Thus, the stripping away of clothes has the potential to symbolize the stripping away of sociality and even of humanness.”
Barcan interviewed a funeral director who told her that in Australia (where the author is from) bodies are always buried clothed or, if no clothes are provided, in a shroud-like cloth. Clothing is seen as “a very important part of how his staff continue to treat the corpse as a human person.” I believe we could say this of American society as well.
In interviewing a medical technician who cuts up and prepares human bodies for medical students and research, Barcan comments on the “layered conception” of the human body that these people may have. It’s complicated. Referring to this particular medical technician , Barcan writes: “Her job involves embalming bodies, turning them from human person into medical specimen. The removal of clothing is an important marker in this ontological change, removal of both individuality (a particular history, an identifiable social position) and humanness (part of the transition from person to specimen).”
I’m not suggesting that those highly trained medical professionals don’t understand this (doctors and nurses) or haven’t been academically trained about this – although I question how much time is actually spent reflecting upon and discussing this issue from a personal standpoint – and reading seminal texts like Barcan’s. But I will suggest that in the routine business of everyday clinic and hospital work, nudity becomes mundane and for some, a non issue, an invisibility. They may notice patient discomfort, especially with opposite gender intimate care, but neither find the time not the correct gendered staff to mitigate patient stress or embarrassment. “They’ll get over it,” becomes the excuse – and some patients may. On the other hand, there can be a fine line between person and specimen, and unhealthy working conditions can push good caregivers over that line toward unintentional dehumanization.
A key to this process of potential dehumanization is that proverbial piece of cloth most patients have come to despise – the hospital gown. Barcan writes about how the medical technical above looks upon this flimsy article of elemental clothing. “Psychologically, she said, it is an easier process to strip the bodies of their clothes when the person arrives from a hospital rather than from a home or nursing home; the hospital gown has already helped to departicularize the body, and the transition from individual to human to specimen has already begun.”
Medical professionals need to closely examine their attitude and philosophy regarding the use of these gowns. Can they be redesigned for better modesty? When are they absolutely necessary for medical reasons and when can they be replaced by hospital underwear, shorts or pajamas? We can’t solve all these problems all at once – but it seems to me that we can start with a more humane approach to in-hospital clothing with a reexamination of the traditional hospital gown.
MER

Anonymous said...

Part 1 of 2

“The modern social contract,” writes Ruth Barcan in Nudity: A Cultural Anatomy, “deems that one has a right to be protected from the nudity of others.”
There was a recent case somewhere in the Pacific Northwest. Maybe someone here can find the specific incident and note it for us. A woman claimed it was her right to walk around naked. The town couldn’t find any law that forbade her, so they did pass an ordinance outlawing her escapades – for the protection of the public, especially children. As I recall, the town set the age limit on walking around nude at 8 years old. Beyond that age, it would be against the law.
“Women and children,” Barcan writes, “have been deemed to be in special need of protection from adult nudity (even though children are also accorded greater freedom to be nude, and women, as carers, have traditionally had closer contact with certain kinds of naked bodies: infants, sick or elderly people). Women and children have been considered more vulnerable to its {nudity} powers, a ‘weakness’ whose positive guise is feminine modesty.” I’ve written in past posts about a tradition in the history of nursing of more concern about the female nurses sensibilities in working with naked men than there is with how the naked men might feel by having a female doing intimate care. The focus culturally has been on protecting the female against the male nude.
As Barcan writes, females traditionally having “closer contact” with the sick and elderly is one thing. We’ve talked about the difference between the ER, LTC, ICU, etc. Many men accept or more readily tolerate opposite gender care in emergencies or when the are very sick. But what about the various cases we’ve heard about non critical opposite gender intimate care – what about medical pubic hair shaving?
Barcan discusses the social history of pubic hair shaving. Greek women shaved their pubic hair. The men did not. Greek men did shave their legs, but male pubic hair was considered highly erotic. Note that in Greek statuary, we see women without and men with highly stylized pubic hair. Customs in Rome varied. After the Crusades, European women adopted the depilation practices of the Middle East. Catherine de Medici later terminated that, and from then on it became a minority practice. Art, during these periods, however, never showed pubic hair, especially on women. During the women’s movement of the 1960’s, not shaving became a mark of independence and freedom for women. “Depilation can (in part) be read as a form of enforced ‘domestication’ that makes women more ‘nude’ than ‘naked’ – bringing her into culture,” writes Barcan.
MER

Anonymous said...

Part 2 of 2

Body parts can be highly symbolic.
“A hairy male body has signified virility, power and sometimes nobility,” Barcan writes. In our culture, we consider women with too much body hair as masculinized, especially if the hair is in the “wrong” places. More to the point of this blog, according to Barcan, “Compulsory depilation can also serve as a ritual device facilitating entry into and subordination to a particular institution.” Thus, military conscripts or prisoners having their heads shaved.
How about hospital shaving? What about shaving women’s pubic hair in labor? Anthropologist Robbie Davis-Floyd sees this as more ritual than rational. It separates the “patient” from the everyday world. I would suggest the same is true for what used to be the nipple to knees shave for men, too. More ritual than rational. The rational was to offset infection. Note today that this kind of shaving is not the norm – clipping only in the area to be operated on is more the standard. Shaving is said to have the potential to cause more infection. “Pubic shaving separates the laboring woman from her former conceptions of her body, and, like the gown, further marks her as being in a liminal state and as belonging to the hospital” – this, according to Davis-Floyd. The same could be said of what happens to men when their pubic hair is shaved.
My point – Much has been written about pubic shaving of women for labor and its psychological, sociological, philosophical meanings. Little if anything has been written about pubic shaving of men – how, if done especially by a female, it can represent to some men demasculinization, if, indeed pubic hair can represent virility and power as suggested. Like the gown, shaving pubic hair for both men and women can certainly represent the transition from person to object, from autonomy to possession by the hospital.
Medical professionals must pay more attention to the highly symbolic nature of the genitals and pubic hair.
MER

Joel Sherman said...

MER, I'll try to comment on your last 3 posts individually as they range very widely.
Concerning your first post, clothes do certainly make the man, or woman. We rely on them for much of our individuality. We gain all kinds of clues about people from how they are dressed and groomed. In a locker room, all this is diminished and it may be hard to tell who’s the lawyer and who's the plumber. People give up much of themselves when they check into a hospital and put on a gown. If you believe in democracy, that's not all bad but some people feel at a disadvantage and modesty is not the only issue. But of course no one would wear a tux to enter a hospital for gall bladder surgery. What is the alternative?
As you're probably aware, modest gowns are available but are generally not used. Some hospitals may have them available if you ask, but it doesn't seem to be an issue that gets raised frequently except in hospitals that serve a large proportion of religious Muslims and other orthodox sects. I assume if more patients asked, they would be more available, but lacking clear interest, hospitals shun the extra costs. My guess is that if hospitals included a survey question about better gowns, they would find a great interest in them. They likely don't ask because it would be an uncompensated extra cost. You're right though that most hospitals just don't see it as an issue. They don't inquire and patients usually just accept whatever gowns they are given without complaint. I've been in that situation too.

Anonymous said...

Thanks for your response, Joel. We're always looking for potential solutions to this modesty issue, something productive. I believe the symbolism of the gown is so strong, that if hospitals addressed the issue it might go toward making some patients feel more safe and respected. Even those who have no problem with the gown, might feel better at least being asked. Those who do have problems, might be pleasantly surprised and, psychologically, their positive feelings about how they're being treated might transfer into other areas of their treatment in the form of trust.
Why couldn't some hospital do a study/experiment with certain departments where modesty issues might be most evident? They wouldn't have to go the whole expense of all the modesty gowns, just enough to run the study.
But you're right. A case of where they know that if you ask you'll get answers, not necessarily the answers you want, and answers that will cost them more money. Back to money.
The gown seems like a simple issue. But sometimes fixing the simple issues can make the biggest difference.
MER

Joel Sherman said...

Relative to MER's double post of 5 days ago:
An example of legal nudity and its problems occurred in Brattleboro VT. Apparently nudity there has traditionally been legal though not well publicized until a couple of years ago. Some teenagers then paraded downtown nude as a prank. This got some national or regional publicity and ultimately drew adult out of town nudists to make use of the same custom. Not surprisingly, this got many complaints from the locals and eventually the law was changed. However it may have been amended again to permit some nudity. I can't keep track of it. But one thing is sure, public nudity in any form is bound to attract attention and controversy.
I never gave much thought to the symbolic importance of pubic hair in different cultures and those comments I find interesting. I personally would not be happy having a nurse or worse, an assistant shave me there and would likely refuse. No reason why a conscious patient for elective surgery can't do it themselves. It is not rare for patients to be instructed to prep the area of surgery (doesn't have to be genital) the day before or morning of surgery. That is much more acceptable. I personally don't worry what happens in this regard after I'm under anesthesia, but many contributors here would. It would help if all patients were instructed how to prep themselves. Lacking this, it would be wise to ask the surgeon ahead of time.

Anonymous said...

Would it really be that difficult to prep patients privately using same sex nurses?
Once draped, most of us wouldn't care (unless the surgery exposed our genitals)
Our privacy and dignity are more likely to be violated when we're being prepped and perhaps, at the end when the drapes are being removed.
Also, why not all male or all female surgical teams for gyn and urology surgery?
Makes perfect sense to me, if you set out to create these teams, you'd be offering a service that people would probably travel to use...give your hospital the edge.
Janie

Anonymous said...

"Why couldn't some hospital do a study/experiment with certain departments where modesty issues might be most evident?"

If I was handed a normal gown knowing that other people in the same hospital had better ones I would get pretty upset and demand the better gown. But I like your idea MER. If given the choice I think MANY would respond and take the better gown.

Janie, I like your ideas.

GR

Joel Sherman said...

Here's an article about patient stereotypes concerning dentists. As this is a profession that has little to no intimate contact you would think it would be minimal, but instead the old stereotypes come to the fore. Women are thought to be more empathic whereas men are considered more dedicated and perhaps more competent (in control).
There are more factors that effect our gender preferences besides how we feel about intimate care.

Anonymous said...

Dr Sherman,
My father only uses female accountants because he studied criminology at University as an elective subject and discovered that men are far more likely to swindle you...something like offenders were 90% male and 10% women. The women were usually gambling addicts. The men stole for lots of reasons, a grander lifestyle, to reduce debt burden, to fund addictions of various types.
Everyone in the office at his work is female. He says every cent is accounted for...
NV

Joel Sherman said...

That's news to me NV. I would have guessed that the difference wasn't that great in non violent crime. It's also not my impression from reading the daily local newspaper where many of the white collar crooks are women.
But one thing I am sure of is that your father's employment practices are illegal under federal equal employment laws. Female sex is not a BFOQ for accountants.

swf said...

I would be surprised if those statistics were valid. I worked as an auditor for 10 years, and controlled money for another 10. The amount of men to women that attempted theft was fairly even, but the willingness to believe women were thieves was very low. Perhaps it is really an issue of denial.
I have a tendency to dis-believe that genders are as far away from each other as predominated. Statistics are changing, and we are all quite similar, even if we do not want to believe it.

Anonymous said...

If you wonder why patient modesty is sometimes so low down on the priority list in health care, listen to this youtube bit called "If Air Travel Worked Like Health Care." If this doesn't make you laugh, nothing will.
MER

http://www.youtube.com/watch?v=5J67xJKpB6c
MER

Joel Sherman said...

Here's a good US based article on women's preferences for ob-gyn care. As in most studies, the majority had no preference to gender preferring to base their choice on other attributes. Of those who did care, most preferred women, but once again, men were acceptable to over half the respondents.
The full article is here.
Here is a summary graph.

Joel Sherman said...

MER, I listened to the video through. (Actually I had previously heard the first minute of it.)
It is of course a satire on the lack of transportable records in our so called health system. I've talked about this somewhat on the EMR thread.
Unfortunately it's easier to make fun of the system than to fix it. I don't believe that anyone has the slightest idea how to develop a fully transportable digital health record despite Obama's infusion of billions. It needs to be usable by Medicare, Medicaid, 50 states and a 1000 insurance companies all with different requirements and regulations. Plus we're not dealing with numeric data like bank statements or flight information. A human being is many orders more complicated.
Don't hold your breath for a fix.

Anonymous said...

Good points, Joel. But I think it's more a matter of will than it is technology or complexity. We have teh ability to do this much better. When you've got 300 people on a plane the stakes are high, safety wise as well. What seems like logistical problems can quickly turn into safety issues in some cases. No question -- medicine is different, it's a different kind of complexity, a more human complexity but not impossible to fix.
But I won't hold my breath, yet. I do have confidence that we can and will if not solve this at least manage it much better. It has to change. People are getting fed up. And, as with airline safety, the logistics of this paperwork and communication can quickly turn into safety issue under the right/wrong circumstances.
But it's a funny video, anyway.
MER

Anonymous said...

I don't take that sort of research as gospel.
Many women are still reluctant to say they prefer female care. There is still a bit of the old, judgemental attitude out there...that women are silly if they worry about such things.
I saw some research a few years back that showed some women don't request female doctors or reject male doctors even though they strongly preferred female doctors because they feared they'd be ridiculed or made to feel immature or silly, but when they simply had to tick a preference on a form...a huge number selected female doctors. (for intimate exams)
I've always seen female doctors even though I rarely need intimate exams, I just prefer them...but I know women who've suffered extreme embarrassment with male doctors because, "they didn't want to make a fuss".
I don't think we all tell the truth when it comes to surveys and often we suffer, because we feel unable to make a point.
I know many women cite "no time, too busy" as a reason why they don't have smears. I don't believe that...I think many don't like the invasiveness of the test, but feel like they'll be judged if they tell the truth - too busy is easier for them.
Also, if you want a female gyn in Australia it usually means a wait...I think only 30% or 40% of gyn's are female, but that's changing as each year goes by...
I think as more become available, more women will see female doctors. At the moment a wait might cause worry or may not be possible if you're in pain or just discovered you're pregnant.
A friend is a receptionist in doctors rooms. They had a new female ob/gyn start last year and many of the patients seeing the male gyn's immediately transferred to her care. They had been unable to get into see a female ob/gyn. (they weren't taking new patients) It worried a couple of the male gyn's.
I think it makes perfect sense...it always puzzles me when I read an article pondering why some women reject male gyn's like we have 6 heads...I think it's perfectly understandable. I also see why a male patient might reject a female nurse doing an intimate procedure.
One size doesn't fit all...some people ar nudists, others go topless at the beach, some undress openly in gym locker rooms, others use the cubicles...we all fell differently about modesty and privacy.

Anonymous said...

Dr, the thing about those studies is they include women who had no choice as young women...there were no female doctors. Most had to find a way of coping...my Aunt said she went into brain freeze when she saw a male doctor for something embarrassing, but would not have asked for a female Dr for fear they'd think her a silly old woman. You see...women were made fun of when they asked for female doctors in years gone by. That has made older women reluctant to ask...many just lump it. Others got used to it or found a way to cope.
Now there are middle aged women who've always used female doctors and are confident to ask. People often say older women don't care about male doctors, but they are the women who had no choice for much of their lives.
I think as women age now...they'll stick with the choice they made as young women.
I don't see anything wrong with that...
I wonder if you looked at those stats whether they'd show many of the women who didn't care were older than 55 or 60...I think those stats will change in years to come.
I know my nieces all see female doctors and used female obstetricians and midwives to have their children. They are now in their mid 40's and still seek female medical care.
Interesting discussion.
Avis

Joel Sherman said...

Ladies I agree with you that the study did not clarify the ages of the women who took the poll. Yes young women clearly prefer same gender ob-gyn care to a much greater extent than older women. I disagree though with the implication that all women would prefer same gender care if they had known it. A large number of older women have now had care with both men and women ob-gyns, and still don't have a strong preference. My wife saw a woman for awhile, and then switched back to a man. Personality, not gender, was the reason for the switch.

Anonymous said...

Joel:

I finally read this article by Margaret McCartney:
http://www.guardian.co.uk/lifeandstyle/2005/may/03/healthandwellbeing.health1

I was curious because one of your posters wrote: "I don't agree with getting rid of the box for gender preference either....I'll forgive her that one..."

The link and discussion is on your "Women's Privacy Concerns" thread.

McCartney questions the whole idea of gender choice, but here's kicker. She writes: "Well, what mattered to me most when I gave birth was that the hospital was decent, etc., etc., etc. "Me, Me. Me." She extrapolates from her experience that her attitude "should be" the attitude of everyone else; that her attitude is the "right" attitude; that patients can't walk and chew gum at the same time, that is, they can't want same gender care and the best care; and, that the health care system can't walk and chew gum at the same time, that is, give the best care possible while still respecting gender choice."
Note how she makes this ridiculous statement: "If a male patient didn't want to see a woman consultant about, say, his dodgy gall bladder, should I think that's OK and tick the box for a male consultant?" Two points about that:
1. Whether she thinks it's "okay" or not isn't the issue. Respecting the patient is the issue. Maybe should should talk with the patient and find out why. There may be a good reason -- and if there isn't, maybe an open discussion of the issue might change the man's mind. Communication.
2. She equates a gall bladder problem with extremely intimate genital procedures and care. I would suggest that although some men may not find it comfortable having a women doctor for anything, these men are in the minority. If most men are sensitive at all about gender, it's mostly related to intimate kinds of care and procedures. I don't see why some female (and male) can't understand that -- yet they sure understand it about their female clients.
I do want to say that I admire McCartney for the other stands she takes, but not this one. She has many good points to make about many different issues.
You should post this article under chaperones, and under one or two other of your threads.
MER

Anonymous said...

You often hear that from people, although my main pains were women. I chose a female gyn when I got pregnant in 1995. Every friend without fail exclaimed when they heard about my Dr, "oh, have you got a female Dr, how silly, it doesn't matter".
Because they had male doctors, I was expected to explain my "bizarre" choice.
Even professional women challenged my choice of professional woman to help me give birth.
I was made to feel silly, petty and immature. It did take some doing in 1995 because you had to be on the doctor's books BEFORE you got pregnant. I saw my Dr a year before I got pregnant to make sure.
Much of that is now gone and there is now an acceptance that some women will choose female doctors...in fact, increasing numbers. Several of my critics now have female doctors themselves.
We have a battle to start...but slowly acceptance follows. Men need to fight for male nurses and the same will happen.
Maggie

Anonymous said...

This preference is something new and many younger women forget about that...
I helped pack up an elderly lady's home recently. I found a book on women's health and a chapter on smears and other intimate exams.
I was shocked to read a comment...something like - some women find these exams embarrassing but remember the doctor is used to viewing naked women and this is all in a days work. Even if you know this Dr socially, remember your health is more important.
I was shocked...and spoke to my Aunt about it.
My Aunt looked at the date the book was published and it was 1968...she reminded me there were very few female doctors around back then and only one or two female gyn's.
She said many women living in small towns or in the country might find themselves seeing a Dr they knew socially.
I'm very relieved those days are gone. I have only seen a female Dr and that is definitely my preference.
I felt really sorry for the women who had no choice of doctor.
We take that for granted today.
I think everyone should have same gender healthcare if that's their preference.
Tilly

Anonymous said...

Here is a good example of where we are regarding patient modesty and the double standard in American medicine:

The first site below is for young girl teens needing pelvic exams. Note that these girls are told some girls may prefer a male doctor and others may prefer a female doctor. They are told that if they choose a male doctor, he will bring in a female chaperone. Note that the sensibilities of these young girls is respected. The fact that they have a choice is emphasized. Here's the site:
http://kidshealth.org/teen/sexual_
health/girls/obgyn.html

Now, the same site has a page for young male teens about testicular and hernia exams. No choice is indicated here. The "doctor" is consistently referred to "he or she" throughout the text. The young men are even told that they may get an erection and that it is not uncommon, not to worry about it, and that it will not bother the "he or she" doctor. The point here is that these young men are not told they have a choice and there is no attempt to respect their sensibilties.
Here is this site:
http://kidshealth.org/teen/your_body/medical_care/testicles.html#

It's about communication, about giving complete information, about recognize that both genders may have modesty problems, that both genders should have a choice. But it's clear that young men are expected to just accept whatever gender happens to come along into the exam room. The double standard is quite clear here.
MER

Joel Sherman said...

Nice comparison MER.
It's worth pointing out though that the girl's site is reviewed by a woman and the boy's site by a man.
It doesn't occur to the man that gender choice should be equally applicable to boys.
Of course in practice, it's not equally available.

Anonymous said...

The problem men have with their modesty being respected has more to do, I believe, with the attitude of other men in power than with women. Look at what we've seen regarding how some recruits were treated during group physical exams. Males were in charge of those exams. Look at male doctors who bring in female note takers and nurse assistants to assist during intimate exams and procedures without asking the male patient. In today's world, male caregivers have too much to lose if they're not savvy regarding how they treat female modesty -- and the men know it. Apparently, they think they have little or nothing to lose if they ignore male modesty. Or perhaps they think it doesn't exit. What are your thoughts on this?
MER

Joel Sherman said...

This topic does need analysis. Preliminary thoughts:
I think that group physicals, especially military physicals, are unrelated to what doctors do in their private practice.
During the draft era, the military was ruled by a desire to process as many men as possible in as short a time as possible. A secondary thought was to turn these raw recruits into 'men' as quickly as possible and arbitrary discipline and humiliation was considered fair by many. In short, they didn't care what the recruits thought. In general, the physicians involved didn't have much to do with the procedures of the examining stations. They were cogs in the wheel. We must also remember that group male nudity was routine in that era, though the presence of females was not excepting nurses who were always acceptable.
Doctors in private practice are a different matter. Personally I don't know any male doctors who bring in female note takers during intimate exams. I doubt that it is common. Do you know differently? I’ve seen stories that female doctors do it, but I can’t judge how many of the stories are fiction. Most doctors give little thought to male modesty, but they have little to gain by humiliating their patients. They just need to be reminded.

Anonymous said...

Joel:

It's not uncommon among dermatologists to have all female staffs, med. assts., and and they are used to take notes. I do believe that most dermatologists, if the male patient objects, will do the exam alone, shield the patient, or have the asst. leave at certain points. I have to think this, but I don't know. How about urologists? Most of these offices don't have nurses anymore -- med. assts., and most are female -- but I did a brief survey a few months back and called various urologist offices. Only one didn't have a male asst., and they were looking for one.
I think what happened with the draft during the Vietnam era may have been unique. We were in the midsts of changing sexual and bodily mores. You're right. Nude men in groups doing certain activities has been traditionally a bonding ritual. But women were never part of the ritual. That changed during some of those Vietnam War recruit exams. I don't think it was purposeful, allowing those female clerks, to humiliate the men. But it did happen. The old male bonding ritual was permitted to die due to logistical problems (small spaces, not enough staff, large numbers). Add to that the turmoil of the 60's, draft riots, etc. In many cases, these young men were purposely examined nude in order to control them, to prevent any kind of challenge during a time when the draft and the war was being challenged. Psychologists and psychiatrists purpose examined these men in the nude because it was thought they would get more honest answers. And yes, these doctors were just taking orders -- but who was giving the orders? Other men. It was the men in power themselves who broke the "rules" of these nude male rituals.
Your other point -- "the presence of females was not excepting nurses who were always acceptable." I don't agree. Except in emergencies, it wasn't that long ago that nurses did not "finish" the bed baths on men. They had to call in a male orderly. Most female nurses were not allowed to cath a man -- if a male nurse or orderly wasn't available, the doctor had to do it. This started to change in the 1970. It's unclear about things like pre op shaves, etc -- but I think until the 60's or 70's, male orderlies did that in normal situations.
There's a thread on allnurses called "You know your old school when..." Check it out. The older nurses are writing about this kind of stuff and these issues come up. The thread is quite enlightening, and interesting from a historical point of view to show how quickly medicine has changed in the last 30 or 40 years.
MER

Joel Sherman said...

MER, I disagree with one point. Twenty plus years ago nurses did not do procedures on men or handle their genitalia routinely, but their presence was acceptable. In fact it was probably more common than today. Nurses were physicians' handmaidens in those days and followed doctors around. Today they are well paid professionals and no one can afford to pay them just to stand around and watch.
As I said, I don't know how common it is to use note takers during patient exams. Undoubtedly a few physicians use them, but it is expensive. We are gradually switching to a high tech system using electronic medical records where physicians can make notes as they go.

Anonymous said...

I'm sure you're correct, Joel. On the other hand, as we've talked about on different threads, these "notetakers" are most likely considered more as chaperones. If you need to have or feel more comfortable with a chaperone, you might as well have them do something.
MER

Joel Sherman said...

Actually MER, most note takers are really there to take notes, not primarily as chaperones. Transcribing medical info takes some special training; chaperoning takes no training as it is usually performed. Accurately noting the lesions a dermatologist describes has to be thorough and accurate. A medical assistant just out of high school couldn't do it without significant training. That's not to say that note takers don't also serve as chaperones when present, but I think that is incidental in most cases. My guess is that only a small percentage of physicians use note takers. It's another level of expense.

Anonymous said...

Joel:

I would think that qualified chaperones, to be relevant and credible, would need to know enough about the exams or procedures being conducted to note if something were out of place, or to note communication problems. Otherwise, they could only recognize the most blatant kind of abuse, which most likely would never take place with a chaperone present. Somewhat of a paradox.
MER

Joel Sherman said...

MER: qualified chaperones, to be relevant and credible, would need to know enough about the exams or procedures being conducted to note if something were out of place, or to note communication problems.

That's correct, but I said as usually performed, where their only real function 90% of the time is to protect the physician. They do need to be trained to not only protect the patient but also help the patient through the exam which may be very stressful especially a first pelvic exam. I'm sure some chaperones are really trained to help patients face gyn exams, but it's the exception.

Anonymous said...

I see what you're saying, Joel, but the irony is that an unqualified chaperone has no credibility which includes protecting the physician. Can you imagine an unqualified chaperone on the stand being cross examined by a talented lawyer? What kind of training have you had? How is this exam conducted? How could you know this or that with no training? Etc. They'd be crucified. I would think the jury would buy the patient's testimony much more readily than that of an unqualified employee of the person being accused. That's why I can't understand why some doctors think these unqualified chaperones are actually protecting them.
MER

Anonymous said...

"Personally I don't know any male doctors who bring in female note takers during intimate exams. I doubt that it is common. Do you know differently? I’ve seen stories that female doctors do it, but I can’t judge how many of the stories are fiction."

Female doctors just don't seem to understand or care about male modesty. While I personally would never let a female doctor give me an intimate exam or procedure I understand why other men would be more comfortable with a female doctor than with her support staff. They don't seem to get that. How in the world a female doctor would believe a male patient would be more comfortable with two women gawking at him then to be alone with him I'll never understand.

Unfortunately there are enough male patients that are exhibitionist perverts that they ruin it for the rest of us. I hear complaints about all of us stereotyping female nurses but I think healthcare women stereotype all of us men even more. Just because some men enjoy being gawked at and fondled doesn't mean all of us do. Some of us have morals and are faithful to our wives.

swf said...

Here is something that I think is interesting. Maybe a few of you knew it already, but sometimes one can miss the obvious:
Female caretakers consider me a sort of traitor.
When all honest conversations are over, these women understand perfectly well the modesty issues of men. They have issues themselves with opposite gender care. They even have their own horror stories, and some will admit being upset with the idea of opposite gender care for their spouses. Their issue with me really is (partly) this:
More male nurses mean less female nurses. (jobs)
More male nurses mean less readily available choices for women.
Everyone is afraid of change, and what it means to them. But more importantly, if women have a job market cornered then the last person they expect to fight that is another woman.
"Why is this your problem?" they yell. "If men have a problem with us let the men take care of it".
I guess history proves that for everyone who wants a right, someone is afraid it will take their's away.....
I only bring this up because most will admit to liking a few male nurses available: but just a few.

This isn't going to stop me from advocating, but it might change my tactics a bit.

Anonymous said...

I think these are bigger issues for Americans because you all seem convinced you need total body examination every year of your life.
This means you're more likely to run into problems and have these concerns. I've seen the same doctor for years and only go into the surgery when I'm ill. I recently turned 45 and will have my blood pressure and cholesterol checked every couple of years.
My wife and I are not convinced about the value of screening tests - these extra tests often involve intimate exams, another opportunity for your modesty to be violated.
Even skin exams (I don't have any moles so my Dr said an exam was unnecessary and just come in if something new appears or something changes) seem mandatory for everyone in the States and they include the genitals. I know a few people who surfed for years and they have checks, but are given information so they can check their own genital area. I guess if you wanted the doctor to check that area you could make a request, but most seem happy to stay in their underwear.
Perhaps, it might be time to look at the need for many of these exams and tests.
Bill

Anonymous said...

"More male nurses mean less female nurses. (jobs) More male nurses mean less readily available choices for women."

swf -- Unfortunately, you're correct. I've stated your argument several times in past posts. That's why I've brought up issues of discrimination against men in nursing. Lack of men in nursing, why there are not incentives, affirmative actions, quotas, etc. under gender equity -- is a political issue, not just a social gender issue. It has more to do with power than anything else. As you say, most nurses enjoy men in nursing when it's only a few and female jobs are not on the line. That's understandable. Men would feel the same.

I don't think we'll ever get to 50/50 in nursing. Men just don't seem to "prefer" that field. Some studies suggest that reasons why, for example, we don't see more women in science or math, is really a preference issue, certainly not an intelligence issue. I also don't think we'll ever get a 50/50 gender balance in fire fighting or the military. But there's no reason we can't up the ratio by giving incentives to those men and women who have the inclination, desire, and talent in these areas. For many years (between WW1 and the Korean War) men were forbidden to join nursing unions and were not admitted to nursing schools. Of course, women ran into the same problems with medical school and male unions. But that's changed for women. It hasn't changed much for men.
But the lesson, I think, in your post is that because female nurses are aware of the male modesty problem, it's more difficult for them to ignore it when pressed. That's the key. "When pressed!" When men press the issue.
But, as I've stated, now, many of these intimate exams and procedures and done by cna, cma's and other nurse assistants. They have little clout, no power within the system. If they're told to do something, the'd better do it. Nurse supervisors don't want nurses or assistants constantly saying the can't do this or that because the patient is modest. They want to keep their jobs. So -- they come up with strategies to get the job done regardless of male modesty -- and with men that isn't to difficult because men most often won't speak up or complain.
MER

Joel Sherman said...

Interesting observation, swf, though not at all surprising.
Can I ask if this is your general observation of how things work or have you talked or interacted with nurses on this topic? If the latter, I think we'd all be interested in as much detail as you can give.

swf said...

Yes Dr. Sherman, I have interviewed caregivers, future caregivers, and those just thinking of going into the field. I'm not sure that my specific conversations are interesting to anyone, but moreover that they have taken a shift in admitting the awareness of modesty, and even the preference for same gender care.
I personally believe that what that means for advocates is that we can stop banging our heads against the wall and saying "Why don't they get it?" and renew the effort as to what can be done about it. Because...of course they get it. Almost all humans have some modesty issues. We are not so different as people that the concept of nudity with strangers is a mysterious concept.
However: my newest conversation (not the yeller) came to me after thinking a few days and said she believed that it was a matter of men not being humble enough to ask for care, whether intimate or not.
Once they humble themselves, it is easier to perform intimate care because they are now passive.
I'm not sure how this sounds to others, but to me it still means coersion of sorts. "Becoming humble" and humiliation are too close for comfort as tactics go.
So, although they are admitting men have concerns or preferences, they are still activly seeking manipulative tactics.
I'm not sure if this is the kind of info you wanted. (?)

Joel Sherman said...

Thanks swf, that is very interesting.
I'd encourage you when you can to give fuller details, such as how many women you interviewed and what kinds of questions you asked them. Your informal study is worthy of more attention.
I know that's asking a lot and I won't be disappointed if you don't want to add more. You're to be commended for attempting to obtain some real information.

Anonymous said...

We're often told that we're safe at the doctor's surgery, they are professionals and don't see us as sexual beings, we're a collection of organs and limbs.
Well, that doesn't say a word about our feelings. I'd never see a male doctor unless I knew precisely what the exam might involve, so often consults end up being about things you didn't even imagine might be relevant. I find it difficult to refuse things in a consult room and therefore I see a female doctor.
It's washed away as ridiculous, but we are at risk sometimes, we don't know what is going on in a doctor's mind or his/her background. I've never heard of a female doctor assaulting a male patient, but I've heard of male patients assaulting female doctors, there was a case last year. I have heard of female nurses behaving improperly with male patients and there are lots of cases of male doctors and others assaulting females.
I don't agree with whitewashing over the subject. Even if the risk is small, if it happens, it's devastating and scars you for life.

My friend walked out of a consult with an unknown male doctor who was behaving in a creepy way and asked her out on a date. She declined and left feeling very confused. She rang me, "Is it improper for a doctor to ask a patient out on a date?" He also asked her if she needed the Pill and tried to delve into her sex life. (or if she had one) He was also trying to talk her into a pap smear. She was there for a sprained wrist!
She plays beach volley ball and has a great body, she's always being hassled by men. She thought she was safe at the doctors, but now thinks that's naive, men are men after all. She also thought the power of his position made it easier to take advantage and hide unsavoury motives.

Her mother said he was probably being proactive about safe sex, but didn't think asking her out on a date sounded right, had she misunderstood what he was saying?
She also said doctors often raise smears in unrelated consults. She didn't want to believe that a doctor might behave improperly.

I think risk varies throughout our lives and the young and very attractive are most at risk.
She decided to see a female doctor from that point on.

It's a reminder that these people are out there, a wolf in sheeps clothes. We also can't rely on the authorities to deal with these people effectively. This doctor (see linked article) is still practising whatever it is he practises, certainly not medicine.
Very worrying - any of us could walk into his exam room not knowing his history. It makes me shiver, it's like putting a rat in charge of the cheddar cheese!

http://thedawnchorus.wordpress.
com/2008/10/29/dr-sabi-lal/

Kathy

Joel Sherman said...

Kathy,
Just to be clear, it is never proper for a physician to ask a patient out on a date.
In the US, in order for it to be ethical, the patient physician relationship has to be formally ended first. If the physician is a psychiatrist, any personal relationship is improper no matter when it occurs, even years later.

Anonymous said...

I can do that. The survey will be easy to post but it'll take a few days to do stats.

swf

Anonymous said...

" Unfortunately, you're correct. I've stated your argument several times in past posts."

MER: Part of my advocacy 'evolution' is to try to take advice from (some) others and your past posts about the issue helped change some of the ways I conduct my surveys. Letting go of my nature to believe that people will do the 'right' thing and face that they will usually only do the necessary thing (again something you and I discussed) allowed me to get to the heart of women admitting the truth of their issues with male modesty.

You read....you learn. Thanx.

swf

Anonymous said...

"Once they humble themselves, it is easier to perform intimate care because they are now passive."

swf -- This is a very disturbing attitude. It goes to the whole issue of power that I've written about and you'll find addressed in many medical training and sociology/psychology texts. Caregivers who insist on a humble attitude on the part of their patient, are playing a power game. As you suggest, it's no accident that the words humble, humility and humiliation come from the same root. But that quote from the caregiver is fascinating. I've never heard the "humble" argument used. Those who use it have a serious need for humility themselves.
MER

swf said...

http://afpmgoals.blogspot.com/

Perhaps anyone interested in working together can revisit the advocacy site where (with permission)ideas from Dr.'s Sherman and Bernstein has been consolidated.

Any new ideas or info updates would be appreciated.
You can check out past great ideas, or post in the general comments.

Renewing interest in the site would be a great step forward. Thanx to all who sent these great ideas flying our way.....

Joel Sherman said...

Thanks swf. I have not been aware of this site until now. Hope everyone will contribute ideas. I will copy your post to the organize thread as well.

Anonymous said...

Dr. Joel Sherman

Is it common to hate your own gender? Some women here seem to really hate women. I don't get it.
They seem O.K. until you read these posts.
Isn't that sort of a part of a gender war too??????

confused

Joel Sherman said...

Well I don't see it that way 'confused.' Although a minority of both sexes do prefer opposite gender care, that's not related to hating your own gender.
Most of the rest of us have spouses, children of both sexes, and significant others who are of equal concern to us. I try to get everyone's perspective on these issues. I have learned most from the women's thread because I knew less about it from the beginning.

Joel Sherman said...

Here's an interesting article from Stanford University about teenagers' preferences for the gender of their provider. I have summarized the results:

Journal of Adolescent Health; 1999, 25:131-142.

50% of girls preferred a female provider with 48% having no preference. 23% of boys preferred a male provider with 65% having no preference. Younger girls preferred to have a parent present whereas boys had no preference. Older children preferred being alone with the physician. 57 and 66% of girls and boys respectively spoke privately with their physician. A possible criticism of the study is that intimate exams were not looked at separately.

Anonymous said...

As you note, Joel, this study is not specific as to the kinds of exams we're talking about. It seems to be focused more on communication, that is, talking about sexual or other personal issues. The Australian study is the best I've read. They addressed specific kinds of procedures and exams. In the study you quote, are these girls and boy being asked how they would feel about a male/female dealing with a genital exam? If they are, the study isn't clear. There is a real homophobic tendency on the part of some male teens, maybe female teens, too. That hasn't been studied. Also, I note that this study mentions that many of these youths hadn't had an exam in years. What do they know about hospital care, intimate care, exam specifics. If they haven't had the experience, esp. the boys (the girls would be more likely to have intimate exam experience), how could they possibly know how they feel. It always amazes me that studies like this always ask what but never ask why. That's the key. Why do patients prefer one gender over an other and under what circumstances. I'm constantly surprised at how inadequate most of these studies seem to be, except for the Australian one. I would also want to know the motivation for the study -- why were they done? Why was gender an issue important enough for these researches to do a study? How do we find that out? That answer could indicate the potential biases involved.
MER

Anonymous said...

Not sure where to post this, so I'll put it here

Gale Sheehy, who has written books about male and female life cycles (Passages…), has written a new book: “Passages in Caregiving: Turning Chaos Into Confidence. In an article in the May/June issue of AARP magazine, she shares her research into male caregivers. She writes:
“Many male caregivers keep this role a secret. In two years
of research and hundreds of interviews for my new book…I discovered that many male caregivers fear a sigma in the workplace. Among men and women who work full-time while taking care of adults, it’s the men who more frequently try to hide emergency phone calls, doctors’ visits, and other distractions that come with the role.
“And men tend to approach the job of caregiving differently from women, I found. Most men who help care for family members opt for executive tasks such as dealing with insurance companies. Women caregivers, by contrast, are more likely to do hands-on tasks. The AC/AARP study confirms this. Though male and female caregivers employ about the same amount of outside help – 35 percent used paid aides during one year – among caregivers of people over 50, men are more often the ones who arrange that help. But men are only half as likely to assist with the more personal task of bathing. Men who do shoulder the work of dressing and toileting a family member are particularly reluctant to talk about it. It isn’t seen as manly, many told me.
“Male caregivers opened up to me after learning I had cared for my late husband for years. Often, when they did confide in me, painfully buried emotions – embarrassment, inadequacy, despair – bubbled to the surface.”

Her research raises many questions regarding our topic here. Do the men who regard the intimate work of caregivers as “not manly,” then prefer female nurses? Or does their general embarrassment about the whole issue lean them toward having a male nurse? Are men who are unwilling to talk about this subject when it comes to them caring for family members, even more reluctant to talk about this subject to caregivers when it comes to care for themselves? Does this research just reinforce the fact that men don’t speak up? Sheehy’s book should be interesting.
MER

Anonymous said...

Found this comment on an old allnurses thread that's reopened. The thread is about the double standard that sometimes prevents male nurses from working with female patients but allows females to work with males.

"Every time I see this sort of thread open up, there is always opinion on what amounts to two different subjects.

Subject one: What the patient wants - yea, verily. If a patient is more comfortable with a nurse of the same sex, then by all means, accommodete the patient's needs. I don't think that I've seen too many responses that say that the patient doesn't get what they want in terms of the gender of the provider.

Subject two: Management's response to assignment of staff to patients based solely on gender. This is the area that is going to generate some issues. Unlike "subject one" this proclivity to single out men for perfroming (or not performing) a particular task in nursing based on their chromosomes would, in any other career field, would be grounds for a discrimination suit.

I think we can agree that the patient's desires come out on top regardless of how reasonable we (the nursing staff) might view that request. Even if it bucks the current zeit geist for gender relations, we are bound by "patient bill of rights" to respond accordingly to their request. Anyone disagree?"

My point in posting this: As I've consistently contended, I believe this is the standard in nursing today. It's not 100 percent, but the vast majority of nurses know these requests are tied into the patients bill of rights. Problem is, most patients, espeically males, don't realize this. And even if they did, many males just won't ask, even politely insist on same gender care. Men need to understand that in most cases, when dealing with nurses, especially in large hosptials, they will be accommodated. Especially if you insist and remind them of that patient bill of rights when it comes to your dignity and values.
Where's the problem, then? It's with doctors in private practice, especially in clinics -- dermatologists, urologists -- doctors who dont' hire nurses at all, but medical assistants, and don't hire any male medical assistants. This is where you need to do some research. Find out about their staffs before you make an appointment, and then insist on what you want.
Problems also exits for those who want all male operating teams. But I dont' think it's impossible.
Here's the URL for that thread:
http://allnurses.com/men-nursing-forum/great-double-standard-190171-page2.html
MER

Joel Sherman said...

Thanks for the comments MER. I know Gail Sheehy's first book Passages was a big seller, Did you read it? Is it pertinent to these discussions? I think we even have it. Passages in Caregiving: Turning Chaos Into Confidence will be out in May.
Concerning the allnurses thread, I am always impressed by the wide variety of responses, experiences and opinions. Some male nurses hardly ever have the problem caring for women; others are told they shouldn't and never given a chance. Clearly there is no standard policy on these subjects throughout American medicine. It usually just depends on the nurse involved, often the head nurse or instructor in the case of students.
There's another factor worth mentioning. Some patients have gender preferences because of prior sexual assaults or harassment and will never be comfortable with an opposite gender nurse. But many others, mainly women, are uncomfortable because they've never experienced opposite gender care and are fearful. In the latter case, many would find it to be no problem once they've actually experienced treatment from a caring respectful male nurse of which there are many. Since most men have experienced care from a woman, they are more comfortable with it. But women will become more comfortable with male care as well once they try it. I don't know the percentage of patients, both men and women, who refuse opposite gender care, but they are a minority of both sexes. Just as our society was once intolerant of racial prejudices and prejudices based on country of origin, prejudices based solely on gender stereotypes will diminish with greater exposure.

swf said...

Dr. Sherman.
"Just as our society was once intolerant of racial prejudices and prejudices based on country of origin, prejudices based solely on gender stereotypes will diminish with greater exposure."
I'm fairly certain that you are not saying that modesty is usually based on prejudice. (?)
I know my modesty, and most of the people I interview isn't. I've been very open with my reasons and modesty concerns, and would hate to think people would reduce my ethical issues to prejudice.
I have to assume that you mean a select few may base their concerns on that?

Joel Sherman said...

swf, I was not referring to modesty with that statement, I'm referring to gender preferences based not on modesty alone but on a feeling that men (usually) can't be good nurses or caring individuals. This is indeed a significant proportion of why some patients (women and men to a lesser degree) prefer their nursing care to be performed by women.
The definition of prejudice: A prejudice is a prejudgment: i.e. a preconceived belief, opinion, or judgment made without ascertaining the facts of a case. The word prejudice is most commonly used to refer to a preconceived judgment toward a people or a person because of race, social class, gender, ethnicity, age, disability, political beliefs, religion, sexual orientation or other personal characteristics. From Wikipedia.
Modesty is a separate and an unrelated reason for gender preferences and certainly I would not term that a prejudice. There are many reasons for gender preferences and as MER has pointed out, the reasons have been very poorly studied and explored. Many studies have looked at gender preferences, but few indeed have asked why the participants had those feelings.

swf said...

I do think it is interesting to ask people why they have preferences as to gender care. I have noticed 5 general reasons, perhaps others have different ones.
1. Religion
2. Moral (sorry: I know that is a sensitive one)
3. Ethical
4. Entitlement
5. Past abuse history
I have to admit that I don't remember having ever run across someone who feels (or at least admits to me) that a certain gender is enately not capable of the job. Yes, that would certainly be prejudice. Since I have to claim ignorance here, is this fairly common?

Joel Sherman said...

I certainly don't know how common it is swf. It's certainly mentioned in articles as a factor to some people. Same problem; there's just not much reliable information.
Your 5 reasons are interesting. Though they are not the same, morality and religion are interrelated with most people. That is they base their morality on religious beliefs or teachings. Not sure what to make of entitlement as a reason. It just begs the question, 'why do you think you're entitled?'

Anonymous said...

I am not in the remotest bit interested about how capable a female is.I don't want female care in intimate circumstances because i don't want females no matter how capable to be present when i am naked.

I would be happier with a plumber who was male before I would accept a female urologist.

Some will think I am being silly, i assure i am being serious

Anonymous said...

From a female student nurse on a nursing blog. Attitudes are changing:

"I would say that male and female nurses (in the US) should be expected to do the same tasks and give the same care UNTIL THE PATIENT REQUESTS OTHERWISE. But this also means that nurses should offer patients a choice right from the start, so that the patients who are afraid to speak up are encouraged and given an opportunity to do so. If you enter the room and say “you need a catheter for this reason” and explain the procedure, THEN SAY “if you are comfortable with me placing it, I can do it now, but if you would prefer a nurse of my opposite sex, it would be no problem for me to get one for you,” the patient does not have to go out of his/her comfort zone to request someone else."

She does have some unsettling things to say about how "chaperones" are handled, but I think she represents a younger generation. You can find this blog at near the bottom:

http://www.realityrn.com/visitor-topics/should-male-nurses-do-all-that-female-nurses-do/364/#comment-85480

MER

Joel Sherman said...

That's a good thread MER, an excellent find. For some reason I believe the varying points of views are better expressed than on most allnurses threads.
It is encouraging that these topics are discussed openly on nursing threads. It will help achieve progress. It's still rarely discussed on physician's medical blogs

Anonymous said...

Joel -- Perhaps some of the nurses are the ones who need to teach the doctors about this. The nurses are more intimately involved in this kind of care day after day. The good ones really understand it and could really educate those who don't see this as an issue.
MER

swf said...

Pretty remarkable site, reading about caregivers actually standing up for people's rights to own their own bodies. To say who can and can not touch them. To remind others that their job is just a job, not an entitlement bestowed on them to violate others.
Out of the workplace we would not have to remind them that they are just people. Out of the workplace we would not have to remind them that they can not touch us if we don't want them to. And out of the workplace this conversation would not have to happen.
But in the meantime, bizarre but true, we have to fight to take our bodies back.
The website is well worth the read

Anonymous said...

Dr. Sherman mentioned this blog, -- an allnurses thread about patient modesty, especially male modesty where a doctor, DonMD, posted an interesting comment about male modesty that elicited numerous responses, mostly, it seems, from not medical professionals -- patients. I notice today that we find this comment as the last post: "Thread closed for staff review." That usually means, with this subject, that the thread is permanently closed and may eventually be taken off the blog.

Read the post just before the closing post. It's obviously from a patient calling for activism on this issue.

The appearance, at least to me, is this:
1. Once patients get on these allnurses threads, especially topics like this modesty one, and post controversial comments, the threads often get shut down.
2. The last thread frightened and bothered this older generation of nurses who are running allnurses. Why would these posts by patients bother these nurses? I think we need to study this if we're going into an activist mode.
3. They know this is an issue. They also know that in most cases they may not be able to accommodate men. They also know that to get to a position where they will be able to accommodate men, they will actively have to recruit more male nurses in nursing schools and then actually hire more male nurses. All this may involve some kind of an affirmative action model where some women may not be hired because more men are needed.
4. We need to realize that the practical aspects of change for this issue involve politics and economics. It also involves the old guard within a single gender profession holding fast on to the power they have. It's always about power to some degree.
5. We need to keep this issue on the table despite attempts like this to keep it off the table. We may -- and I do say "may" -- want to encourage other patients to begin threads like that thread on allnurses and blogs like it. If they get shut down, they get shut down. But we must not stop challenging attempts to prevent discussion of patient modesty which includes the patients themselves.
5. Finally, read that last post again before the thread was shut down. It offers a way for the profession to begin changing the current situation, the double standard with men. For some, this is a dangerous movement. Have no doubt.
As we move forward with this and go public, we'll find some allies in the health care system, many who consider the subject a non issue, and some who will fight us all the way to the bank. Apparently, those nurses running allnurses may be among those who will fight this issue, at least an open discussion of it. As I read it, this old guard may even want to move toward change, but they don't want patients involved. They want all the discussion and change to occur on their turf, behind the screens, out of the public view.

We need to go into this with our eyes wide open.
Here's the link:
http://allnurses.com/operating-room-nursing/modesty-issues-130341-page10.html
MER

swf said...

I am sending a request to 'Iris' (Sir1 who closed the thread for review) to ask if a thread could just be created to discuss the issue with them. "No" may be the likely response, but I am more curious to see a justification from her. Long shot would be that they are tired of us hopping in on other places and could decide to finally let it play out. ( They could see us as a fad) Could also be that I get closed off from posting. Not a big price to pay.
But the interest is certainly there. There were a great many "guests" viewing the above thread a few minutes ago.

Anonymous said...

We can take a lesson Florence Nightingale, who had a maxim thus:
"Proceed until apprehended." That's what we need do. Keep posting. Refuse to let the topic be shut down. We still must be positive in our discussion, civil, polite, use logic and reason and make our criticism constructive -- but keep the subject on the table.
MER

Anonymous said...

If you haven't found it already, you need to check out this allnurses thread. It looks like the administration of allnurses has come around to discussing this modesty issue seriously, looking at it from a practical point of view. This particular thread is specifically about surgery, modesty and the possibility of same gender teams.
The last few pages of the thread have turned to practical solutions to the issue. I must advise that, if those on this blog decide to post, simply complaining will alienate supportive nurses from what has turned into a productive and important discussion. We've been looking for ways to advocate -- will this is one way right here. You'll find the thread at:
http://allnurses.com/general-nursing-discussion/patient-modesty-concerns-196068-page10.
MER

Joel Sherman said...

That link doesn't work for me MER, but the thread is still open. Today, June 6th, tbrd450 has posted what to me is an interesting point of view, that is if same gender care is available to women it should be available to men as well as a matter of law as to do otherwise results in employment discrimination. Don't know if that has really happened, but it is certainly a legal argument with some validity.

Anonymous said...

Yes...if it is available to women it should be available to men. The point in posting the examples was that it was readily available and these nurses seem to discount the entire need for same gender care. If they referenced them they would see there is a market and we are not just trying to cause problems in thier life.
Actually, it was an attempt to show the need for all, not just for women. Maybe the nurses on that blog are still the sort (unfortunately) that value their own modesty and can't find the natural logic in valuing all.
Sorry if it seemed I was respecting one and not the other. Not my intent.

Anonymous said...

We're making some progress. Check out this site, post some comments, but let's be civil. It's counterproductive to name call and bash professions. It makes the those who do it look like extreme idiots and hurts the cause.
MER

http://patients.about.com/b/2010/06/26/modesty-and-medical-care-one-more-time.htm

swf said...

I would only add to MER's statement that even if you feel posting your experience (yet again and one more time) may be redundant:please reconsider. Trisha is also looking for a quantity of experiences..all in one place...to pass along to those she feels are relevant in the move to create change.
Please please post them..

Anonymous said...

Another interesting site -- Men's Health Network with a link with advice for women about men's health. Look under "Additional Suggestions" Number 3. It reads:

3. Find out whether he is more comfortable seeing a male or female health care provider and make sure he’s seeing the one he prefers. On a related note, try to avoid physicians who tend to scold."

Now this is progress. But here's where we need to work harder. IMO, most women in health care get the fact that some men may prefer male doctors (health care providers) just as some women prefer female doctors. But they don't extend that understanding to include all the extra female staff that this entails. They don't get the fact that just because a man gets to have a male doctor, that doesn't prevent totally female staffs as assistants even in the most intimate circumstances.
So, we're making progress. But we need to continue by making the industry understand that there's more to just being comfortable with a doctor of the same gender.
You'll find a link to this page on this site at:
http://www.menshealthnetwork.org/women.htm
We should get on sites like this and tactfully and civilly explain the big picture.
MER

Anonymous said...

I post this link below as an example of the kind of stereotyping men put up with these days within the health care culture, and even from other men. Read the article, but especially read the responses. The male modesty issue is just one part of an entire attitude that responds to men's needs based totally upon cultural stereotypes. Here's the link:
MER

http://www.kevinmd.com/blog/2010/07/kidney-stone-pain-experienced-man-woman.html/comment-page-1#comment-137803

Joel Sherman said...

THIS THREAD IS FULL. PLEASE CONTINUE POSTING ON PART 2.

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