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Wednesday, November 7, 2007

Make Topic Suggestions

Please make any suggestions for new topics here.

59 comments:

Mike said...

Can a medical doctor, nurse, or tech. honestly 100% of the time leave their gender outside of the door of the examination room?

Joel Sherman said...

IMO Mike, the vast majority of providers can and do act appropriately 100% of the time. What they think is a different matter, though most do that too. If there are other providers who want to comment besides me I'll start a separate topic.

Anonymous said...

How do we get other providers, Dr.'s nurses involved in these conversations so we can get both sides of the issues and different perspectives on them? JD

Joel Sherman said...

Fair question JD.
As I've said, patient privacy and modesty are subjects which seem to be mostly under the medical radar except for HIPAA regulations which mostly don't apply on a one to one basis. Dr. Bernstein says he now teaches it to his medical students, but certainly I never heard a mention of it in medical school. For whatever reason, it has been mostly a nursing issue, though I'm not sure that they do any better with it.
So most physicians just don't think it's a significant problem (and I've certainly had some doubts as well). But interest in the topic does seem extensive. It has certainly garnered more interest than the other 400+ topics on Bernstein's blogs.
If this blog and others keep going, it will certainly help raise awareness with physicians and other health professionals. A link to this site on nurse’s forums would also help. Keep posting. It's a slow process.

Anonymous said...

Ray, Dr. Sherman
You both have contact with many other healthcare professionals. Perhaps you know a nurse or tech who could access the allnurse website and encourage some of them to join in here. From what I understand of the site you have to be a nurse-student-etc to post...It would really be helpful to get views from both sides...I have picked up a lot from the two of you...I put the request out there on voy, but I am not convinced some of the posters are really nurses as they say they are...and to both of you, thanks for the forum and the help...JD

Joel Sherman said...

Thanks for the support JD.
I've only recently started to look at the allnurse forums. I do not think you need to be a nurse to post there as I have seen a few posts from what seemed like lay people. If you register, I believe you can post there yourself. Use the advanced search feature to focus on a topic. You don't have to be registered to do this. I believe the posters there are indeed mostly real nurses and unlike voy, the posts seem to be serious and honest.

Anonymous said...

Agreed it would take a lot to be the lead on an effort to change the system to a large degree. But how about this for a topic...what have you (as in us) done to address this issue with a facility/provider and what was the response/result. Maybe we can zero in and identify specific things people have done that worked or didn't. I know I have taken comments from this blog and both found motivation to return to trying address an issue, and found specific terms, tactic's etc to use in that endeavor

Joel Sherman said...

Anonymous, I agree with what you said. Most responses to this are filed under 'What We Can Do to Improve Privacy Rights.' If others desire I can make individual responses to hospitals and physicians a separate topic. I'd certainly be willing to suggest courses of actions for specific violations discussed.
I really think that this is the heart of the matter. Little will change if patients like yourself don't speak up when you feel your privacy is violated. I've outlined the steps I would take in the other thread, starting with the nurse or physician and working your way up to the hospital CEO, state regulatory commissions and HIPAA.
You must educate your friends and others who care so that they know they can complain and the best way to do it.

Anonymous said...

Dr Sherman, I agree with your thoughts, perhaps to many sub catagories would be to fragmented. I have gleaned some valuable advise from this process and am working my way up the ladder.

Anonymous said...

Joel,

I'm not sure if you’re willing, but I think a good topic would be to share information on starting an activist group? Dr.Berstein has put that challenge out there and it has been briefly discussed here but not that real in detail. Would you consider that as a topic? I think there would be enough support across the boards to get this thing going; I'm just not familiar with the whole process......YET. Jimmy

Anonymous said...

Joel,

How about starting a topic on Universal Health Care? I've started to read into this program since this is Obama's major push to get into office. Just from what I've read so far and heard from hospital officials, it wouldn't be good for a working citizen like myself who already pays for good insurance and likes to have his choice of doctors. This really concerns me and I've found these blogs very useful in finding out information I may not have found on my own. Jimmy

Joel Sherman said...

Thanks for the suggestion.
It is a topic I'm interested in and have expressed some views on elsewhere before this.
Of course there is lots of information available elsewhere and it has nothing directly to do with patient privacy.
It would take some research as well. Anyone else interested? If I or others can come up with good references I’ll probably add it.

Joel Sherman said...

Jimmy,
If you're interested, you can find some of my thoughts re health insurance on this dormant Bernstein thread.
I know where you are coming from, but the problem is much bigger than any one individual's situation. I think national health insurance could be instituted without taking away an individual's right to better health insurance.

Anonymous said...

Some of the most disgusting Comments are on allnurses, it
only affirms my oponion when you
see their responses to certain
threads. They will ban you or
lock the thread!

Anonymous said...

I would like to know exactly the
protocol to complain if a nurse
violates your privacy in an
unprofessional way. What will
the state boards of nursing do!

Pt

Joel Sherman said...

Pt, I'll do my best to answer this, but look under the thread on 'What Can We Do to Improve Privacy Rights" for a response.

Anonymous said...

One topic of interest would be all out abuse, especially of a sexual nature, committed against male patients. In the big picture, it may be relatively rare, but I suspect it happens more often than may be realized.

I posted my own experience on allnurses entitled "eek!, there's a woman in my room". I detailed my own experience as an adolescent and got a surprising number of responses. Some got heated and got deleted, but I think it's fair to say that the deleted stuff probably wasn't constructive anyway. Some nurses posted their own observations about similar situations which led me to believe that my experience wasn't unique.

Just a thought.

Mike

Joel Sherman said...

I'd certainly consider it Mike. The topic seems to arouse interest alright. It certainly can be discussed now under the more general topic of privacy violations. Are others interested?
My only hesitation is that I don't want the blog to degenerate to become a vehicle for misogynists. There are plenty of violations of both sexes to go around though I agree that violations of male patients are not recognized as much as they should be.

Anonymous said...

Dr. Sherman,
My experience was not a modesty violation, but abuse. I suspect there are plenty of women who have experienced what could be described as abuse. Could it be argued that modesty violations are a form of abuse? I guess it would depend on how blatant.

Mike

Joel Sherman said...

Yes it was an assault if I'm thinking of the right incident.
Feel free to post it under the new topic heading.

Anonymous said...

how about a heading for success stories where we can post things that we have done that had some success, it might provide examples for others to use when facing the same situation

Joel Sherman said...

Definitely has merit, though it overlaps greatly with the present topic of 'what can we do to improve privacy rights.' Anyone else like to see it separated out?

Anonymous said...

After seeing your post I would have to agree, I never thought of it like that. Will post some things there

thanks

alan

Anonymous said...

I have read posts (and a separate blog was started) on "how husbands feel" with regard to pelvic/breast exams, etc. done on women by a male physician. How common is the reverse scenario? Males (husbands) having female nurses doing very intimate procedures and genital care: how does this effect wives?

I would think this is NOT something a wife would be open and accepting of.

Joel Sherman said...

I don't think it's a common concern. There was one lady on Bernstein who was upset about it, but I've never heard it brought up elsewhere. Undoubtedly more men care about their wives being examined by another man, although it's still uncommon except for devout Muslims.

Anonymous said...

I find the fact that having your husband cared for by other females just as upsetting as men feel about having their wives examined by a male healthcare worker/physician. Maybe it hasn't been spoken of or statistically viewed. I would not want to have a female doing a genital procedure and I know my wife would not want a female taking care of me in that area. Both sexes have the same feelings in general so it probably has not been verbalized.

Anonymous said...

How about a resource list where people can posts links, sources, contact information etc where someone wanting to address a institution could go for data information and data. There have been some good references and reads here and elsewhere, but I tend to forget where they are.......alan

Joel Sherman said...

Alan,
Your suggestion has merit. But I note that from the very beginning I have included links to JCAHO, the AMA and Privacy Rights Organization.
What other info would you recommend be included? Does anyone know of a compendium of lists for the 50 states? That would be difficult to do, but may already be available somewhere. Any further suggestions welcome.

Anonymous said...

I was thinking along the line of articles. There has been several articles referenced here such as the Catherine Dube article etc. For awhile we had a sociologist posting that referenced articles. If there was a section where someone wanting to go talk to a provider about the issue could go and print articles etc to send......alan

Joel Sherman said...

Thanks Alan,
Those posts are scattered around in various topics. It's inevitable that they're going to get diffused among the various topics though I hope Improve Privacy Rights has the majority of them.
As the blog expands few people want to read through all the posts.
If you can help compile a list of the posts you think are important, I can consolidate them.
Don't have to post this. You can email it to me. My email address can be found under my profile.

Anonymous said...

I would like to see a new topic
called military induction physicals
please.

PT

Joel Sherman said...

PT, Thanks for the suggestion. Military induction physicals are I believe more of historic interest than current interest, but are certainly still relevant. Much information is available elsewhere such as the Yahoo group 'group-physical-exams' with many thousands of posts.
Rather than open a separate thread though I have generalized the group school physicals to include military exams. Please post there. If there is a lot of interest, I can break it out into a separate thread.

Anonymous said...

While not under the banner of privacy I do have an issue about communication in the health service.
As a pubescent schoolboy in the mid 1970s I contracted mumps and unluckily for me I had the worst kind which made my testicles swell and left me with one virtually useless testicle which in turn left me with serious problems when I came to start a family in my 30s.
My beef is that at no point can I (or my mother) recall being sat down by a doctor and told what the consequences of mumps might be. Had I been treated like a young adult at 14 and told the truth then although it might have been frightening initially I would have been able to take steps to have the problem treated rather than having to endure 3 years of trying to conceive before realising something was wrong.
I don't know how these things work or the procedures current in those days, or now even, but could my doctor not have suggested a semen analyis or would that have been frowned upon as a young teenager?
Even when I saw a specialist at the age of 30 I still do not recall being given any indication of what the problem was, simply being informed that I had a low sperm count.
Is communicaton generally this poor in the health service?

Joel Sherman said...

It's hard to know quite how to answer your question. I think many doctors are reluctant to scare patients needlessly when they present with an acute illness by telling them all of the possible complications, most of which will never happen. However, assuming the doctor knew you had a swollen testicle (orchitis) he/she should have at least warned your mother that fertility problems were a possibility down the road. It's a well known complication. I don't think there's much that can be done after the fact to treat it when the swelling has diminished. I don't think that acute treatment to reduce the swelling has any proven effect either ( though I'm not up to date on the subject) so the problem couldn't be avoided.
But communication is always difficult and haphazard. A concerned patient should take the time to research an illness. Nowadays it is easily done on the internet. When my family has a problem that's not in my field, I always read up about it. When you or your wife actually saw a physician about infertility, the possibility of mumps should have been raised by the doctor very quickly.

Anonymous said...

Must a female or male be a 'registered' nurse to insert a Foley catheter in a male or female patient? Or, can they be 'called' a 'Medical Assistant' that never went to any kind of medical or nursing institution or graduated high school who may have previously worked at Burger King to be able to insert a Foley Catheter?
Really curious about this one -

Joel Sherman said...

I think that the vast majority of urinary catheterizations are done by nurses nowadays. But it is certainly legal for other trained personnel to do them. Up till about 20 years ago they were routinely done on men by orderlies who presumably all received specific training.
In general within legal limits it is legal to train people to do specific clinical tasks. They would routinely be called technicians, not medical assistants. The terms used though are not legally binding. Unfortunately, if you really want to know who is doing what on you, you generally have to specifically ask about their training. As job specific uniforms and ID tags are out of vogue, it is not rare that I have to ask someone what their position is.
It is an interesting topic.

MER said...

How about a thread on what's being called "Shared Medical Appointments" and how this relates to privacy.

This is where one doctor meets together with up to 15 patients for a 60 to 90 minute "session" with those who share the same or similar condition.

One benefit, doctors say, is that it gives access to people who might not have access. People with the People with the same condition can share stories. Patients get more time with the doctor.

Right now this is being experimented with voluntarily. But I can see this become part of a multi tier system where only the poor get to do this, and they have no choice.

Any thoughts on this? Maybe you can find an article about this on the web. I just read about it in the June 2009 issue of AARP Bulletin, p. 6.

Joel Sherman said...

I doubt that there's much to say about this MER. A clinic in Boston has been doing it. I've seen a few references to it. I doubt it will catch on, but you never know.
Certainly if you go to a sub specialist they might have group meetings to discuss individual diseases like diabetes, but this is something different as it includes at least some physical exam. I'll post an article under the personal privacy violations thread. If others are interested I'll start a separate topic.

Quiact said...

Deception with pharmaceutical clinical trials, and their collusion with institutional review boards, contract research organizations, trial investigators, and medical journals.

Joel Sherman said...

Quiact,
If you read through the informed consent threads and to a lesser extent the electronic medical record thread, you will find some relevant posts.
Also check the HIPAA thread for articles on Amgen and Enbrel.
Did you have any specific occurrences in mind?

MER said...

Joel:

I would like to see you add a topic: "Patient Modesty as Shown in the Movies." I'd like to develop an annotated bibliography. I'll start with this one:

THE RIGHT STUFF, about the original Mercury 7 astronauts. There's a lengthy scene when they are being examined and test in a hospital. They are paraded around naked in their gowns, through the halls, in front of visitors, in the elevator, etc. The nurses are shown as arrogant and wielding their power and authority. This takes place about 1959.
Now, how much of this is Hollywood and how much is reality? That's the question. The movie is based upon the Tom Wolfe book of the same name. But I've noticed in most movies, male modesty in medical situations is show to be humorous, and men's modesty being violated, according to the movies, is just plain funny.
I'd like to see other moves that depict this for both men and women and compare how it's done and whether is real or Hollywood fantasy.

Joel Sherman said...

MER,
How about patient modesty and the media? Restricting the discussion to movies is too restrictive. Lots more on TV et al, though I don't watch any of it much.

MER said...

That title sounds fine. I'll start posting some sources next week. We can include, as you say, everything -- ads, TV, movies, and anything else that doesn't come under a specific category. I think the most revealing media depictions of patient modesty, esp. male modesty, is in the movies. And this is a good example of the common question as to whether film creates reality or depicts reality. How real are these versions of modesty violations? I believe they are real, based upon the experiences of the writers and directors. If that's the case, then the question is how common are they?
We can link some of these sources, perhaps, to photos or clips.

Anonymous said...

How about a wall of shame thread
that lists all of the institutions
where cellphone pics were taken.
The facility where Mr stumps
privacy violations occurred.

PT

Joel Sherman said...

PT, please post any information about this on the taking videos and pics thread. Naming institutions is fine as long as you're linking to published reports.
I note though that most of these cases are related to individual employee abuses and don't necessarily represent a systemic problem with the institution. Repeated abuses within an institution are a different matter.

Anonymous said...

Having been subjected to medical sexual abuse and other cruel and degrading treatment in the hospital, why not start a thread about this terrible practice. While not prevalent it does exist as the systemic problems with elder care, abuse of the disabled and the mental health system.

The consequences are devastating for patients who will not return to the hospital where trust is eroded in the aftermath and physicians don't care or want to help you get what you need regarding same gender care.

Anonymous said...

Whether the problem is with a few individuals or systemic in an institution, the real problem is that the institution is not accountable and doesn't take responsibility for not only establishing strong sanctions nor protection for victims

Joel Sherman said...

Anonymous, although this blog is not primarily about clearly criminal violations and assaults, you can post any related comments on the 'Add your personal privacy violations' thread.
If there is sufficient interest I will consider starting a separate thread.

Anonymous said...

A topic that would be of interest to me is something like how (if at all possible) we can avoid the mind games of medical personnel (especially nurses) if we're in situations like refusing cross gender care, especially for males. But females (like me) may be really not respected and walked over... and what they really mean when they say certaing things and how to avoid taking their crap....Thanks!!!! the blog is excellent.

Anonymous said...

I really would like help about the mind games medical personnel (especially) nurses and male doctors for women plat, especially when they lie, manipulate, or are trying to hide a gross error... What they really mean when they say certain things and when a red flag should go up....especially what we have to do when refuse cross gender care, especially for males, and what we cal do, if at all possible, to avoid taking their crap, especially ina an abusive situation. By the way, females kike my really do get sometimes walked over....

Anonymous said...

I would like advice with medical personnel, especially nurses) how to avoid their mind games, and if at all possible, if there is a way in we can know whether they are lying, trying to cover up an error or gross unething misconduct or just giving you a hard time for fun, which is common. What to do, especially if you are in a really abusive situation, and how to avoid taking their crap. What iis the best way to refuse cross gender care would interest me, especially for females, for we do get walked all over....

Joel Sherman said...

Advice on how best to obtain same gender care is scattered all through this blog and is a frequent theme. It can probably be found on the improving privacy rights thread and others.
There's no easy solution to the problem, but I can try to consolidate some of the posts about it to their own thread if there is interest.

Daniel said...

I would like to know more about the science and research related to modesty and gymnophobia. Dr. Bernstein mentioned on his blog that intimate exams are usually done last so they don't throw off readings for other tests (e.g. blood pressure). I've looked and looked and can't find more material of this nature.

The medical community would be much more sensitive to modesty concerns if they were shown hard research attesting to its importance.

Joel Sherman said...

Thanks for the suggestion Daniel. In fact I had to look up the term gymnophobia or the fear of being seen nude.
It certainly plays a role here although I think the majority of posters here are concerned only in a cross gender situation. I don't think that modesty rises to the status of a phobia very often.
But if others are interested or can come up with good references I can certainly devote a thread about it.

Daniel said...

I use the term 'gymnophobia' loosely (perhaps too loosely).

I'll try to be more specific: I'd like data on measurable physiological or behavioral responses to exposed nudity and how that varies according the setting and situation.

Physiological differences:
Let's suppose we were to study physicals where the (male) patient has no choice as to the doctor's gender and where the patient knows the dreaded words 'turn your head and cough' are imminent. Would physicals given by women doctors yield significant differences in blood pressure readings? Would group physicals yield even greater differences?

Behavioral:
Let's suppose we were to study the percentage of patients who make a follow-up appointment that involves intimate exposure. If the patient less likely to make that follow-up if he or she expects opposite gender health-care workers to be there?

Ignoring the ethical issues of torture in interrogations, what is the scientific justification for stripping detainees naked in order to foster a willingness to talk?

Joel Sherman said...

Those are excellent questions Daniel. I've never heard of any studies that included those questions.
If I come across any, I'll certainly post them. Maybe MER knows of some?

Anonymous said...

"Would physicals given by women doctors yield significant differences in blood pressure readings?"

That happened to my father. He needed a physical when he worked for the Federal government and was sent to a military base to have it done. The doctor he needed to report to had a name of Swedish descent that wasn't instantly recognized as a male or female name. When a woman with a Swedish accent entered to take him to an exam room for the physical (including hernia and prostate exams) he about had heart attack. Turns out she was just a nurse and the doctor was a man but my father's blood pressure went through the roof and didn't correct itself in time. He passed everything else but had to report to have his blood pressure taken at a local clinic every week for a month to prove it wasn't normally that high.

Anonymous said...

Just found this thread. No, I haven't seen any medical research on this subject and would be surprised to find any. Most male doctors would have no interest in this, and it would perhaps seem threatening for some female doctors to actually learn the truth about this. If studies showed this to have a significant impact on some patient data, it would threaten the whole notion of gender neutrality.

The other question: "Ignoring the ethical issues of torture in interrogations, what is the scientific justification for stripping detainees naked in order to foster a willingness to talk?"

During WW2 and Vietnam, it wasn't uncommon for psychiatrists to interview new recruits while the solders were naked. Why? Easier to get honest answers. Same with torture techniques. The history of nudity in warfare and prison is quite clear. Taking people's clothes is the first step in dehumanizing them. Dehumanizing them not only helps to make them more cooperative, but also helps the guards to regard them less and less as human beings and allows those in charge to get the guards to do what needs to be done. Study the Standford experiments.
Does getting people naked in medical situations make them more cooperative? You bet. Is that the purpose of getting them naked? To some extent, yes, but it's more of a habit and medical ritual, in some cases a thoughtless, useless ritual. Sometimes it may be necessary. But most medical people don't even think about it. They just do it because that's what they've been taught and that's what they're told to do. And those that actually tell the patient to take off all their clothes are usually the people with the least power so they're not going to challenge anything they're told to do.
Why have men and boys been lined up naked or in their briefs for medical exams? Mostly for control and efficiency. Why are prisoners stripped? Not only for safety, but also for control and to let them know who is now in charge.
I really think that in hospitals and clinics, caregivers think, because they're helping people,none of this matters. Few look at the situation from the patients point of view. It's the old, "We're here to help you,and we have your best interest in mind, so just do what you're told."
What patients are beginning to learn is that the American medical model today isn't about helping patients, isn't about curing them, isn't about respecting them. It's about money.
MER

Joel Sherman said...

When you think about it, it is almost certain that seeing an opposite gender physician could raise the BP in some patients, certainly in those patients who have a sexual fetish about it, and possibly in those who are embarrassed.
It is well known that sexual arousal raises BP and HR. Here's an offhand reference. Certainly coitus can precipitate heart attacks in susceptible men.
My guess is that most women physicians are quite aware of this if they routinely do genital exams on men (though the reverse is also true). No one would claim that this disqualifies women from examining men, but it could easily make a difference in patients with labile hypertension.

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