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Wednesday, June 17, 2009

What Can We Do To Improve Medical Modesty & Privacy Rights

Please suggest actions that we can take to solve current problems.

179 comments:

Joel Sherman said...

I can think of 2 main routes to take. One is filing complaints with the appropriate institutions or government agencies. One cannot sue under HIPAA, complaints have to be filed with the feds and only they can enforce it and levy penalties. That would be one way to push compliance, that is to file a complaint with US Department of Health and Human Services, Office for Civil Rights, HIPAA (see links). To do this one would need hard facts and names. Anonymous posts won't do.
Another way is to get the HIPAA laws amended to cover these situations specifically. I intend to write my congressmen and maybe a few other legislators who are active in health issues (anyone know who they are?) on the issues to be discussed.

gve said...

At present the whole system is geared towards the health care providers and what suits their "resources". If they have plenty of female staff, that must dictate what will be offered to male patients (or so they would have us accept).

What needs to happen is they need to starting ASKING the patients what they would like to happen in personally intrusive procedures, NOT imposing their limitations upon us.

In the antecedent blog (Dr B's) I suggested that JS MD should canvas opinion as to what was desirable, from a random selection of patients (i.e. all he saw for a week) and report back what he found.

Health providers are frightened to death to address this issue, we all know why and they know we know, unfortunately, we are not in some situation comedy farce, this is the real world - WAKE UP and smell the coffee, things must change!

Joel Sherman said...

gve,
Sorry to ignore your suggestion but I am a sub specialist and rarely do any intimate exams. My practice is just not conducive to such a survey. It would be much more worthwhile in a general practice or academic setting. I think your suggestion is a good one but I'm not the one to do it.

Anonymous said...

Hi Joel and gve, this is Ray Barrow.

Gve suggests that to help answer questions pertinent to the issue of improving privacy rights we conduct a survey. I think conducting a survey is a great idea, so let's do it. However, to get our research questions answered does not require interviewing or giving questionnaires to the patients of any particular physician or set of physicians. Other options include conducting a survey with a sample of people from an organization (e.g., a university), set of organizations, community, set of communities, state, a number of states, or the nation as a whole. One's resources will, of course determine the option chosen. We will find that almost all or a large percent of the subjects can report on their experiences as patients (depending on how far in the past they are asked to go). Even those who have not been patients can give their opinions regarding patient rights.

Before the research is conducted, however, a number of questions must be answered including the following: 1) What exactly are patients' privacy rights (as gleaned from sources such as HIPAA, JCAHO, AHA, APA, AMA, AOA, etc.)? 2) Which of the rights identified are most frequently in jeopardy or are systematically violated someplace in the U.S. (as gleaned from research, self-reports on blogs, publications in popular journals, etc.)? 3) What do scholars write about the subject and what have researchers found?

From the information gathered, research questions associated with the improvement of privacy rights can be formulated and a pool of items developed to measure the variables that are included in the research questions. A sample of people from some population can be chosen, questioned, and the data analyzed.

This next winter/spring, I will be teaching a research/statistics course. The theme that will guide the research conducted by students will be "patient rights." They will be grateful if some of the preliminary work (1 and 2 above) is done for them. Then they will be free to determine the theoretical significance of the research, choose a sample, conduct interviews or distribute questionnaires, test instruments for validity and reliability, analyze the data and draw conclusions from the analysis. -- Ray

Anonymous said...

The problem with the system as I see it, is that they are dictating to us what service they will provide and by who. This is the same service that we are paying for? We must start speaking out and leaving these offices/hositals in order to be heard! Hospitals and offices need to change the staffing practices to accommodate us! It's our American right!
Jimmy

Joel Sherman said...

Ray. It would be great to do a survey. It's relatively easy to get the guidelines from the AMA and JCAHO. I can do that I believe. After looking at them you'll have a better idea of what specific questions to ask in a questionnaire. The exact questions are critical and can easily color the survey. Obviously it's not enough just to ask about privacy in general. Specific situations are needed.
If I can find appropriate links I'll post them.

Joel Sherman said...

Ray, all AMA policy can be searched and/or downloaded here. You don't have to be a member. You can find guidelines on videos and pictures, chaperones and much more. Take a long time to go through it. Haven't found much yet on examination procedures except for chaperones.

Anonymous said...

Thanks, Joel. Tell me if I am incorrect, but I think our major concern here is not with issues regarding records but with, in effect, the right of patients to decide how their persons (bodies) will be treated, who will be involved in the treatment, what the treatment will be, knowing the whys behind the treatment, and where the treatment will be given. If so, then all we need are statements from documents that address the latter and not those that address the treatment of records.

Jimmy -- I like what you've written but I'm pretty ignorant of much that goes on in healthcare settings. So, can you elaborate on what you have written so I can connect it to issues of privacy? For example, what are the staffing practices now that undercut privacy rights, how do they undercut privacy rights, and how can staffing practices be changed to reduce the problem? Thanks.
-- Ray

Anonymous said...

Ray,

My point, as it relates to privacy issues in a hospital setting is that I don't have a choice of the staff if I have to have a procedure done. Hospitals don't feel inclined to provide patients with this choice. It's my feeling that since I'm paying for this service, it should be my right to specify what happens to me and who does what to me. If I want a male nurse for a specific need, it should be available. GVE said it best, hospitals are built towards their needs, we can rant and write on this blog and Dr. Bernstein's all day long but action is the only way to get things changed. Have a few thousand men walk out of hospitals because their request aren't met and see how soon change can occur. If it is as rare as stated on Dr.B's blog, why would this be so difficult? I think we all know the answer.
Jimmy

Anonymous said...

Jimmy-- I agree with you. However, I'd like to make a distinction between rights and privileges. Rights are automatically accorded to people because they are human beings. Rights are not, by definition, earned or purchased. Privileges, on the other hand, are earned or purchased. I personally believe that it is ethically obligatory for hospitals to recognize those rights that they have posted on their walls whether patients pay for services or not.

You have a right to choose those who participate in your health care and -- with a few exceptions that I won't mention -- nobody can ethically separate you from that right. If females are available to care for females and males for males and if patients ask for one or the other in order to avoid unnecessary humiliations, then it is ethically obligatory for a healthcare facility to honor patients' request.

What I'd like to know is what are the specific objectives which, if achieved, will increase the observance of patients' privacy rights and decrease the likelihood of their violations?

I suspect, Jimmy, you'd like to ensure that patients can choose the sex of their care givers. On who should the burden fall? Given the assymetical power relationship between care giver and patient and given that we're talking about a right, not a privilege, it would follow that the burden should fall on the provider to ask patients whether they'd like a male or female provider. So, we have three objectives: 1) patients are given a choice of male/female provider; 2) the burden of asking falls on the provider; and 3)patients are allowed to make appointments at a time during which their chosen provider will be available. Whether or not it is feasible for any specific individual to enjoy these rights may depend on any number of variables. But, there is no reason for all but a few healthcare facilities (e.g., most Planned Parenthood clinics) to resist creating a policy to accommodate these objectives.

There are other simple things that can be done in hospitals to reduce unnecessary privacy intrusions. They can be among the objectives as well. For example, providers create, implement, and enforce a policy requiring that 4) examination room doors be locked when in use (except under some limited circumstances); 5) signs that read "occupied" or "unoccupied" (or something similar) be placed on examination room doors; 6) patients be allowed advocates, especially in those areas in which privacy intrusions are most likely to occur (e.g., during preparations for surgery, in recovery rooms, etc.); 7) affirmative consent be obtained from patients before using them as teaching tools or visual aids (or, more euphemistically, teaching subjects); 8) affirmative consent be obtained from patients before anyone who is not directly involved in their care (other than family and chosen advocate) is allowed in with the patient (including, but not limited to, industrial representatives, members of film crews, nonparticipating healthcare providers and staff, and friends/family members of participating providers). Anyone want to add, subtract, multiply, or divide to these objectives?

As for collective action to bring about change, that's a tough one. First, problem sites must be identified which requires evidence. Successful collective action requires that there be collective dissatisfaction, a communication network to communicate that dissatisfacion (That's what we have here.), resources (money, access to the media, access to powerful legislators, time, etc.), a sense of efficacy, and leadership (especially charismatic leadership). Efficacy has to do with the perception that the benefits outweigh the costs, and that's a toughie. Most people I know don't even want to think about the things we've been writing about let alone participate in a social change movement. -- Ray

Anonymous said...

Ray,

I'd like to say that the burden should fall on the facility but the chances of that happening are slim to none. It should fall to the patient if he or she has a specific requests as it relates to their treatment. The burden of honoring that request should fall to the facility. Most facilities don't ask nor would honor such a request. I'd feel alot worse if I was asked, only for them to say that it's not available.

I have a hard believing that if every patient was given this option (honestly), that most wouldn't mind. Most people I talk to just go with the flow and complain afterwards. The people that I know that have asked, where always told that it wasn't an option, you'll get who's available. I can't think of any other service that I have to pay for where I don't have a choice.

As you can tell, I feel actions speak louder than words. I've went through three procedures where this was the hospitals policy but after I spoke up or in one case, started walking out, they changed their stance and accommodated me.

I agree with you 100% on the objectives you have outlined above. That would be a good start. I just feel to get the point across, you have to set an example. The best place to start would be in their pockets. Do I think this should be done. No, just said it would be things moving faster. JMO

Jimmy

Joel Sherman said...

Jimmy and Ray,
For a physician I have an unfortunate tendency to look at questions from a legal perspective. It comes from having too many lawyers in the family.
We have a right to privacy but it is ill defined and the extent and reach of it is never clear.
You have the right usually to choose your own provider (though of course subject to your insurance restrictions). You almost never have the right to choose ancillary personnel. If you reject personnel assigned, your only choice may be the inalienable right of refusing all treatment.
Under Equal Employment laws race, gender et al are protected. That means that you can't specify the race or nationality of personnel. Gender has more exceptions but still it is not a right that you have. Gender preferences are granted only if the institution can manage it and wants to do it. Most institutions are not sympathetic to such requests but will usually accommodate requests if they can. But they have great trouble accommodating same gender requests from male patients. Establishing same gender preferences as a right would be very difficult in our politically correct society. I personally have very mixed feelings about the issue. Equal employment laws have helped both men and women have a more equal footing in the health industry. Anyone see any solutions to this quandary?

Anonymous said...

Joel,

Thank you for the enlightenment. There's nothing about your response that I disagree with. The topic of this blog was "What Can We Do To Improve Privacy Rights?" I responded in my first post that hospitals should evaluate their hiring practices so they can accommodate these requests. I feel this would improve my privacy rights. I agree with all other ojectives noted here, many I would've never considered until I read them here.

Jimmy

amr said...

This is also a market driven thing. Has anyone heard of a male being hired as a xray tech where mammograms are given?

But, at a MRI place where MRI's are taken for breast, male techs are present.

-- amr

Joel Sherman said...

amr, lots of male techs are present in offices where mammograms are taken, but they don't take the mammograms. Never heard of MRIs for the breast. Must be something new.
Thanks for the kind words Jimmy.

Anonymous said...

Regarding your November 12, 2007, 6:20 post, Jimmy, you are, I believe correct. You've recognized the gap between the ideal (what constitutes ethical behavior) and the real (how people actually behave) and between many patients' definition of the situation (right to choose healthcare provider) and providers' definition of the situation (entitled to provide service for which one has been trained). When you are compelled to exercise a right, then those who are compelling you to do so are not treating it as a right.

You write about hospitals "changing their stance" when you threaten to walk out. There is a recent post by "JK" on Dr. Bernstein's blog who tells similar stories of his own experiences. Unfortunately, when one exercises his/her rights, it is likely to cause friction. After all, patients who exercise their rights are not infrequently seen as violating the patient role by wresting away control/power that healthcare providers wish to have over them. I have examples of (sometimes successful) efforts by healthcare providers to regain contol by intimidating patients into conforming to their expected role.

I've been told by a few people in healthcare that physicians make the worst patients. If this is true, I suspect it is due, in part, to their resistence to being relegated to the status of patient. This phenomenon is dramatized in a motion picture called "The Doctor" (a must see) starring William Hurt. Jack, the physician protagonist, tries his hardest to maintain his dignity and autonomy but to no avail. The film was loosely based on a book by Dr. Edward Rosenbaum originally entitled "A Taste of My Own Medicine" and renamed "The Doctor" following the airing of the film. Here's a quote from the book which is pertinent to the subject at hand -- "Then I was subjected to the final indignity: They took away all my clothes and gave me a skimpy piece of cloth. . . When I tied that piece of cloth around my neck, it wasn't long enough to cover my important parts. It was far too tight and hung open at the back. I felt as nude as a newborn baby and suddenly as helpless. . . Now I was the patient, literally stripped of my dignity. . . I was treated like a baby. . . The nurse came into my room and treated me like a child. I know she meant well, but it was embarrassing. She wasn't more than twenty-five years old [Rosenbaum was 70]. I had always been her boss, and now she was telling me what to do. Without asking my permission, she removed the sheet covering me and there I lay on the bed, almost completely naked. All I had on was this hospital gown which reached ony to my belly button." The good doctor experienced, in the words of Erving Goffman, a mortification of the self. When he walked into the hospital, he did so as a sound-minded ambulatory adult but was quickly relegated to the status of a dependent child; his self-image was obliterated and he was compelled to take on a new identity. -- Ray

amr said...

Joel, in LA there are women health centers where the mammograms are done, with the machine always set up to do just mammograms. That is what I was referring to. And MRI have now been recognized as important tools in the diagnosis of breast cancer, especially after xrays show up problems. They also help with dense breasts.

--amr

Anonymous said...

I knew a male tech who did mammograms at a clinic in our town. I also recall reading -- in a Dr. Gott column, I believe -- about a woman who was assigned a male to do a mammogram. She expressed a desire for a female tech. Her request was accommodated but not until after she was scolded by the director for her immaturity. -- Ray

Anonymous said...

Ray,

Q. At the beginning of this blog, it was your opinion that a survey would be a good start. Just curious as to where that stands? Once you have the questionnaire filled out, can you post it here? I may be able to get it to a few offices and a hospital in my home town if you wouldn't mind. Just let me know so I can make some phone calls. Jimmy

amr said...

This is taken out of the blog entry made in modesty blog:

Some areas of interest to me would be:

1) Location in the hospital or clinic (such as xray, mri, urgent care)
2) Who involved (nurse, doctor, other health care professional)
3) What was the event (touching, comments, exposure, pelvic or dre exams not consented to etc)
4) Was it reported. If so, what was the result. Was there blowback?
5) Is it considered by the reporter as “business as usual” and common or is it rare (rank the findings)
6) How often are events observed by a reporter
7) Is this institutional, regional, or national problem.
8) Did other patients observe the event
9) Did a pt report the event.

This could start out in one city just like the Ubell study did.

Mike said...

First let me introduce myself to this board. I am Mike from south Georgia and I am founder of the yahoo based group called (How Husbands Feel) and also a poster on Dr. B's blog. I have a real life outside of this computer screen and unless this was an important issue to me I would not have invested countless hours into keeping the HHF group up and running. I strongly feel that the medical profession needs some change relating to patient privacy and like already stated here does not honestly want to address these changes out of convience and profits problems.


Joel: As a medical doctor there is one very important thing that you can do as well as every other doctor. You can raise everymore Hell whenever one of your fellow doctors (bad apples) as Dr. B calls them is caught with their hand in the *nookie jar* AKA sexual misconduct. In 2 short years at the how husbands feel group we have collected over 900 news articles and what is most shocking is that in 95+% of these cases the doctors are repeat offenders or some of their supervisors had knowledge of their actions. Pressing for a universal policy of 1 strike and your out for sexual misconduct instead of helping these bad apples to cover their tracks would do 2 things. (1) It would go a long way to helping to restore paitient trust. (2) It would bring down malpractice insurance rates. The good doctors are now paying for these *bad apples* to keep their practices.

Jimmy, are you JK from Dr. B's blog? If so you could ask your wife to hep do a survey since she is CEO of a hospitle.

If anyone here doubts the 900 number all you have to do is ask and I will have a CD mailed to you containing all 900 URL's as well as the articles themselves in word and PDF files. It is shocking what some of these *professionals* have done and been allowed to do again by letting them keep their practices.

Respectfully submitted:
Mike founder of the group How Husbands Feel

Anonymous said...

I’m sure you’ve all been reading Dr.Bernstein’s blog. On Wednesday, Nov. 14th @ 7:03 an anonymous wrote of her recent gynecologist visit. Not to get into the details, but a few things she noted has got me curious, they were:

“The tech flung the door wide open, and I got a nice view of a guy not six feet away standing in the hall, who got to see me covered by nothing but a scanty paper sheet.”

“She opened the exam room door and immediately gave an exhibition of me nearly naked to several people who were standing at the desk talking to the receptionist.”

I know that there are a lot of building codes that have to be met in order for a physician to practice at a certain location but I haven’t found the specifics. Would it be unreasonable to require examination rooms not be in the line of sight from the administrative desk? This struck me because the few that I’ve been in have always been closed to an extent from the patient’s area. If this was the case, it would’ve saved this individual a lot of humiliation and prevent accidently exposure to the public. Still need to find the details from my state, just wanted your thoughts.

Jimmy

Joel Sherman said...

Jimmy, I've never built an office so I have no direct experience, but I'm aware of no building codes that only apply to medical office buildings. There are many considerations that go into designing an office and privacy is certainly paramount. Walls should be sound proofed so that patients next door cannot overhear what's being said etc. But none of these are building codes. I've certainly seen offices that don't meet standards of privacy. Maybe the AMA has guidelines.

Mike, welcome. I haven't agreed with all you've posted on Bernstein, but we certainly have many goals in common. Please continue to share you thoughts.

Anonymous said...

Joel,

Our local hospital just completed a new physician practice office building and I know it was delayed to get up to code (I was told that our state inspectors are harder on physician buildings). It may have just been minor things like wiring, lighting, number of outlets but I'm not sure. I've figured out from reading these post that I'm pretty lucky to have the conveniences that I have. I’ve never been in an office that’s in plain sight of the waiting area or general public so that’s why it got my attention. Would you disagree that it wouldn’t improve privacy? Jimmy

Anonymous said...

Not sure if this is on topic or not, but there was a post with a web page from,,,I believe st Micheals in Toronto that provided gender sensitive care, If there was a place to compile or post these facilities, it would be a good tool to approach local facilities with. If they fear people will go to other facilities who are more open to thier requests, they will react. St Vincents in Indy has a web page that allows you to search Dr.'s by gender...its a start..if we had these resources to say, its being done here, by these facilities and they are asking us, we don't have to ask...it may start the ball rolling JD

Joel Sherman said...

JD,
I don't know if it is on topic either, but I'd certainly be willing to post a list of such institutions as we discover them.
At present I'm sure that they will be applicable to very few readers.
St. Michaels.

Anonymous said...

Jimmy -- I've been out of town for a few days. Just saw your post. I won't be working on any questionnaire until next January. I'll be happy to post it here. Participants on this blog may have some suggestions.

I might have some students work on creating a dignity index or privacy index. It will measure the level of privacy (or dignity) the policies of healthcare facilities offer to patients. Ideas for items can be gleaned from this and other blogs. Once the instrument's validity/reliability is established, it could be used to rank healthcare facilities based on their scores on the index.

Mike -- I don't doubt your 600+ number. Could you send me the CD about which you wrote? It may provide me with some data for a paper I've been writing. I'll cover the cost of the CD, shipping and, handling if you tell me what it is.

Joel -- I just found out that the American Hospital Association dropped what I consider to be an important part of its Patient's Bill of Rights. It's original 1973 document read: "The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present." It eliminated the last sentence in its 1992 revision. I e-mailed the AHA office last week and asked for "the history behind and the rationale for this removal." I've not heard from anyone and would be surprised if I ever did. -- Ray

Joel Sherman said...

Ray, I like your privacy index idea. Be happy to contribute. Ideally it would be a questionnaire sent to every hospital which they'd fill out and return. Of course there's no way you could guarantee cooperation, but even if you only got back a few (undoubtedly from institutions who scored well) it would be a significant start.
Haven't heard anything about the AHA dropping the permission recommendation. I looked briefly. It doesn't appear that they even publish their policies. Of course they are a trade association of hospitals and they exist to promote themselves, so I guess you couldn't expect too much. On the other hand, the same could have been said for the AMA, yet they have published thorough policies which appear to have the interests and protection of patients in mind, if not foremost. My respect for the AMA has increased since I started this blog.

Anonymous said...

Ray, Please drop me your mailing address to this email address. tenderhusband@yahoo.com I will have you one in the mail by weeks end.
Mike

Joel Sherman said...

Please look at the section on stories of privacy violations for my opinion on how different kinds of violations need to be handled:
1.) Violations due to thoughtlessness of procedures or physical layout need instant complaints and feedback to the providers involved.
2.) Illegal actions such as talking about named patients to others requires formal complaint and/or legal action.
3.) Concerns about gender preferences involving the personnel used in your care are more complicated and I believe all a patient can do is make their preference known and hope the institution will listen.

Anonymous said...

Jimmy Here,

I recently went in for a minor procedure. It was nothing that would violate my privacy or anything like that, but it was done at a hospital that I've never gone to before so I had the great pleasure to fill out all the new patient forms. Anyway, with all this being fresh on my mind (blogging that we've discussed here) I actually paid attention to what I was told for a change. Basically, all she went over was a brief history, my insurance information, my mailing address and then a few HIPAA regulations (who to contact and if they can tell an outside person if I'm at the hospital) and then asked that I sign. It wasn't until I asked that I was given a booklet with my patient rights. It would've taken me a day to read through the whole thing. So, I figured out that's how they get patients to consent their rights over. To me, this is important. I had the procedure scheduled for well over a week; couldn't they have mailed it to me so I could've read over it? One thing is for sure, if I schedule anything in the future, I'll ask for it to be mailed to me so I can examine it. I just feel that this is important enough that the patient shouldn’t be rushed and should have ample time to review and ask questions.

Anonymous said...

About two months ago I was having an ultrasound done when a woman walked into the room and wandered around acting as though I was on display for her benefit, a frequent occurrence in the hospital's Radiology Department I found out. When I questioned the propriety of her presence, she asserted "This is my room" and the ultrasonographer defended her presence with "She does ultrasounds too." A complaint to her supervisor elicited what appeared to be an honest apology and a suggestion that I write her a letter of complaint and send a copy to the quality control nurse which I did. In the letter, I requested only that I be apprised of the action taken to prevent a repeat of unnecessary and deliberate privacy intrusions of the sort I experienced. I received a poorly written and dismissive e-mail with a disingenuous apology from the quality contol nurse. "Appropriate action" to deter the offender would be taken, she claimed, and to prevent future intrusions she would "train" new staff to "say I'm sorry" when they intrude. With a sardonic flair, she added that it would be desirable but not feasible for her to be with her staff 24/7, as if her presence in the examination room would have somehow been less offensive than the unnecessary presence of others. "This response is less than reassuring," I replied, so "I will not be seeking future radiology services at your facility." I also asked for the name and position of the offender so I could file a complaint with the appropriate state authorities. After 2 weeks without a response, I wrote to the CEO requesting the same. Another two weeks transpired before he responded with a letter apologizing for my experience but denying me the name and position of the offender claiming that "It is our practice not to give out names of our employees for security reasons." My next step is to query the corporate owners of the hospital and JCAHO regarding the propriety of such a pratice. It is a strange doctrine indeed that recognizes the right of patients to know the names and positions of those who participate in their health care but denies them the right to know the names and positions of those who violate this right and other rights such as the right to privacy.

The paid apologists at this hospital no doubt consider my efforts to be especially querulous. Personally, I believe it is obligatory for others who have similar experiences (many of them far more offensive) as I to press the issue as far as they can. How else can the culture of entitlement and bureaucratic inertia that permeate an organization be effectively challenged? -- Ray

Joel Sherman said...

Well you've certainly done what you can here Ray. If only a small fraction of people did what you have done, these kinds of privacy violations would be rare indeed.
I'm not sure how much more you'll achieve by going beyond the hospital in this case as they have promised to take corrective action. I'm sure the x-ray techs involved have heard lots of feedback already. I have no idea if JCAHO follows these kinds of complaints. They license hospitals, but they also make their money off them. If you do contact them, let us know what kind of response you get. As I've said before, most states have a regulatory agency with powers over hospitals, nursing homes etc. If your state has one, I might contact them first.
I personally wouldn't pursue the offending tech much more. I'm not sure what you'll do with the information. If you want to bring a civil suit, the name would be discoverable, though I don't think it's worth pursuing to that extent. Many years ago, a recovery room nurse who didn't follow procedures nearly caused my wife's death. Fortunately my wife recovered fully. At my behest, the matter was investigated. I never asked the hospital what action they took. The nurse called me and apologized. I forgot her name long ago. She may still work there for all I know, but I have no vendetta against her. Today such an event might well be considered 'a sentinel event' by JCAHO and precipitate a formal investigation.

Anonymous said...

Joel -- What happened to me was minor. The problem is that such unnecessary intrusions in radiology (and probably elsewhere in the hospital) are institutionalized and justified by a subculture of entitlement at the facility in question.

What happened to my daughter there several years ago was more egregious. She went to radiology for a procedure because of a urinary tract infection. She immediately walked out crying and told me she refused to go through with the procedure and, I remember it well, added, "You can't make me do it." The room was like being in a fish bowl, with people walking in and out without regard for patients' privacy and dignity. Efforts to mollify her were in vain. The physician did some guessing and prescribed her an antibiotic which was apparently not the best one for her problem. We traveled to Boulder and she ended up in the hospital for 5 days with nephritis. She was treated with the utmost respect there. The point of this annecdote is that treating patients as has been described by me and others can have harmful, even deadly, effects -- discouraging people from seeking health care when they need it or putting it off until their acute problems become chronic.

Following my daughter's experience, I received tests in the hospital's Radiology Department several times. Although efforts were made to intrude on my privacy, I made it clear that I wouldn't tollerate them and was spared.

My query, rather than complaint, to the corporate owners and JCAHO will not be regarding the intrusion but the refusal to give up the name and position of the offender. My intention is to file a complaint about her behavior with the appropriate state authority. This is not a vendetta -- a blood feud between two families -- but is intended to be one step toward a corrective action which, I believe, should be taken more frequently. Unlike the nurse who apologized to you, admittedly for a much more grevious action than occurred to me, the last thing I heard from Jane (I did find out what her first name is.) was a haughty justification for her action. Also, her supervisor admitted, "We have had a lot of trouble with her." I suspect that, at best, any complaint I make against her with the state will be documented without follow-up. Were all those who had "trouble with her" to do the same as I, she might ultimately be advised to seek another line of work.

Although hospital administrators contend that they plan to take corrective action, they have not expressed any interest in taking preventive action even though I recommended some very minor changes (e.g., locked-door policy and "occupied"/"unoccupied" door signs). Reticence to take minor preventive action such as these is an extreme example of bureaucratic inertia. The following is an example of just the opposite. Several years ago, visiting parents to our campus complained that as they passed by a men's bathroom, they could see several students micturating in urinals. Within a few days, custodians installed a barrier to prevent a repeat. Pretty simple.

Of course, I would not bring a civil suit against Jane. I could do so in small claims court, I suppose, but I would have to show damages and that would be difficult to do. Besides, since I know the two local judges personally, they would probably have to recuse themselves and bring in another judge, a waste of the tax payers dollars.

I had a similar experience as you in 1995. An ER physician blew it with my asthmatic daughter, advising that she return home in spite of her 88% O2 level. Thankfully, my wife refused and, after the ER physician and nurse "abandoned us" (my wife's words), phoned our pediatrician who rushed to the hospital and took action to stabilize my daughter. He advised that we file a complaint with the CEO and urged us to insist that the offending physician become licensed in ER medicine, which we did. The CEO asked us if we wanted compensation of some sort. "Not at all," I responded; all we wanted was someone competent running the show. The ER physician phoned us and apologized and the matter was closed. By the way, he was licensed in ER within the year.

I too am interested in what response I will receive, if any. Even if no response is forthcoming, that will be instructive; as a research prof. of mine once said, "No responses are data." -- Ray

Joel Sherman said...

I pretty much agree with everything you've said Ray. Didn't mean to imply that you might have a vendetta against the x-ray tech. I will say though that in some ways her actions were worse than the example I quoted about my wife. My wife's nurse’s mistake was one of carelessness and hopefully it was unintentional, though it could be she had done this before without problems and had gotten into a bad habit. She gave my wife morphine for pain in the recovery room and then sent her up to the floor without waiting the required 20-30 minutes. Upon arrival my wife was not breathing. Fortunately an alert floor nurse picked it up and called for help. What the technician did in your case was clearly intentional, knowing full well many patients would be uncomfortable.
I've been told by many nurses that protecting the patient's modesty is one of the first subjects they're taught in school. At least that was the traditional teaching of 3 year nursing programs. I really don't know if it's the same today, with almost all nurses having degrees. Most of them perform more like managers, supervising care rather than doing it themselves. In some hospitals they spend far more time at computers than at the patient's bedside. I have no idea what the aides who do most of bedside care are taught. I also have no idea if medical technicians are taught anything about patient modesty. Maybe someone who knows could comment.

Anonymous said...

We have read a ton of issues on this and other blogs, the question still remains to a large degree unanswered "What can we do to Improve Privacy Rights". While I have recieved a lot of personal benefit from these blogs, for instance, started making my preferences known, and most recently I e-mailed a patient advocate twice with no reply, I was ready to drop it until I read this thread and changed my mind. I obtained the vice president of the hospitals address and have sent copies of the e-mails and asked them to reply to my original concerns and why the patient advocate had ignored my e-mails. The larger question of how to do something on a united basis remains. Consider if requests for answers were presented from an organization rather than an individual. The problem(s) of course are not simple patient privacy, liablity, etc. are numerous. But if there was a clearing house where people could bring an incident to someone, who could present it to the facility with the approach that we are not asking to address this paticular incident, but wish to clarify policy regarding these issues. The facility would not have to be identified as an accusation, but thier response in a general response rather than to an accusation..could be and they could be identified. Likewise facilitites that refuse to comment could simpley be listed as such...this would at a minimum put some pressure on them to respond rather than be dismissive as we have seen here and I experienced. It would require some ground work, and time from someone to dedicate the time and effort to do the contacts, organize the group in a manner which would give it ligitamacy, and it would require someone who was responsible in their duties ie presenting issues to providers and publishing responses in a responsible manner so as not to incure liability....perhaps it takes an individual who starts the process with links to sites like this, the fear of public disclosure has a lot more wieght with providers.

On the other issue here, as a business owner I might also suggest asking the facility for the name of thier insurance carrier and fire off a letter stating your concerns and mention emotional stress, discrimination, and liablity. I know our insurance carrier puts all sorts of attention on these types of incidents in our industry. We are all battling rising insurance costs....pencil pushers and business people like me are prone to knee jerk correction when our bank accounts are in peril. JD

Anonymous said...

Joel -- I want to make clear some of my thoughts. Even if you did imply that I might have a vendetta against the x-ray tech, I wouldn't have taken offense. One of the problems with communicating with the written word, it seems, is that the reader of the words have no opportunity to read the nonverbals and hear the tone of voice of the writer. For example, my words, "Of course, I would not bring a civil suit against Jane," could be taken as a defensive response were I speaking and the tone of my voice rose between the "of" and the "course." Instead, were I speaking, the tone of my voice would have decreased, suggesting a mere statement of fact. This communication problem was made evident when Dr. Lowrey in the "modesty" blog imputed motives to me that I simply didn't have. I sure don't want to send the wrong message again.

B.S. nursing students here are taught to protect patients' modesty and privacy. However, after speaking to some of their professors, it seems that by protection they may mean protection from others, not protection from themselves. For example, one nursing instructor expressed her belief that it was important for a nurse to be with a physician during an examination to serve as the patient's advocate. She looked at me in apparent confustion when I asked, "Wonder if the patient doesn't want you there. Wouldn't you be serving as an advocate of the patient by leaving?" I never did get a response to my question.

I too wonder what LPNs, med techs, unlicensed assistive personnel, etc. are taught regarding patient modesty and right to privacy. I suspect whatever they and other healthcare students are taught, these teachings are challenged by a hidden curriculum and the reality of resocialization once providers are in the field. -- Ray

Anonymous said...

JD -- I hear your frustration. I feel it too. You're right on regarding addressing the "larger question of how to do something on a united basis." Social change requires collective action and, as you suggest, collective action is best addressed by organizations. I concur with you regarding the other things you've written.

Right now, my intent is to inform my ignorance. I need to familiarize myself with what HIPAA and JCAHO have to say about privacy of the sort we've been discussing rather than privacy as it pertains to records. Joel and Maurice have been helpful regaring some of the AMA's statements but I need to read more on that. I'm still waiting for Jimmy's disk with the 900+ articles about sexual misconduct by physicians. I am interested in this information for research purposes and because there could be an empirical link between the laxity of minor infractions and escalation by some to major infactions, an extreme of which can be found in James Stewart's "Blind Eye" about how healthcare providers turned a blind eye to the behaviors of a provider named Swango who may be the most prolific serial murderer in the history of the U.S.

We have made some progress here. We've identified some objectives, I plan to conduct some research with students on the subject, and we're beginning to conceptualize what needs to be done. How the objectives can be achieved at a more global level is, however, elusive.

Those who have written about social change suggest that certain conditions must be satisfied before social change will occur -- collective discontent, a communication network to communicate that discontent, mobilization of resources (including a communication network), efficacy, and charismatic leadership. You've pointed out several resources including time and dedicated people. Are there any charismatic leaders interested in our plight out there?

In the meantime, we can give each other support by, for example, making recommendations about how to protect our privacy before we visit a healthcare provider, reading and making suggestions about letters of complaint sent to facility administrators in which our rights have been violated, continuing to provide each other with links to sites that might help us better understand what's going on in healthcare regarding privacy rights, etc. -- Ray

Joel Sherman said...

JD, your suggestion has merit. It would be a significant endeavor however with substantial costs and liability concerns. Couldn't be done as a hobby, like this blog is. If successful it would be a full time endeavor.
I am looking into the prior suggestion of getting input from nurses on allnurses.com.

Joel Sherman said...

I'm just consolidating Mike's 3 posts for clarity:

mike said...
Ray, here is the link again if you would like to download the sexual misconduct articles. We are already in the process of making a new link as the database has grown to over 1000 now.

Download this link.

It will take about 3 minuntes to download.

Mike

Anonymous said...

Thanks, Mike. I tried to download the file. It took 40 minutes before I could click on to a file and nothing came up on my system. I'll have to go to the computer system help desk next week to see what the problem is. -- Ray

Joel Sherman said...

A couple isolated comments after reviewing this thread.
First, how did we get here? I think it's true that 30 years ago when orderlies did most of the work on men, same gender ancillary care in hospitals was more common than it is today. Why have orderlies been essentially eliminated except for patient transport? I've never seen a study, but I think it's simply due to the immense financial pressures on hospitals. I don't offhand have the statistics. My guess would be that the average hospital employs 30-50% less people than it did in the 60's and 70's. So jobs have been consolidated. It's not going to reverse. Roughly 10% of nurses are men. I don't know that the number has significantly changed over the years. Although some localities may try to encourage male nurses, there is certainly no national push. On the other hand, there are more male technicians than ever before which has impacted women as well. It is rare that hospitals make a point of having available both genders for procedures and tests. I don't see any easy economically viable solution to this. As most patients don't object, hospitals have little incentive to change. If Ray can bring out a compelling study that shows that patients do indeed care (and I don't know that it will turn out that way), that would help. But ultimately the only real convincer, would be for patients to be routinely speaking up. These blogs may be helping, but there's a long way to go. These comments apply equally for other violations, such as lack of privacy in exam rooms and procedure rooms. You have to speak up ASAP.
Ray you asked before exactly what rights do patients have? Legally, at least nationally, they have very few rights except as defined by HIPAA which concerns information transfer almost completely. In terms of personal privacy or modesty rights, there are almost no rights guaranteed that I can see. State laws may sometimes cover it. JCAHO guidelines may help here, but I still haven't seen them. They are not readily available except to paying hospitals. That should change. As JCAHO is quasi official, may be federal regulations could help force them to make their guidelines public.

Mike, a question, what do you intend to do with your compilation of physician misconduct? No one questions that it exists; all the cases are public. As it must be, it is dealt with on a case by case basis. The larger problem is that a valid claim can be made that at least some state boards have dealt too leniently with offenders. I'm sure you're not the only one who thinks so. I would think you should organize your info with statistics on repeat offenders and send it to the boards responsible. Certainly no physician who has multiple violations should be able to return to practice.

Anonymous said...

Okay, I hate to beat a dead horse here but I need to understand this statement that I copied out of JCAHO Office Based Surgery Standards.

"Patients have a fundamental right to considerate care that safeguards their personal dignity and respects their psychological, cultural and spiritual values. Understanding these values guides the practitioner in meeting patients' care needs and preferences. A practice's behavior toward its patients and its business practices have a significant impact on the patient's experience of, and response to care."

When I read this, I understand this as the physician knowing how the patient feels and finding a way to treat the patient without causing harm. Am I'm on queue here or off base? It also states that the patient does have that right to choose that which safeguards their dignity. Please, I just want to know if I'm reading this correctly? No need for a debate. Thanks, Jimmy

Joel Sherman said...

Jimmy, I don't think that statement means anything. It's just a nice sounding platitude, but what it means in practice is probably nothing. It’s not enforceable.
I just searched JCAHO lists of publications on the term modesty. No hits at all, though if you search on privacy you get hundreds of hits. But even then, the hits are not in the title of the publication so it's probably just an incidental statement. Found one booklet intended for patients on 'compassionate care' but I doubt that it says anything beyond platitudes as well. The only significant statements that a hospital could be held to would be in JCAHO’s formal regulations for hospitals which appear to be a series of books priced at near $1000. I would look there if you can get access to any of these.

Anonymous said...

Jimmy, I read that to be as much phylsophy as a doctirine enforcable in a legal or other venue. But even so I do not take it as of no value. It should be something that providers use to guide thier practice. I would think it would have its greatest value if a patient were to remind them of the doctrine when pointing out areas such as modesty that run contrary to this phylosphy. The problem comes in that they are so caught up in the day to day they forget this, and second they define it from thier point of view, "well if we wait until they are out it doesn't matter what we do". Unfortunately the only value it has now is using it on an individual basis as people like myself would have little reason to know who JACHO is unless they read blogs or other publications. The other thing is it is still up to the provider to choose to accomidate or not, it isn't binding. After reading this blog I sat down and wrote a letter to a provider I had problems with. I had e-mailed the patient adovcate twice with no reply. With the info I gleaned from this thread, I have written a letter to the VP of patient relations, this time I referred to BFOQ such as the Backus case and JACHO etc. not in a threatening way...but just to see if it gets someones attention...I was going to send it Monday but will do a little editing to include your section...I'll let you know what I get back. JD

Anonymous said...

Joel,

Thanks for the response, I always appreciate the knowledge that you (and everyone else) freely share.

I found this statement when I searched for procedures. I to did a search for modesty and didn’t get any hits. What’s troubling to me now is that it seems that they say one thing but practice another, isn’t this misrepresentation to an extent? Maybe Ray can shed some light on it but I really don’t think they should advertise it if they don’t follow it. JMO for what it’s worth. Jimmy

Anonymous said...

Mike -- I finally got the file downloaded. Thanks for sending it to me.

Joel -- I teach a Sociology of Health course every couple of years. Each time I do so, I check to see what percent of nurses are males. In the '80s the figure was as low as 3% and has never been above 6%. I think the figure is still less than 6%. However, there has been an increase in the number of males going to nursing school -- to about 13%. Unfortunately, male nurses are almost twice as likely as female nurses to quit nursing within 4 years (7+% vs. 3+%, respectively).

Regarding gender preferences, I listed a bunch of studies conducted between the '70s and '90s in the "modesty" blog, most, but not all, conducted in the United Kingdom. I imagine there are other publications since I last studied the matter. None of these studies are among the best I've read, but if one were to aggregate the findings, it appears clear that, at the time, a large minority to a small majority of respondents prefered same-sex nursing care when it involved the rectum, genitalia, and breasts. The studies regarding sex of physician preference are superior to the former and show about the same thing. My students' survey of university students and community residents here was consistent with these studies. So too is anecdotal evidence. When a female urologist joined the local urology clinic, many of the women who had been seeing the male urologists at the clinic reportedly switched to her while the men remained with the male physicians. Given she is the only female urologist for thousands of square miles, she reportedly attracted female patients away from other male urologists in the region. The U.S. is becoming more culturally heterogeneous. Unless xenophobes have their way, I suspect this trend will continue. If so, it could be that gender preference in health care will become an increasingly important issue in the minds of new immigrants (especially from the Middle East) at the same time, ironically, health care providers downplay its importance.

As for legal protection, I'm not an attorney, so my understanding must be taken with a grain of salt. The case law reading I've done suggests that patients do have legal rights which if violated could be considered torts and successfully litigated. I interviewed an attorney with the Missouri Civil Liberties Union several years ago who suggested that some privacy violations (e.g., filming without consent) if committed in government-funded healthcare facilities could be considered 4th Amendment violations. As far as I can tell, all courts that have addressed the subject have concluded that patients have a reasonable expectation of privacy in hospital rooms, including emergency rooms, and emergency vehicles. The courts have also concluded that people do not give up their rights enjoyed outside of healthcare facilities by virtue of falling ill and being compelled to enter healthcare establishments. Consequently, a reasonable jury could decide in favor of a patient plaintiff who sues when some of the intrusions described in this and other blogs are committed (e.g., filming without consent, lifting sheets to ogle a person's genitalia, etc.). Regarding the removal of covering to ogle patients' genitalia, as one nurse pointed out on the "allnurses.com" blog, it is a criminal act -- a form of sexual battery labeled sexual abuse in the first degree in Missouri -- and, in some states, those who see it happen are legally obligated to report it to legal authorities. That none of us know of criminal charges being brought against offenders doesn't mean there is no legal protection. It simply means that the legal protection has not been employed. The reason it has not been employed is an empirical question.

Jimmy -- I agree with you; implicit in the JCAHO statement is that the patient has a right to decide what is dignifying and undignifying. Although any particular healthcare provider may believe s/he is entitled to make this decision, to do so is unquestionably inconsistent with the statement.

I agree that the statement probably carries no legal weight. However, I'm not certain that the statement is purely platitudinous. It reads like a preamble to a set of specific, codified regulations. But, it wouldn't surprise me if it was included to function as a feel-good ploy. If so, it suggests some degree of cynicism inherent in the bowels of JCAHO.

I can't say this statement is a misrepresentation. There is no gap between the statement and practice because JCAHO does not practice in the usual sense of the term; it is purely an accreditation agency that measures the degree to which the practices of healthcare organizations parallel well-articulated regulations. That's what it did back in the '70s when I helped agencies prepare for what was then JCAH (Joint Commission for the Accreditation of Hospitals) accreditation visits, and I suppose it does the same thing today. -- Ray

Joel Sherman said...

Ray,
A year or two ago I saw a reference to a paper by a nurse who studied the percentage of males in nursing. Unfortunately I don't have the reference. But she agreed with you that the percentage of men in nursing has not changed significantly. It does vary over the years, but the major variable is actually whether we are at war or not. The major factor bringing men into nursing has apparently been military medics coming home from combat. The issue is of concern here as it goes without saying that unless there is reasonable parity in health care providers, it will be very difficult to satisfy gender preferences in medicine. I'm not sure that these statistics apply to technicians however where there has been an influx of men, though I don't know the actual percentage. I also think that gender statistics on physician assistants are needed. They should be available. My guess is that more men choose this route as it doesn't carry with it the same onus of being a male nurse.
Please feel free to copy the statistics you gave on Bernstein here as they are very pertinent to our discussion.
I've been in medicine too long to believe that the JCAHO statement is anything but feel good public relations. But it would help to see it in full context.
I certainly agree that patients have significant privacy rights which can be litigated, especially for the more egregious examples we've discussed. Hard to know how far it goes though. You'd have far more trouble suing about the careless exposures and disrespectful treatment that we read about here frequently. In house complaints are likely here the major remedy.

Anonymous said...

Joel: I agree with you on all counts.

An internet source I found put the percent of female PAs at 44%. I couldn't find a figure for medical techs. except EMTs -- only 30% are females.

The relationship between % of male nurses and peace/war is interesting. I assumed the small variation in male nurses from year to year represented random fluxuations; I never thought someone would find a pattern that could be explained by something such as war and peace. But it does make sense. -- Ray

http://health.groups.yahoo.com/group/howhusbandsfeel/ said...

Joel and other MD's. Have you ever prepared a survey paper to give to your patients to take home, fill out and return to you without names to tell you how they feel about patient modesty/privacy? To me this would be the best first step you to take.

MIke

Joel Sherman said...

Mike, I refer you to the 2-4th posts at the start of this thread. I am all in favor of the suggestion, but it's not suitable for my practice. Hopefully Ray will eventually get similar information.

gve said...

Why not have people suggest suitable questions for the questionnaire? Perhaps a hospital somewhere could then be perusaded to use a compilation of these as part of a customer satisfaction survery.

If I could start the ball rolling with a few suggestions:

Were you at any time unhappy about being treated by a person of the opposite sex during your stay?

Would you prefer to receive personal and embarrassing procedures in the presence of only your own sex?

Would you like to be offered same sex treatment without having to ask for it?

Have you ever been made to feel more uncomfortable during an embarrassing procedure by the presence of opposite sex medical staff?

etc

Anonymous said...

This is only a suggestion but would it not be possible for us all to agree upon a series of 5-10 yes/no questions, then randomly select names from our phone book in our area, then compile the data. I'm sure most of us are in different areas of the US/globe, would take some time and would depend on the number of people willing the gather the data but still would be something we all could do. Does this deserve further discussion? Jimmy

Joel Sherman said...

Explain your idea a little more Jimmy. Who are you proposing asking the questions to and what general type of questions? Most physicians might be willing to answer questions from long time patients, but you'd have trouble getting a physician to answer potentially contentious questions from people they didn't know who had little standing to ask. Possibly a few large clinics and hospitals might be willing to answer questions, at least they would have a person who might be delegated for such tasks though I haven't had much luck with my hospitals and apparently Dr Bernstein didn't get a response from the hospital he said he would contact. So unless you have something different in mind, I'm not too hopeful you could accomplish much.

Anonymous said...

Joel,

I'm just wanting to get just a basic series of yes/no questions to the public in general. This would have nothing to do with a hospital or office, just random names from your phone book. One thing that I think we can all agree on is that everyone as been a patient at some point in their life so it shouldn't be that difficult to find those people, the challenge would be with the questions and selection. We may need some qualifying questions to start with so we can make sure that we're talking to the right person and also would depend on the number of people willing to get that data. Just would be something that we all could participate in without any strings attached. Just a thought... Jimmy

Anonymous said...

The idea of polling patients has a lot of value from the fact that if it showed what we all here believe to be the case....patients care more than providers admit...and could tie that to profits either passive or direct (the happier a patient the more positive thier opinion and more frequent they would use a facility or patients actively or would actively use a facility that offered greater accomidation...it could effect some degree of change as money drives the world. The tricky part would be collecting and colating the data. Getting people to partcipate would be difficult without an organization of some type to give legitimacy, people are inundated with gimmicks and span, mail based would require self addressed and stamped envelopes to get people to partcipate. I do think the excercise would be of value and would be willing to spend some money on my end to advertise to solict partcipation in my area,,but we would need sometype of web site and "organization" to host the web site. We could come up with a questionaire...Ray seems to have a very good grasp on research technique...still have to have the vehicle to get it out and get data in..Thoughts? JD

Joel Sherman said...

OK, for the moment we're just considering questions directed to the general population, i.e. all potential patients. Hopefully Ray will be starting a project on this in the near future. Here are questions I proposed to him separately:

Questions I would consider include 'who do you feel more comfortable
with, same gender providers, opposite gender or no preference and then I'd break it down as to how strong a preference it is differentiating general vs. genital exams. For example, I might prefer a male urologist all things being equal, but would accept a female urologist if needed for say an emergency or if there was a specific reason (like I had a specific referral to her). But I might not care at all for general providers. How many patients would be drawn to an institution or practice that advertised that same gender preferences would be honored?

Obviously questions directed to providers would be quite different.
I certainly think we can get some good ideas by asking friends or random people these questions, but a more rigorous study and control could best be provided by Ray.

Anonymous said...

I'm back! Hope everyone enjoyed the holidays.

On Mon. October 22 6:48pm I posted the results of a couple of studies I and students conducted in the past regarding cross-gender care on Dr. Bernstein's blog. You can take a look at what I wrote and determine if either of the studies is, at least in part, what you'd be interested in.

I can replicate and expand on these studies this semester using a sample of people from the Kirksville area rather than using only students as I did in the past (thereby getting more male respondents). In one sense it is apropos to conduct the studies here; Kirksville is where Andrew Taylor Still founded osteopathic medicine and the original osteopathic school. The Andrew Still School of Osteopathy and Northeast Regional Hospital are located here.

I'll create an instrument or instruments and post them here for your analysis and critique. However, that may not be accomplished until mid-semester. -- Ray

Joel Sherman said...

Here's the post of Ray's that he referred to from Bernstein's modesty blog of October 22 2007. It is more than pertinent to include it fully here as well:

Regarding your request,Dr. Bernstein, there are a mess of studies including the following: Harr, Ester, Victor Helitsky and George Stricker. 1975. "Factors Related to the Preference for Female Gynecologists." Medical Care. 13: 782-90; Levinson, Richard, Kelly T. McCollum and Nancy O. Katner. 1984. "Tender Homophily in Preferences for Physicians." Sex Roles. 10(February): 315-24; Cooke, M. and C. Ronalds. 1985. "Women Doctors in Urban General Practice: The Patients." British Medical Journal. 290: 753-8; Nichols, Sally. 1987. "Womens' Preferences for Sex of Doctor: A Postal Survey." Journal of the Royal College of General Practitioners. 37: 540-3; Fennema, Karen, Daniel L. Meyer and Natalie Owen. 1990. "Sex of Physician: Patients' Preferences and Stereotypes." The Journal of Family Practice. 30: 441-6; Kelly, Michael. 1990. "Sex Preferences in Patient Selection of a Family Physician." The Journal of Family Practice. 11: 315-24; Weyrauch, Karl, Patricia E. Boiko, and Barbara Alvin. 1990. "Patient Sex Role and Preference for a Male or Female Physician." The Journal of Family Practice. 30: 559-62. These all have to do with preference for male or female physician.

In the 1980s and 1990s a number of studies were conducted designed to tap female patients' preferences for female or male nurses. Most of these studies took place in the United Kingdom. In two studies, patients who received care from female nurses were asked their preferences for male or female nurses. Depending on the procedure, anywhere between one-third and three-quarters of the subjects objected to receiving intimate care from male nurses (Mynaugh, Patricia. 1984. "Male Maternity Nurses: the Patient's Perspective." American Journal of Maternal Child Nursing. 9(November/December): 373-8; Cooper, Maryn. 1987. "A Suitable Job For a Man?" Nursing Times. 83, 34(August): 49-50; Mathieson, Elizabeth. 1991. "A Question of Gender." Nursing Times. 87(October 17): 40-3). Only Mathieson's study, which was conducted in a psychiatric hospital, used male subjects. She found that thirty percent "were uwilling to discuss sexual problems with a female nurse." Brian Lemin (1982. "Men in a Woman's World." Nursing Mirror. 155(November 24): 32,34) and David Newbold (1984. "The Value of Male Nurses in Maternity Care." Nursing Times. 80(October 17) 40-3) found that between one-third and one-half of their female subjects objected to having been cared for by male nurses.

I and nursing students in a research course I instructed found the following regarding subjects' gender preferences of nurse for different procedures: genital exam -- 77.3% same sex; rectal exam -- 66.7% same sex; shave pubic hair -- 71.2% same sex, 27.3% doesn't matter, 1.5% different sex; empty bed pan -- 59.1% same sex; 37.9% doesn't matter, 3.0% different sex. All the differences were statistically significant at below the .001 level except bed pan (p = .069). We broke up the reasons subjects gave for their preferences into four categories ("personal" including discomfort, humiliation, embarrassment, modesty, shyness, and stress; "patient rights" including violation of privacy and compromise of dignity; "culture" including not used to them and goes against my upbringing; and "prejudice" including don't like opposite sex, don't trust opposite sex, opposite sex not sensitive, and technical knowledge not sufficient. "Personal" responses were, overwhelmingly, the most frequent and the differences were highly significant (p < .001).

Back in the early '90s, students and I conducted research which resulted in findings consistent with comments made by a number of the posters to your Blog. We hypothesized that the greater the social distance between male physicians and their patients, the greater the patient dehuminization. We failed to find a significant relationship using all our indicators of social distance except on the variable sex. And, the relationship was the opposite of what we expected; women were less likely than men to be dehumanized. After one of the subjects proclaimed that she would never go seek health care because she didn't want to be "clinically raped," we decided to do a little probing. We created an instrument to measure how badly people felt about having been dehumanized (some items reflected the affective reactions of rape victims) and found that men who were dehumanized tended to feel worse (more embarrassed, more humiliated, more angry at themselves, etc) than women who were dehumanized. We also found that men who were dehumanized were less likely than women who were dehumanized to complain about it. In short, men were more likely than women to be dehumanized by health care providers and were less likely to complain about it in spite of feeling worse than women about having been dehumanized. We also expected, consistent with the literature, men's "macho" image of themselves would explain their tendency not to complain. Instead, we found, consistent with what some folks have written in this Blog, that it was dehumanized men's perception that others would think of them as being less of a man that deterred them from complaining.

js said...

When I called to make a post-operative visit after surgery, I found out the surgeon (male) did not see his patients. It was a female nurse in the office that was to remove a dressing in the groin and evaluate the incision. This really could not have been done discretely. I don't know if other male patients objected at all but I did not go in. I had my wife do it.

Anonymous said...

My students are in the initial stages of planning their research. There are only 8 students in the course and they work as teams. So there will only be between 4 and 2 teams.

At any rate, I’ve listed some research questions in blocks of relevance. If you can think of more research questions that can be feasibly pursued, I’d appreciate your feedback. Research using physicians as subjects is not feasible. Unfortunately, osteopathic students are probably out of the question too. Their dean of students has put a nix on my students’ research in the past in spite of the vigorous endorsement by osteopathic faculty and the approval of our IRB.

Here are some research questions.

Are there differences among different types of nurses (LPN, ADN, BSN) in their perceptions of what constitutes the ethical, legal, and most desirable treatment of patients? Is there a difference in their knowledge of what constitutes legal and illegal treatment of patients? Is there a difference in their knowledge of what constitutes ethical and ethically questionable treatment of patients? How do the perceptions and knowledge of nurses differ, if at all, with the population at large?

Are men or women more modest or are they equally modest? Are the behavioral and emotional responses to violations of dignity different for men than for women, or is there no difference? If there are differences, what are the sources of these differences? Are women or men more likely to protest violations of dignity, or is there no difference? If there are differences, what are the sources of these differences? Will the likelihood of patients questioning their treatment vary according to the status of the healthcare provider (e.g., physician, nurse, technician)? Will it vary according to the perceptions subjects’ have of the degree of power imbalance between them and healthcare providers? What kinds of actions, if any, by healthcare providers do patients think compromise their privacy/dignity? Does this belief vary by sex of subject? What do patients believe can be done to reduce the frequency of or prevent these actions?

Have subjects experienced what they consider violations of their dignity at the hands of healthcare providers? If so, what healthcare providers are most likely to be responsible (physicians, nurses, technicians, etc.)? Are men or women more likely to experience such violations, or is there no difference? Is there a difference between men and women in who is responsible for the violations? How do violations of dignity influence subjects’ perceptions of and interactions with healthcare providers, likelihood of seeking healthcare in the future, likelihood of seeking another healthcare provider, and relationships with others (such as spouses or other intimate others). Is there variation by subjects’ sex?

What percent of men and women, if any, prefer same-sex providers for intimate procedures? Are men more likely than women or women more likely than men to prefer same-sex providers for intimate procedures? What reasons do subjects give for preferring same-sex providers? Is there a difference between men and women in the reasons they give? Does the status of the provider make a difference (e.g., physician, nurse, technician)? What percent of subjects, if any, have had opposite-sex intimate care? Are men or women more likely to have opposite-sex intimate care, or is there no difference? How have subjects responded, behaviorally and emotionally, to opposite-sex intimate care? Do men respond differently from women, or is there no difference in responses by sex? Are men or women more likely to voice their objections to opposite-sex providers (or their supervisors) who provide intimate care, or is there no difference? Does opposite-sex intimate care influence subjects’ belief in their likelihood of delaying or seeking healthcare in the future and trust of healthcare providers? If so, does this response vary by sex of subject? Do subjects believe that opposite-sex care influences their relationships with others including healthcare providers, family members, and friends? Is there variation by subjects’ sex? -- Ray

Joel Sherman said...

Great that you're getting started on the project Ray. Be glad to offer any input I can.
Can you give me a clearer idea first though of to whom the questions will be addressed? Will they be random patients, providers, nurses or any combination of them? How many responses or interviews are you hoping to get? I'd be better able to suggest questions with that info. Your possible list seems ambitious to start.
Will the students do interviews or send out questionnaires? How will you get subject volunteers if the former or pick names if the latter?

Anonymous said...

Ray,

Great start on the questionnaire. I'm not sure it would be feasible but could you include some of the "if given a choice, who would you choose" questions? Just from my experience in speaking to individuals (meaning family, friends, and co-workers), many will be more open to questions and responses if they feel like they are getting a choice in the matter. I can't count the number of times I've heard a male patient say "well they sent me her, I guess that's all that was available." Just a suggestion, may have more once you’ve determined who will be answering these questions. Jimmy

Anonymous said...

I agree with Jimmy, it would be interesting to see not only if there they were given a choice, but did it matter, and were males or females given a choice more frequently.

Also, if there is anything we can do to help let us know. I.E. if you want to post the questionaire on line, I would be willing to run it in a area papers etc.

Thanks Ray for the effort and Dr. Sherman for the thread JD

Anonymous said...

Thank you all for the input.

What I've listed are research questions not questions or items that will be placed in a questionnaire or interview schedule. The research questions, of course, constitute guides for items on a questionnaire or interview schedule. The questionnaire or interview schedules will be developed later after students review the relevant research. I'll probably get started on it before they are done and will seek input from you all. And, I should add, we will probably not answer all the research questions in each block. I just listed as many as I could think of as a guide.

All the research questions listed have been derived from one of the blogs. If there are research questions that you'd like to see answered or research hypotheses that you would like to see tested, I'll run them by students and see if they are interested.

Joel -- The subjects who will be used to conduct research designed to answer the first block of questions are nurses. I don't have access to patients, per se, so people in the community will be used to conduct research pertinent to the last three sets of research questions. Of course, only individuals who have been patients will be used to answer questions regarding experiences as patients.

If nothing goes right regarding access to the sample populations we want, we may have to resort to using students as subects to address the last three sets of questions. That's unfortunate, but that's the way things go sometimes.

I'm hoping we can conduct telephone surveys using interview schedules. If we're able to do that, telephone numbers will be chosen at random. We may send out questionnaires to addresses chosen at random or systematically to answer the last three blocks of questions. In that case, students will phone residents first and alert them to the arrival of the questionnaires in order to increase the likelihood they will be answered. We have no resources to do anything better.

If we are relegated to student subjects, we'll just use anonymous questionnaires and convenience samples. Of course that can only be done with the last three set of questions. -- Ray

Joel Sherman said...

Here's a good reference from the patient privacy rights organization (see link) for a 'toolkit' on patient privacy with lots of information.

Joel Sherman said...

I just came across this old allnurse's thread again. It's long but still getting current posts.
Anyone who's interested in modesty and privacy concerns in the OR should read it through. It has a variety of views. It should give some pause to anyone who wants to control what happens to them in the OR, especially in terms of same gender care.

Joel Sherman said...

One of the hospitals I use just put out a new pamphlet entitled Patients' Rights and Responsibilities. Here's one pertinent paragraph from it:

To be interviewed and examined in places that provide visual and hearing privacy. This includes the right to have a person of one's own sex present during certain parts of the physical examination, treatment or procedure performed by a health professional of the opposite sex. Patients have the right not to remain disrobed any longer than is required for an examination, treatment or procedure.

This statement is not exactly a major breakthrough, but at least it does recognize a right to modesty. Hospitals don't use chaperones much at all which happens more in offices, but it would seem to allow for a male patient refusing a female chaperone's presence, though I'm sure that was not the intent of the section.

Joel Sherman said...

Here's a new wrinkle I was unaware of. Insurance companies have used the information posted by kids on their MySpace page to deny them health coverage.
In this computer age there are so many ways to compromise your privacy that it is mind boggling. Or should I say mind blogging.

Joel Sherman said...

Here's a problem I haven't thought too much about, the privacy of patient physician phone conversations, in terms of whether the patient can talk in a confidential private place when you have to call them at work.
The article makes the point that most patients would rather be told bad news or sensitive information in person than over the phone. On the other hand if you tell them they have to come in to discuss the results fully they already know it must be bad news. The only real alternative is to make everyone come in for results, but that would be a waste of time and money if you're only going to tell them that everything is fine.

Anonymous said...

Dr. Sherman

Perhaps you can answer this, if a patient wants to make a request for surgery or a procedure such as wearing underwear or shorts, who normally can grant that accomodation, the Dr./surgeon or the facility. JD

Joel Sherman said...

JD, there's probably no consistent solution for differing hospitals and surgeons. I would start off by asking your surgeon what to do. If he/she won't accommodate you there's no point in talking to the hospital. If the surgeon is agreeable, he should be able to arrange the rest of the details with the hospital. I would certainly then ask the surgeon if there's anything you should do at the hospital to reinforce and remind them of the accommodation you agreed upon.

Anonymous said...

Hope you don't mind Joel, but I have alot of experience on the subject of wearing underware that JD asked about.

As Joel said, they are not consistent and it varies from doctor to doctor or hospital to hospital. When I first started having orthopedic problems with my shoulder, I was going to a doctor in my hometown that practiced at my wifes hospital. When my only option was surgery and we had our consult, I simply thanked him for all his help and told him I'll sleep on it a few weeks. He didn't want to do the procedure that I knew could be done by a different physician so I went to him and still go to him this day. The hospital was the same I spoke about on Dr.B's blog that tried to make me wear just an open ended gown to remove a cyst on my ear, my EAR! They allowed me to wear scrubs and leave my underwear after I started walking out, but only then.

I have found it easier to speak of this after I have an understanding of the procedure that I'm going through. I also know that it's not just the surgeon, it's the nurses and the anesthesiologist (SP?). During my last knee scope, I had to get approval through all three groups and then still had it noted on my chart. If you take the time to learn about your procedure ahead of time, that may show them how much it means to you. When I spoke to the anesthesiologist, I had an educated conversation about the different nerve blocks the use for knee procedures and he commented to me that he was impressed with my knowledge on the subject, he was also the same guy that told me that it was more a nursing thing (not wearing underwear) than a doctor thing. He even thought is was a dumb rule (his words to me). He did tell me to bring an extra pair of underwear though just in case I had an accident. I didn't and most don't, it's just one of those unproven/outdated rules that they've always done. I really don't know what the difference would be for a person that has an accident wearing or not wearing underwear, atleast it would be contained in underwear instead going all over the surgical table and having to move the patient for clean-up? But hey, what do I know. Jimmy

Joel Sherman said...

One thing you can do to improve privacy rights is not to let ill considered legislation pass. Here's a story from Massachusetts about a legislator who wants to make physicians responsible for telling the motor vehicle department when for instance their patient breaks an arm and can't put two hands on a steering wheel. It's a variation on an old problem, if you make physicians responsible for enforcing and reporting laws, people affected won't go to get medical care. My daughter was told by her physician not to take my granddaughter to the ER for fear that she would be investigated because the child dislocated an elbow and had another bruise. We go too far when we make reasonable and responsible people afraid to seek medical care because they may hear from the law.

Anonymous said...

The hospitals I have worked on all require no underwear for every surgery. Years ago a patient wanted to keep their underwear on and begged the pre-op nurse to let him wear them. Round and round they went. He asked if he could plead his case to the OR nurses and his surgeon. She said ok.

He then went round and round with the nurses and surgeon all of whom explained to him that it was SOP. They relented as he was so distressed. He had on clean briefs and they felt they could scrub below them. They did tell him that if they felt they needed to be removed in surgery they would be and he agreed.

Fast forward and the patient sues for an infection. When the patient spoke to his lawyer he mentioned wearing underwear. He admitted the staff was kind and this was his request. The medical staff also admits they allowed him to wear it even though it was SOP.

They settled for big bucks out of court because having to admit they didn't follow SOP in the OR would be deadly to them. Never happened again. If you refuse they don't operate. Until SOP is changed many hospitals will continue this policy.

Anonymous said...

Hospitals can't offer what they can't provide. At present the nursing profession is at approximately 10% male nurses. Those aren't good odds for men getting same gender care.

In the OR which staffs approximately 5% of nurses (both male and female) the odds are even less. You could get a male tech, but chances of having a whole team of men is rare.

*You have the right to refuse if your need isn't met.

Wheras patients have great leeway in regards to same gender care where their doctors and surgeons are concerned, it is greatly lessened when nurses and their support staff are a part of the process.

Anonymous said...

As a patient you can refuse a chaperone or assistant for an exam. That's your right. If you are having a procedure done an assistant might be necessary. If that isn't the case simply tell your doctor you don't want an additional person in the room. The doctor has the right to refuse the exam, but I doubt this happens all too often.

I'm male and my doctor always does exams alone. A female fill in did bring as assistant into the room and I asked them to leave. They did. It was no big deal. I prefer my exams to be completely private.

Joel Sherman said...

Anonymous of February 27, 2008 6:23 PM, could you provide further detail? What area was the surgery in and where was the infection? I can't see how you could for instance implicate underwear being related to a shoulder infection. The hospital could of course have a patient formally sign a waiver mentioning infection, though nothing would hold if the surgery and infection were in nearby areas. Standard operating procedure should certainly not be violated if that was the case.
Anonymous of February 27, 2008 7:23 PM, nothing in US medical practice formally recognizes chaperones as voluntary. See my thread on that subject. Nonetheless most physicians would honor that request. But in some cases you may not realize that the personnel present are really intended as chaperones as you could be told that they were assistants. Sometimes it's not a clear boundary as doctors might prefer to have assistants available that they could manage without. As a physician I would probably know the difference, but most patients wouldn't.

Anonymous said...

A signed waiver wouldn't help here. The burden is on the hospital not the patient to ensure a safe environment that provides the most successful outcome. This often includes not deviating from SOP. I would however like some SOP changed. In hindsight, they should have refused to proceed. I would strongly urge all medical personnel to speak to their legal team before accepting a waiver and making it part of the patient file.

My biggest pet peeve where chaperones/assistants are concerned is that the AMA doesn't state they have to be medically trained. I find it a huge violation of a patient's privacy to bring in a secretary, office manager, etc. even if they are the same sex of the patient. I really wish more would speak up on this matter.

I have dismissed a female assistant (who really was a chaperone) from the room. I see no need for it nor do most of the people I know. We do however speak up. I believe that's key.

I wasn't involved in the case. It was a knee surgery. A cath wasn't put in place, but one was needed post op as the patient couldn't void. Patient had a bladder infection and a wound infection from what I recall. I'm not a doctor, but I really didn't feel the underwear was even remotely the problem. It did however help their case because they based a large part of it on how SOP wasn't followed and it had somewhat of a snowball effect from there.

Long story short is the hospital seemed to settle primarily due to deviating from SOP. I'm not so sure it was a slam dunk, but they feared word getting out to the media. They were fearful of bad press and publicity. People hear they didn't follow standard protocol and they panic. I can understand that. Not everyone takes the time to really look at the case and all the facts. Hope this helps.

-TM

Joel Sherman said...

TM,
I agree that a waiver is not absolute protection, but it helps. Also 'standard operating procedure' can be changed. I'm not a surgeon and I don't know the legal standing of SOP. But if medical evidence supports the wearing of underwear for unrelated surgeries, or at least documents that it is 'non inferior' I don't see the problem. The hospital as you say may well have settled for other reasons.
Have you been a hospital counsel?
The AMA's stand on chaperones is clearly aimed at protecting providers if you read that thread. Only the British seem to look at all aspects and include the patient's view. But AMA guidelines have no force of law and every state can make their own regulations. I have not seen any that would satisfy me. All patients should feel free to object to chaperones.

Anonymous said...

TM and Joel,

Who oversees the SOP's? Is it the hospitals responsibility or do they have a base set of rules they have to follow depending on how they are acredited? I've been on the other side, I've been asked to remove all clothes and put on the gown just to remove a small cyst ON MY EAR! It's insulting to ask any patient to endure that when nothing is involved except for entering the OR Suite. I've also had knee surgery, and to my surprise I was asked before the procedure if I would like some undergaurments to wear, I went ahead and wore mine but my point is that it really doesn't hurt anyone to allow them. If they're concerned about them being sanitary, carry some themselves. That would be the respectful thing to do and wouldn't cost them a large sum of money. Jimmy

Joel Sherman said...

I can't answer your question definitively, Jimmy, not being a surgeon. But I would think that it's much more likely that each hospital makes there own rules and could change them.

Joel Sherman said...

I can't attest that this post is a fair impartial look at the issue, but the questions it raises are certainly of concern. Can a state, possibly all states, take genetic samples of infants to catalog genetic diseases and then forward samples to Homeland Security? All this is allegedly being done with only perfunctory 'informed' consent.
It's something to think about.

Joel Sherman said...

Congress is debating a bill to protect genetic information. This is vital for basic privacy rights.
Here's a brief position paper on the bill from the Patient's Privacy Right Organization. I fear she's right. Once companies have the information, how can anyone prove what they did with it.

Anonymous said...

If you can't leave your underwear
on then the OR staff shouldn't
either. Everyone is in a sterile
field. It's all about power. When
we are patients we are the BOSS.
My rules from now on. I've had
my privacy violated 6 times and
2 of those involved unethical
behavior by female nurses.No more!
Rule number 1) The first time
someone attempts to violate my
privacy the game stops right there
and I ask for the head nurse,charge
nurse,physician or administrator.
At that point the shit hits the fan. I want names cause the whole
world will hear about it. I want
an advocate there when I'm
unconscious. Period! Why is it
that most male nurses will ask
a female patient if she wants a
female nurse for a personal procedure like a foley etc. Yet
do female nurses ask men the same
question? Of course not. Do you
know why. Sure you do. IF I need
a personal procedure, then the
female nurse better start looking
for a male nurse. I tell them in
advance! We need to start being
proactive about this. Don't just
complain to the hospital, complain
to the state nursing board. You
can complain to the ARRT in Minn.
if you have a complaint about an
x-ray tech or ultrasonographer as
well as a ct tech or mri tech.

Joel Sherman said...

I think we can all agree that men need to be more proactive to obtain the same options that are usually granted to women. But we also need to recognize the problem, that there are far more women in ancillary fields than men. I think if more men spoke out, it would gradually change. Hospitals would have to recruit more men, but it will be a slow process. They could also hire back more male orderlies and train them to do many of the jobs they used to do routinely, such as catheter insertions. Now they are solely used for patient transport in the hospitals I'm familiar with. I think that was mainly a financial decision. Many traditional nursing jobs, such as bathing patients, are now done by aides and there are very few male aides though a significant percentage of men would rather be bathed by women anyway. There are however far more male technicians than there used to be and a good percentage of physicians' assistants are men.

Joel Sherman said...

From a different thread:
"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"

If any provider violates you, the important response is to complain ASAP. In a hospital the place to start is with the head nurse or nursing supervisor. If they don't respond, you can and should complain to the hospital. Most have a patient advocate to take such complaints but it may vary. If the problem was with a nurse or aide, you should also tell your physician. If you think the problem is more with the hospital, you can pursue your complaints further with a state hospital board or with JCAHO. If the problem was with one nurse, you can complain to the state nursing board who will likely look into the matter. I cannot tell you what would happen. It depends on the seriousness of the violation and on the individual board. I don't think complaints like this to the state nursing board are very common, but they are certainly fair if you're not satisfied with other responses. It is common for state medical boards to receive and investigate similar complaints against physicians.

Anonymous said...

Well, I'll tell you this and with
all do respect. The patient advocates in hospitals are female
nurses. The director's of the
state boards of nursing are female
nurses. Do you really think they
CARE!

PT

Joel Sherman said...

PT, patient advocates work for the hospital and likely have more loyalty to them than to the patient. State nursing boards answer to the public and probably do care. What they do is usually of public record. You never know until you try. It's worth a try.

Joel Sherman said...

Well here's a step in the right direction, the Genetics Antidiscrimination bill has become law.
Bear in mind it's only a step. For instance employers can access your health information. How can anyone prove whether or not they used the genetic information available in order to make a hiring, firing, or promotion decision? They should not have access to an employee’s health information at all except in narrow, well defined circumstances with the express consent of the employee.

MER said...

Joel:

What evidence do you have for your statement that "a significant percentage of men would rather be bathed by women anyway." If you have some quantitative data, I'd like to see it.

I may be wrong, but I believe two things about that statment.
(1) There is little or no hard data. There are observations from medical professionals who deal with this issue. (2) I question the observation because men,in most cases, are just not asked. And men as a matter of psychological record often do not express their feelings and opinions in situations like this. If men were asked, and the data recorded, we all might find out how men really feel about this. I think we would be surprised.

Joel Sherman said...

MER, yes, there is no quantitative data that I know of. Those are my impressions from a variety of conversations. We have tried to get more information. 'c ray b' started a study in his classes, but as far as I know it was never completed. Some months ago (before you) I tried to poll the nurses on allnurses, but they immediately deleted the post because they said I gave this blog's url. They have since stated that they changed their policy for 'research,' but I have not tried again. No scientific data could be obtained from informal polls on blogs in any event. Allnurses is basically a commercial site with their own agenda. But I certainly believe from my readings that most men don't want to be exposed to anyone, but if necessary some would prefer women. Much of this is homophobia as the percentage of gay male health care workers is certainly greater than in the general population. The US is a very homophobic country compared to other Western countries (but I have no documentation for that statement either). As noted in the chaperone thread, adolescent males are far more reluctant to be exposed to females than adults, but they aren't often given a choice.

MER said...

Joel:

Thanks for your reply. I wish a sociologist and a doctor would get together to do a study of this that would give us some data. I do agree with you that a number of men in this country are homophobic, probably more than in other some other countries. Until we get some data, though, I hesitate myself to use the phrase "a significant number." It's a pretty vague phrase. What does significant mean? One third? Nearly a half? I starting to use the word "some," for now at least.

So -- I believe that some men are too embarassed to express embarrassment. That is, they're so unused to expressing their feelings in intimate situations, especially with strangers, that -- as embarrassing as it is, it's less embarrassing for them than having to talk about it, or request another caregiver. This, I believe, is the macho stance. Real men don't cry, don't, don't express shame overtly.

I refer all reading this to a fascinating book called: If Men Could Talk: Translating the Secret Language of Men by Alon Gratch, PH.D. He's an clinical psychologist who deals with men (some women, too). A few quotes:

"While women are often capable of articulating feelings of embarrassment, shame, and low self-esteem, men are more likely to deny or repress such feelings all together." (p. 35)

He lists several characteristics of the male psyche. The first is Shame -- how from a young age we're socialized not to show feelings, or cry. So we often repress our shame and transfer our performance shame to others, especially toward our women.

Another trait is Masculine Insecurity (I'm tired of being on top). Read this explanation and see how it might apply to why some men say they prefer female nurses for intimate care and yet deep down may still feel embarrassed and resentful:

"One patient, a driven, hard-nosed enrepreneur put it this way: "Sometimes I just want to be flattened," by which he meant literally lie down and stop moving, and figuratively put down arms and withdraw from the business wars. But this was not merely an indication of exhaustion or a wish to quite the rat race. Rather, it represented a deep desire to abandon the active pursuit of bravado and to become the passive recipient of care. Consciously or unconsciously, these kinds of wishes -- to be pursued rather than pursue, to be the object rather than the subject (of attention), to "be done to," rather than to do -- are shared by all men. At the same time, such feelings pose a fundamental threat to men's sense of manliness. Therefore, men must overcompensate by searching for, and always seeking to assume, an ever more masculine stance." (pp. 10-11)

With a lack of data regarding men's choices for intimate care, I think we can use the psychological studies like this to at least approach the subject with some theories. That quote above, explains to me (with one of many complex reasons) why some men say them prefer women caregivers. That may also be why some of the also ridicule those men who don't want female caregivers. They want it, yet resent it, and their insecurity transfers as ridicule toward those men who don't want it.

Now, I'm not saying this is fact. I'm presenting it as theory based upon the observations and research of a clinical psychologists who works with men. There are many other great insights in this book that are worthwhile in themselves but also of interest to the topics we're discussing here.

MER said...

Joel:

I didn't know you too had trouble with allnurse.com. You might find it interesting that I found this thread there from some nurses, asking what happened to the Male Medical Modesty thread I had started -- the opne they deleted. Here's what one nurse wrote:

"It was such a great discussion, I personally felt I was learning a lot and reexamining some of my ideas on this..."

Another nurse added a comment, and then the staff came on and said the thread has been "removed from view for the time being."

I can't express my disappointment enough regarding the management of that site. I don't believe they represent most nurses on this issue. They seem to want to eliminate or hide discussion, and the nurses I've talked with are more than willing to discuss this issue with patients so we can learn from each other.

You can find the thread I'm referring to at http://allnurses.com/forums/f8/male-modesty-thread-310517.html

I almost hesitate to reference it here because there's the possibility they now might remove it from view.

Joel Sherman said...

MER, I of course don't know what numbers 'a significant percentage' translates into. My guess is that maybe 10% of men would refuse same gender care while the majority of the rest don't have a strong preference. The overwhelming majority of men would not complain one way or the other. In fact, the majority of women wouldn't complain either. But as always more people care than are willing to complain.
Nurses could give us well founded impressions on this. Too bad we can't get it from them. When it comes to doctors, the fact that there are so few female urologists and some of the ones that are around specialize in women tends to say that homophobia does not loom that large in male patient preferences.

Anonymous said...

Ha, I told you. Anytime a topic
like that is posted on allnurses
they will remove it. If it has to
do with male patients they will
lock or remove it. Now, if the thread makes fun of male patients
it becomes very popular and there
are those threads on there. It
just furthers my beliefs about
ALL FEMALE NURSES!

pt

Joel Sherman said...

PT, my attempted post on allnurses asked gender preference questions, not male modesty per se. It was deleted literally in minutes, because I gave a link to this blog. They have since apparently changed their policy on this to allow links for 'research.'
The reason they later gave me for this policy is that they don't want any posts on allnurses to attract people elsewhere, a solely commercial decision for a commercial site.

Anonymous said...

That site allnurses, has links to
many sites. As I've said, they don't want to hear about male
privacy issues period. Some might
say that it's an "interesting"
thread. You need to look between
the lines!

PT

MER said...

I tend to agree with the last post to some extent. Before they shut down my thread, I had posted many outside links that they allowed. That may have been after, as you say, Joel, they changed their policy about links for research. It's difficult to say.

They do allow discussions of this nature. You'll find many on their site. The problem is, I think, -- that they don't like it when non nurses or non medical professionals get involved with or lead the discussion. I can see their point, to some extent. But they need to realize, not just intellectually but emotionally as well, that patients are not "outsiders" in this discussion. We are as much on the "inside" as they are -- and our views can be quite different from theirs -- and they need to spend more time trying to see things from the patients point of view.

Joel Sherman said...

MER, I'm really not concerned with the motivations behind allnurses posting policies and won't try to second guess them. They are certainly not anti male nurses as they have an active forum running for them.
However as you suggest they are a nursing site dedicated to the concerns of nurses and they are not focused on patient or other concerns. It's too bad that they are not more amenable to patient oriented discussions, but that is their right.

Joel Sherman said...

MER gave this link on Bernstein about a nurse complaining about her treatment in a hospital she was referred to. She wound up writing JCAHO.
I haven't summarized the avenues of complaint and redress that are available to patients in a long time and I thought I'd review them. Always though lodge your complaint as soon as possible.
In a hospital:
1.) Object to the nurse or provider who's giving you the care you are unhappy with.
2.) If no satisfaction, ask to speak to the nurse in charge or the provider in charge.
3.) Most hospitals have a patient advocate and you can call her, remembering however that she works for the hospital, not you.
4.) If the complaint is serious you can complain to the state board that supervises or licenses hospitals.
5.) The last step is complaining to JCAHO. Don't expect an instant resolution from either of the last two, but the hospital will be notified of the complaint and they cannot dismiss it out of hand. It will get their attention.

In a doctor’s office:
1.) Again as soon as possible complain to the nurses or providers.
2.) If the complaint is a serious breach and you're not satisfied, complain to the state licensing board that regulates physicians. Once again they may take no action but the physician will be informed and you will definitely get their attention.

No hospital or physician likes to get complaints filed against them with state or national agencies. It doesn't take much before they change their behavior.
Anyone have further suggestions?

A sub-theme of the above allnurses link is that large referral hospitals aren't always the best in terms of patient treatment. They usually have greater access to new techniques and research, but they can be lacking in patient care and empathy.

MER said...

I want to quote an exchange from a blog called -- About.com: Patient Empowerment. I'll provide the link at the end of this post.

I found this in a section called "From the Professionals," so the assumption is that these are medical professionals.

A writer named Stephansem (apparently he/she's a doctor or nurse) writes:

"Earlier in my medical career I learned that a smart patient going to hosptal better have with him/her a loved one as well as a good lawyer to make sure that he/she gets out of hospital alive.

Does such an advice still hold true in this highly poilitically correct, dog-eats-dog society?"

Trisha Torry, who runs a Patient Empowerment blog, responds:

"In my not-so-humble opinion, Stafansem, I don't give a rats patootie what is politically correct when it comes to care for myself or my loved ones.

When it comes to the question of health, in particular someone needing hospitalization, stepping on someone's toes is the last thing I am concerned about.

That's not to say we can't start out by being polite and using our manners (and expecting the same from the hospital staff.) But at the point where there are any question marks? Then assertive and, if necessary, verbally aggressive may be required."

Now, I realize that the implication in their discussion is probably about more life and death situations. But, my point in providing this exchange is to strongly suggest that -- relative our topic of patient (especially men's) modesty -- men need to be more assertive, even civilly agressive. This principle is the same regardless of whether we're talking life and death or patient modesty.

I once interviewed a man who had made an appointment with his male primary care physician for a complete physical. He had wanted to ask his doctor some personal questions. He made the appointment, called to confirm it, filled out a form or two in the waiting room, was escourted to the exam room, told to get in a gown. Soon a female doctor walked in saying that his PCP was on vacation and she was taking his place. No where along the way he been told of the switch and offered a chance to reschedule.

But that story isn't my point. I asked him why he hadn't spoken up, and why he didn't insist on rescheduling. Here's what he told me: "I was too much of a gentleman."

Part of the problem, especially with men in their 50's or older, is that we've been trained to be "gentlemen" (whatever that means) with women. We don't want to rude, and we shouldn't be. But at some point, if we make our requests and they are not taken seriously, we need to forget about political correctness, become assertive, and even become civilly agressive. Until men do that, the situation will not change.
Here's the URL:
http://forums.about.com/n/pfx/forum.aspx?tsn=1&nav=messages&webtag=ab-patients&tid=36

Joel Sherman said...

I do believe that any seriously ill or post operative patient needs a patient advocate. After a bad experience in my family I would not leave a patient alone until they are clearly well enough to look out for themselves. Mistakes and oversights do happen. That's not to say everyone needs a lawyer though. I'd keep them out of the hospital; they have no medical knowledge. If they're needed, it's much later.
But yes, 90% of the problem encounters can be solved by speaking up, the sooner the better. It helps to be understanding and polite, but you may need to insist or go elsewhere. That doesn't have to happen very often before a procedure is changed.

Anonymous said...

I had an experience at age 13 where I stood up for myself before an unfair surgery. I had broken my nose and was scheduled for surgery to fix it, have my adenoids removed and my tonsils scraped. I was told right before surgery to remove ALL my clothes and put on the "gown" (more like an apron). I refused because my parents and I couldn't understand why I had to be completely naked for a nose surgery. Then, as now, I was prepared to cancel the surgery to stick up for my ethical rights and they finally agreed to let me wear scrub pants.

I felt that I won the battle except for one thing. When I woke up afterwards the scrubs I was wearing were not only untied but were also very loose on me and twisted a little to one side. That bothered me then and even more now because I have recently learned that they will sometimes completely remove them after a patient is asleep and then replace them afterwards.

Does anyone know what the possibility could be that they removed them as I slept? Well anyway, depending on whether they were removed or not I learned that even young people can fight for their right to privacy. That was in the mid 80's.

More recently I had to have ACL surgery on my knee and then again 3 months later. I was not only allowed to wear shorts, I was instructed to. As far as I know they were never removed.

DG

Joel Sherman said...

DG, no one can really answer your question. They could have removed them and put them back or they just could have been scrunched with positioning you.
You'd have to have asked right away to get any chance of receiving an answer. It probably wouldn't be part of any operating room notes.
I applaud anyone who makes their specific requests known up front. Hospitals should reciprocate and say up front whether they can honor the request or not.

Anonymous said...

DG,

Gowns and scrubs have to be untied once you get to the OR. I was awake when I went to the OR for my first knee surgery and the nurse asked me to move soi she could get the gown untied. They do this for safety reasons but I can assure, they probably didn't remove them. I to was told I could wear shorts for each of my knee surgeries (working on a third now...)but had I gone to a hospital, that wouldn't have been possible. That's what drives me crazy about all this, things that won't harm anyone and can give a patient a sense of respect aren't practiced everywhere. If it doesn't interfere with the procedure as stated by JCAHO, it should be allowed for all. Just my opinion. Jimmy

Anonymous said...

The discussion of what have we done, after several years of posting here and on Dr. Bernstein's blog. What have we as patients done to address these issues. What I personally have done is summarized below:

1. After a not so pleasant experience at an imaging center at a area hospital. I wrote the patient advocate, did not get a response so I wrote the patient advocate, cc'd the hospital director and a member of the board of directors. I got all sorts of responses the advocate, the vp of the hospital, the head of the imaging dept. They changed the procedure that central scheduling now has a list of procedures that when scheduling, they ask if you prefer a male or female tech...change did happen from a single person addressing this.
2. I met with two of my state congressmen and presented them with statistics as to how drastic the nurse shortage was, what the consequences were, how large of a portion of their constituancy was effected. I then gave them statistics on the gender discrepancy in nursing, how nurses were now NP, CRNA's, etc which was going to make it worse, and....I gave them information on the "are you man enough to be a nurse" program out of Oregon and suggested they use it to bring more men in to help eliviate the shortage....
3. I regularly forward articles and links to the patient advocates on several hospitals regarding the issue. I often casually refer to HIPPA, JACHO, and make vieled references to discrimination and double standards against males...not to threaten them, but to plant the seed that perhaps I know more than I actually do. No one wants to be brought to the attention of the authorities for any reason.
4. I have sent a letter to my local hospital telling them that while I recognize how important they are to the community, I use the faclities of a hospital in a nieghboring town as they employ male tech's and nurses are willing to schedule accordingly. I tell them that I would appreciate it if they would inform me when they can offer this choice and I will gladly use them instead.
5. I am working with a local group of male nurses to devlop some copy that I can use on a couple of billboards my company owns similar to the Are you man enough......and to print flyers to put at male venues such as in the restrooms of the facilities I won etc to get more men at least thinking about the career.
6. I teach a junior achievement class every year in a local school. It is based on the value of education and occupation. I use this as a chance to hit 7th grade males on the opportunity in nursing.
7. I have no problem asking for accomodation, I also address transgressions when they happen at the time and follow up in writing...I have found it helpful to cc the instution when it happens at a hospital etc. AND I also send letters recognizing and thanking facilities and providers that provide either after or without me asking. (My PCP told me I was one of the first to thank him in writing for doing my vas without a nurse even though he knew men appreciated it, it obviously meant something to him.

8. I also don't restrict my "activism" to medical. I got tired of having women walk in and use the mens restrooms at a local concert venue I go to. I sent a registered letter to the venue, and to the venue's sponosr (they all have names now...the toyota center,etc). Told them of the practice and told them from the conversations I heard from men in there they had a great liablity if something happened to one of these women. I pointed out that now they had specific information of the risk, they had additional liablity if they did nothing. Told them I heard a couple guys talking about trying to use the womens restroom and suing if they were discriminated etc...could have been strictly coincidence...but they down have a security guard at the enterance...no women allowed.

Now this seems to be all male focused, but I don't intend it to be. It is universal, I can only speak from the male perspective, and the challenges the gender embalance puts males through...women face many of the same issues....just a little personal perspective....alan

Joel Sherman said...

Thanks greatly Alan,
I think your points are excellent. As you mention, they are from a man's perspective but what you suggest is equally applicable to women.
The message to all of us is clear. An individual can make a difference in this country and it doesn't take big bucks or a national organization to do it. Just one person who is an activist in every locality could make an immense difference.
Most providers are willing to accommodate people once they know that people care. Regarding male patients in particular, most providers have never even given it a thought as men are reluctant to complain.
Pointing out legal implications and mentioning regulatory bodies helps, but you don't need a lawyer for it. Blogs like this raise consciousness, but only individuals who care enough to speak up can really achieve anything. Everyone should plan what they could accomplish to raise privacy standards locally.

Joel Sherman said...

Alan's thoughts need re-emphasis. If you are a regular reader of this and Bernstein's blog you should have your consciousness raised by now so that you're willing to speak up for your privacy.
I certainly have had my consciousness raised. Last year at a hospital I walked into see a 30 something male patient who was clearly in some distress. I don't know the real reason for his distress, but the fact that he was completely naked and being bathed by 2 female CNAs (one much younger than him) couldn't have helped. What really got me was that the two didn't even cover the guy when I came in to take a history. It shows you what their mindset was. I would never feel comfortable taking a history from a patient who was uncovered unless the circumstances were extreme. I know from discussing this with nurses that patients are supposed to be covered as much as possible in these circumstances. I complained to the head nurse, and the women were talked to. Not sure I would have done that 5 years ago.
In a completely different setting I also spoke up when I would not have before. At a resort, I went into the locker room to shower. The door was closed with no sign on it, but a young woman was in there cleaning. She didn't say a word to me and I didn't know what she wanted. So I decided to just keep my bathing suit on and shower. She was still there when I left. I wasn't traumatized but I just starting thinking that the analogous situation would never be permitted in the women's locker room. The next day I complained to the resort manager who was sympathetic and immediately looked into the matter, and talked to the person in charge of cleaning. Turned out the cleaning girl was a 'trainee' from South America; maybe she didn't even speak English. I doubt very much that the situation will happen again. I wasn't trying to get the girl in trouble; it was probably the fault of whoever was in charge of her. But if you don't speak up, no one will ever know that you care.

MER said...

Joel:

I'm sure that story you told about the 30 year old man happens all too frequently. I don't think it's any accident that those bathing the man were CNA's and that they were young. Frankly, I don't think CNA's get enough training or enough initial supervision. I'm not convinced that they get any significant training in the psychosocial aspects of what they do. They're basically trained to accomplish tasks -- and that in a training that lasts only 8 or 9 weeks.
I was recently at a meeting in a hospital. The room we met in was used as a training room for a CNA course. I got there early and noticed the CNA text on a desk. While waiting for the others to arrive, I skimmed it. Under the chapter on intimate care, like bathing, all it said was that this activity could be embarrassing for both the cna and the patient. That was all. Nothing else. Of course, it did mention proper draping, but there was no honest, open discussion about embarrassment or opposite gender care.
Now, in fairness, we don't know what might have been discussed in class. But I'm not convinced anything significant was discussed in class about this issue. I later learned this was an all female cna class, so I'm convinced the issue of male modesty didn't even come up.
It is interesting that most of the stories I read or hear about modesty violations, especially with men, come from patients. It's rare to get a story like yours from a doctor or nurse. Although I will say, that I have had conversations with groups of doctors and nurses, and when I brought the subject up they did tell stories like yours. But from my experience, doctors and nurses are not only reluctant to tell these stories outside the hospital walls, but they're also extremely reluctant to report these incidents to supervisors. They don't feel comfortable interferring with their peer supervisors. That's another reason why these violations continue and continue and continue. Not only are patients reluctant to bring them up. But the medical professionals themselves who observe these violations are often reluctant to report them for correction. That's my take on this.

Anonymous said...

MER you are right about not wanting to report others in the "inner circle". There was a thread on allnurses, which I think has been removed titled "Whoa inappropriate" about nurses taking turns checking out a young man's apparently large penis while he was unconcious. The vast majority expressed the sentiment that it was wrong, but there was a great dispairity on what they suggested the poster should do. Many suggested she do nothing as it would cause problems, some suggested it wasn't that big of deal...just the nurses being human so let it go, some suggested it was wrong and should be reported, one poster raised the point...what if this were a group of men checking out a female patient, would and one of you suggest to do nothing or that is was no big deal...that was totally ignored. But the mere fact that so many while admitting it was wrong...suggested they not be reported. This is just another reason why people are starting to stand up for themselves. We have got to do so and put the thought in their mind that it not only is an issue, it is an issue we are willing to pursue up the ladder if needed. I do believe the conversation has to start from a calm intellegent place, give them a chance to respond positively. I have to say that in several cases, the response from the facility was better than I expected. They seemed genuinely concerned and in the case of the ultra sound tech, I had three different people from that facility call me. The Tech who ran imaging (female) said she understood completely and had some of those same concerns and feelings when she was a patient....something I would never expect to hear.
There is one concept that can come into play if they do not respond. That is the concept of specific knowledge. It is a term that means something to the legal team at any facility. It basically means if something is brought to your attention, and you fail to act on it, if there is a subsequent issue you bear a higher standard of proof to defend and, you have a higher level if liablity there is an issue. While it may not apply in many cases...legal advisors, including my own, then to advise on strictly a legal perspective. My attorney would cross every single t and dot every i just in case that 1 in ten million thing happens...the big thing to me is to get them to think this is a nothing issue with no consequences to one that is an issue that could have not only benefits and consequences for patient satisfaction (and there by financial implications), but one that some one could make a legal, regaltory, or financial problem. they will dismiss someone they view as a crack pot much more easily than someone they think may actually push the issue and knows how. One thing that I found, the personal satisfaction knowing that I had actually stood up for my rights was so fulfuilling compared to the self loathing and feeling I used to have when I just took it and felt humiliated...alan

Anonymous said...

Alan, excellent post, and I agree 100% with the last sentence. It's easier to just lay there and "Take it" only to wish you had said or done something about humiliating medical care. That time the nurse punched me on the scrotum I said nothing and did nothing. It tortured me for nearly 30 years. It took that long to even tell a therapist about it, before that I told no one at all, not even my wife. As hard as it can be to speak up, once you do and make a diference, you will be glad you did. The more often you speak up, the easier it gets.

Mike (58flyer)

Joel Sherman said...

I don't really know how common the bathing incident like the one I described is. To be honest, I didn't complain right away only because I wasn't sure what proper procedures were. That tells you how much providers know about this. I had to ask a few nurses what the protocol was and they all said the same thing, that a patient should always be covered as much as possible. One nurse said she hates when she hears stories like that; no one said it was rare. I'm surprised Bernstein says he has never seen it, though I'm really not sure if I've seen similar incidents before, that is before I've had my consciousness raised.
Unlike this guy, most casually exposed patients are critically ill, often with reduced levels of consciousness. Modesty and privacy are very minor concerns in those situations compared to the physical concerns.

Anonymous said...

Something that makes one wonder, a relative of mine just started a second career in medical care. She is a PA, basically has a couple courses under her belt. She does various duties, one of them is post op, I made the comment wasn't it a little wierd seeing people she knows like that? She said a little, but she always tries to keep them covered, but the some of the others who have been there for awhile just whip off the covers and leave them laying like that. Probably one of those things that the longer they are there they get calous to it and know the "cone of silence" is there. Now, she also said a lot of the nurses go elsewhere becasue they don't want people they know seeing them naked....ironic isn't it. I would guess this is pretty common, there is you and then there is me...two different concerns....alan

Joel Sherman said...

Alan, sounds like your relative is an MA (medical assistant) not a PA if she's only taken a few courses. Physicians assistants, at least in my state, function similarly to an APRN (advanced practice RN) and go to school for several years.
I don't work in an OR, but I'm sure they vary greatly in how covered they keep sedated patients. Not much you can do about it except make your wishes clear to everyone who will listen.

Anonymous said...

Dr. Sherman I think you are correct, my amazement was how little she had to do to be placed in the position of doing the tasks that many here have found so problematic. It really does throw a shadow on the we are the professionals argument. And as such, casts that same shadow of providers as a whole. If the system is willing to take some one off the street, give them a few classes, and now pass them off as a professional with many of the same rights to access to a persons body, where is the trust suppose to come from, does a patient have to ask each caregiver...what is your education, what is your title? A patient either has to trust everyone in the chain when they hand over control, or they really can't trust the whole system, and unfortunately I think its the later....doesn't man I do not trust my Dr., but I have to trust more than him or I have to take the defensive all the way through........alan

Joel Sherman said...

I've posted some details on medical assistants on the We're all professional thread. It may not be applicable in every state, but the training seems more extensive than I thought. On the other hand, there's no law against calling anyone a medical assistant so the term could be applied to any assistant in a doctor’s office to allay patients’ anxieties no matter what their qualifications actually were.

Joel Sherman said...

Here's an article from the UK about a hospital that is specifically banning visitors from the recovery room because of modesty concerns in the mixed gender room. The assumption here is that the patients themselves don't embarrass each other because they are still at least somewhat sedated. That's not always a valid assumption.
In this country, most hospitals don't permit outsiders in the recovery room. Most of the recovery rooms I've been in are either separate cubicles or curtained off. In the latter instance, patients can't see each other when the curtains are drawn but people walking in the aisle often can. But at least the above hospital is aware of the concern whereas many American hospitals don't seem to give it much thought.

Anonymous said...

I remember clearly back in the 80's my father had bypass surgery. The recovery was very large 6-8 beds, no curtains pulled, my father told me he needed to sit up so he could urinate. I was nervous about it so I got the nurse, she whips back his gown, picks up the cath tube and kind of tugs and shakes it...I was stunned as there were female visitors right next to his bed about 3-4', not to much later same nurse comes over and drops the top of the womans gown right next to me...it was really distrubing..I think it has gotten better, but unless we get something going group wise...progress will be limited...

Anonymous said...

Dr. Sherman:

A hospital a few miles away on the California side of Tahoe is part of "CHART". Although I know what CHART is, I can not get a total breakdown of the specific questions they ask patients as it pertains to percentages.
The last catagory is "Respect For Patient Preferences." They were rated 72%.
I would be curious if you, or others, have had any experience with your state's version of CHART.
If so, could you expand on the types of questions asked, especially the last?

Thanx

SWF

Joel Sherman said...

SWF, can't help you much.
I'm not aware of any state run or mandated program similar to CHART in my area, although I believe that JCAHO mandates similar quality initiatives for all hospitals.
As I've mentioned the hospitals I'm familiar with give each patient being discharged a questionnaire which includes a question asking them if they were treated with 'respect.' They don't define it, and I couldn't get the results of the questionnaire released to me. I have no idea how 'respect for patient preferences' is defined in your questionnaires. Are they referring to respect for gender preferences or something else, like how many times a day you prefer to have linen changed or your room cleaned? Or do they leave it purposely vague. I suspect most institutions prefer to leave awkward questions like these vague.

Joel Sherman said...

I have moved the two following posts here from the cancer thread:


Anonymous said...

To anyone,

If I were in a hospital and I or one of my family members or friends put a sign on the door and above my bed saying "Male caregivers only" how do you think it would be perceived?

I don't really care about female nurses doing things to me when my genitals are covered but don't want any intimate things done by a woman or with a woman in the room.

Do you think anyone would take it seriously? I imagine it would only bring on arguments and threats but I still would like to try it.

I've seen signs like that before but only for female patients.
July 24, 2009 3:50 PM


Anonymous said...

If you recieved verbal abuse or
threats as a response for such a sign that is considered unprofessional behavior by all State boards of nursing in every state. It is discrimination if
a female can place such a sign and
a male cannot.


PT


July 24, 2009 8:13 PM
Joel Sherman said...

I find the suggestion of putting a sign on the door saying male caregivers only quite amusing. I have no idea how a hospital would respond to it. If there was a sign next door saying female caregivers only, I don't see how they could protest. Honestly though in 40 years of practice I have never seen a sign restricting the gender of caregivers outside a patient's room.
However this subject is rather far afield for this thread and if there are more on this topic I will move them to a different thread.
July 24, 2009 8:35 PM

Joel Sherman said...

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

There is not much anymore I find amusing although such a sign I
might consider rash. Essentially,
you have a number of choices when
faced with an intimate ordeal.
Suppose you are told that you
need a suppository,if you place
food stuff in your mouth then you
can place your own suppository.
Nurses do what are called head to
toe assessments. You can skip the
genital aspect if you choose and
your reply being that we can skip that part. If you are told that you
need a foley catheter in which case
you have a number of choices.
Not everyone that gets a foley cath really needs one. They are a
potential for serious infections.If
you can void on you own then thats the end of it. If you need one ask
for a same gender provider.


PT

MER said...

Joel -- you write: "Honestly though in 40 years of practice I have never seen a sign restricting the gender of caregivers outside a patient's room."

Let's be really honest. Although I believe what you say is true, you don't necessarily need a visible sign to establish that "rule." Even today, some male nurses are not allowed to assist with OB-GYN. Much of this depends upon the nurse in charge. It's not a matter of patient choice. In these cases the patients are given no choice. The males are just refused entry into the area. There's no sign on the door that prohibits them. It's just one of those assumed, silent rules of some hospital cultures.
I've convinced that this rule also exists for some female patients who express the desire for all female caregivers. They tell their nurses, and word just gets around. No sign on the door. Just another of those secret hospital rules.
This, again, is the double standard we're all talking about. It exits, very quietly, secretly, and in an occupation dominated by women. The male nurses know about it, but being a minority they need to be careful about what they say, and to whom.
Having said all that, I still believe that in most situations, if males let their preferences be known, most nurses and hospitals will try to accommodate. There are too many exceptions, I realize. But the fact is that most men don't protest and just get what happens to come along. That's how it is with other things in life, too. Sitting on the fence, not speaking up, is actually making a decision and speaking up. It's saying it doesn't matter.

Joel Sherman said...

MER, it's hard to document what you say. In all my years as a physician I have never been told by staff that a given patient doesn't want to see a man. (I note that I don't deal with rape victims where this clearly happens.) That observation doesn't necessarily apply to male nurses where I'm sure it does indeed happen. Even so the male nurses I have talked to don't complain about being discriminated against. Some automatically ask a women to do intimate care when needed for a female patient. The reasons for this are probably multiple. It's just easier to avoid the issue and few nurses enjoy doing intimate care on either sex. But every hospital, floor and nurse are different and handle these situations individually.
It's very hard to gneralize.

MER said...

I'm just saying these things happen in a hospital culture. I'm not saying it's a general rule. I think there's no dispute that male nurses are sometimes not allowed to deal with female patients in various capacities. It's probably not a written rule. You won't find it in written policy. And it may depend upon what nurse is in charge on the floor that shift. But it happens.
Yes, these behaviors are difficult to document. Look what we're discussing here -- Art Stump's book -- which is essentially a participant-observer sociological study. That's how this research must be done by patients. That's the only way we'll get the inside story. Medical professionals are very reluctant to talk about these subject outside their own small group. Occasionally a sociologist or psychologist working with a doctor or nurse may get access. More often doctors and nurses write insightful accounts of being a patient. But studies like Art's are rare in the medical literature -- his observations are top notch, and give us insight into the kinds of things we're talking about.
So -- it's difficult to quantify any of this. But based upon what I've read, and based on the obvious of some male nurses trying to work in OB-GYN, I think we can safely say that same gender care is probably allotted to women more often than to men, and this is not a policy or a public event with no sign announcing it.
Note the Susan Sontag article mentioned and linked on Bernstein's blog and my comments about it. I think it's related to what we're talking about here. We are more empathetic to those whom we have more in common with. Female nurses are more empathetic to female patients. Actually, gender studies show that this is true for male and female doctors as well. They spend more time with their own gender. I've listed the sources for these studies is past posts.

Anonymous said...

"Nurses do what are called head to
toe assessments. You can skip the
genital aspect if you choose and
your reply being that we can skip that part."

How often are these "head to
toe assessments" actually done? How severe must your injuries or illness be to get one. Do most nurses respect the patient's wishes to "skip that part"? Does it happen on every new shift?

Joel Sherman said...

In the hospitals I work I have never noted nurses doing a head to toe physical assessment on admission. They take a full history and assess the patient in a general way, but I have never seen them write up a physical exam.
Doesn't mean it doesn't occur in other institutions, but I can't see why patients couldn't refuse all or part of any exam. But if done, it's for the patient's benefit. They tend to pay attention to some areas that physicians might glance over, such as bed sores or other cutaneous problems.

Anonymous said...

I don't think it's beneficial to the patient to be humiliated for something unnecessary, such as genital inspections. How can patients recover well when they're so stressed out about an upcoming "head to toe" examination and so humiliated from the last one? Don't nurses take that into consideration?

Anonymous said...

Is there anything a nurse can do if a patient flat out refuses an assessment exam (at least with the genitals)?

How about bad baths or showers, catheters or changing bed sheets?

Joel Sherman said...

Patients can refuse anything and nurses and providers have little recourse except to try to talk you into changing your mind.
To be clear, I'm not recommending anyone refuse anything. Ask if you don't know why a procedure needs to be done or if it's a matter of modesty, just tell the staff and see if they can accommodate you.

Anonymous said...

That's good to hear Dr. Sherman (your last post). Have you seen or heard anything about how (female) nurses commonly react to a male patient refusing a catheter, bedpan, help getting dressed, help going to the bathroom, etc?

I'm afraid, knowing myself as I do, that I would refuse help from a female nurse or assistant for any of those things if the time ever comes. One thing I wonder, if I make it clear that I don't want a female doing any of those things or even being in the room during any exposure, is it likely they will do it anyway while I'm unconscious?

SLO

Joel Sherman said...

SLO, I'm sure nurses are used to patients refusing care for lots of reasons, though modesty is likely not a common reason given for men.
If you don't want women taking care of you while you're unconscious, you'd have to make that very clear ahead of time and talk it over with the hospital and/or doctor.

Anonymous said...

What happens when privacy rights cross over into Rights of the Disabled (from PTSD as a result of medical sexual assault)?

It doesn't seem right that such a victim who was abused by strangers be subjected to opposite gender care with bodily exposure by the same entity that was the source of the abuse. It equates to more acts against the patients' will.

I contacted the Pa. Disability Network who informed me they would not legislate this issue due to strong opposition by the healthcare community. An agency, there to protect those disabled has chosen to discrimminate because they don't want to take the time; too difficult.

There is a bill pending in congress addressing needs of female combat vets who have been sexually abuse who have special healthcare needs. So does the public sector.

Any suggestions?

Joel Sherman said...

Anonymous, your question certainly does not pose a unique problem. Rape victims are usually given a female examiner whenever available. They may have special credentials, SANE (Sexual Assault Nurse Examiners). When women ask for same gender care due to a history of sexual trauma, it can nearly always be granted (much less so for men). Have you been unable to be accommodated?
What exactly would you like a model law to say? Hospitals would likely oppose it because of concerns that it would mandate same gender personnel always on call. That can be problematic especially in smaller hospitals and ERs.

Anonymous said...

Thank you for your response. What I would do first is a research project on the psycho social aspects of medical care that are mentally damaging to patients.

Second, it is known that patients with a history of sexual abuse have a higher incidence of perceived sexual abuse in healthcare because sometimes, the line is so thin, the degree of intimacy is high and the vulnerability is so strong.

Medical schools as you know have training to take sexuality out of the equation for medical practioners who examine naked patients. Unfortunately, patients are not afforded the same training.While they have the right to say no, sometimes they aren't asked and most of the time they are too afraid to speak up.

While some sexual abuses are perceived, there are some that are not. Victims of torture also have a problem with some of these issues.

First, identify the problems. Second, identify patients at risk and third establish a model to treat these patients with dignity and respect undertanding that it's not only triggering what happened in the past, it's handling a repeat of extreme humiliation that does two things. First, it erodes trust and psychologically damages patients and second, patients will never again enter a healthcare facility even if it means death. Once your dignity and autonomy are taken from you, what else is there?
Health psychologists who treat otherwise healthy individuals support their decision.

I would actually welcome a meeting with you as I've been writing/researching and currently writing a book about this subject.

You can go into a hospital mentally healthy with no history of sexual abuse and come out with ptsd and not even know it until something happens twenty years down the road.

I'll give you an example...a fifteen year old girl is in an automobile accident and conscience she is sent to the emergency room.
She is restrained to protect her from further injury. The EMT's are standing around, the police are standing around, there are countless medical people and the girl is hysterical. The nurses are trying to calm her down. Any guess why she's freaking out? They are cutting off her clothing in front of everyone leaving her stark naked in front of all these people.

While the medical professionals are doing their best to take care of her, she is traumatized, scared to death, humiliated beyond belief.

I'm not saying, don't do what's needed. I'm saying that it should be done with kindness, sensitivity and everyone should be afforded the opportunity to have same gender care take care of that part of the exam. The argument that there's no time, pales with psychologically damaging someone forever.

The arrogance of the medical profession to think that to some people modesty is unimportant and that victims of abuse should accept an opposite gender nurse when there are no protections is obscene. What is happening to people in hospitals is against "to do no harm". One legislature listening to abuses at Gitmo stated that we treat our hospital patients worse.

Thanks again for a great discussion blog and your input is so appreciated. I write more from frustration that common sense has gone out the window with a persistent passion to change what is and protect innocent people who will not go to a hospital.







Your feedback is most appreciated.

Joel Sherman said...

Anonymous, I substantially agree with your point of view.
Victims of any kind of assault have difficulty finding appropriate respectful care. This includes rape victims and soldiers with classic PTSD.
If you want to communicate with me outside the blog, my email address is given under my profile.

MER said...

I just posted this on Bernstein's blog, but I think it also fits here.

"D" has brought up an interesting point. That point is -- in some places patient modesty is a priority and is working. There seems to be no double standard in these places. "D" mentions his positive experiences in Utah hospitals. I would think for cultural reasons, Utah would be one place due to aspects of the Morman religion.
Social scientists and sociologists use a research method known as Positive Deviance. I'm describing it specifically for what we're talking about, but it's used in all kinds of areas
1. Look into the center of the institution you want to change. In our case, we're talking about clinics and hospitals around the country. Study what they're doing and how they do it, specifically in areas of patient modesty.
2. Find areas where the problem should exist but doesn't. In this case, the problem of attention to patient modesty may not exist in areas where conservative and/or religious values dominate, as in Utah.
3. Go to places like Utah or hospitals that seem to respect patient modesty, places where the problem should exist but doesn't and find out specifically why. What exactly are they doing? How are they doing it? "D" already mentioned specific behaviors he noticed like the availability of male nurses, allowing underwear during surgery, etc.
This is the kind of research that needs to be done. Unfortunately, the medical community seems uninterested in this issue. Perhaps we could get some sociologists to take this on, or psychologists.
By the way, this method was used to solve the Guinea worm disease that devastated West Asian and sub-Saharan villagers. It was led by man named Hopkins. His team looked at the maps, found out where the disease was most common -- but noticed all these little places on the map where it wasn't happening. First they went to places hit by the disease and studied how people lived. Then, they went to those places where the disease didn't exist and studied what people were doing differently there. The basic solution was relatively simple, involving improved collection of drinking water. It's an interesting story.
Maybe certain hospitals and/certain states will become known for their attention to patient modesty. The big word in health care reform today is "competition," especially in regard to insurance companies. But "competition" involves hospitals and clinics. Maybe when the system sees Utah hospitals being flooded by patients because they know their modesty will be respected, the system will start to "get it."

Joel Sherman said...

I wasn't aware that patients were treated differently in Utah, but certainly religion is a major motivator for respecting modesty and privacy. That's why I opened the thread on religion which I later expanded to include race.
The most interesting fact to me is that they apparently have more male nurses, or are some of them aides? If so, how did they get them? Do they actively encourage men to become nurses? I certainly never heard of that. More details from 'D' would be useful.

MER said...

Joel -- If we go to Utah and study the situation, I think we'll find an interesting combination.
-- The general religious culture recognizes modesty as an important value. We'd probably find it carried over into many other aspects of society besides medicine.
-- Patients are very clear about what they will and will not tolerate within hospitals and clinics regarding their modesty. Health care there knows they must accommodate or lose business.

Anonymous said...

I wish I had more information to give you from firsthand experiences, but most of what I know is what friends and relatives tell me. I'm sure many of the male nurses are really nurses aides, but it doesn't make a lot of difference to me as long as it's a male giving me intimate care (in the future). From what I understand it's the aides doing most of the intimate stuff anyway.

D

Amanda said...

Sometimes reverse discrimination occurs.
A friend went to a large public women's hospital to see a doctor.
The hospital does try to accommodate women who wish to see female doctors.
No guarantees are made with delivery and surgery.
My friend was told the female doctors were very busy because they had quite a few Islamic women waiting and they would receive priority because of their religious beliefs.

My friend was upset about that...why should they have priority over a woman who strongly prefers to see a female doctor or even a woman with sexual assualt in her history?
If you're Islamic, you'll be accommodated no questions asked and possibly even in delivery and surgery.
She did see a female doctor after a long wait...all of the Islamic women saw the female doctors first...even ones who arrived after her. (although a triage system might have been operating)

I think all women who wish to see a female doctor should be accommodated...our reasons should not be used to categorize or prioritize us.
Forcing a male doctor on any reluctant woman can be distressing.
Perhaps, it's one setting where it may be useful to just say you have religious reasons for needing to see a female doctor....whether that's true or not.

Joel Sherman said...

Amanda, I don't know that I'd call that reverse discrimination, but our society has always given greater consideration to religious beliefs over ethical or purely moral beliefs. Religious freedom is part of our founding creed. Indian prisoners can ask for peyote in prison for religious reasons, but there's no chance of their getting it for solely enjoyment reasons. Many other examples can be found.
If you look at my thread on religion you'll see others have thought of going to hospitals and saying that they're Muslim.

Anonymous said...

Amanda
I think your friend should throw the discrimination card back at them. Throw the I was discriminated against becasue I was Christian, I was made to wait longer in favor of non Christian...take it to the administration if needed, they don't want controversary from either side....allowing muslim women to see female doctors is fine...but it should not give them preference....I hope she will not let it lie.

I had an appointment with my dermotologist last week. It was a follow up and I was told by the PA to just take off my shirt and the Dr would be in. He did the check, the spot I had removed was on my head, checked arms, neck, etc. the PA knocked on the door, he was in mid sentence and just kept talking to me. She waited outside and knocked softly a little later. He replied just a second, finished and exited carefully through the door opening it just enough to let himself out, squeezing through the opening...and all I had off was my shirt. I went back to my office and wrote him a thank-you note telling him how much I appreciated how he handled the visit and made mention of the specifics of how he respected my modesty....I got a note back from him thanking me for the letter, he said he showed it to his staff and told them how important the little things are, I think its just as important to reinforce the things done right as it is to challenge the transgressiosns...........alan

Joel Sherman said...

Good thought Alan. At least they will think twice before doing the same thing again.

Anonymous said...

I understand everyones circumstances differ. I have had a certain amount of success in business that gives me a little leeway with my finances. I recently approached a hopsital that is very proacitve in bringing high school students into the hospitalwith hope of planting the seed for future nurses. I noticed all of the students featured in the local paper were female, I sent the CEO an offer to fund an inative in a reasonable amount to help attract males. I approached in from the perspective of the nurses shortage, 10% of nurses being male etc. I recieved a call from the person incharge of the program and had a nice talk about the benefits of getting males into the profession etc and set an appointment to meet with her and fund a small scholarship jointly with the hosptial for male students entering nursing. Small step, not a lot of money, but a start. I think there are opportunities to bring the issue to the fore front.....not sure if this belongs here or male modesty..I think we need to think outside the box........Dr. Sherman....please place as you see

Joel Sherman said...

Thanks alan (I assume). I'll copy this to the male modesty thread as well.
It is indeed a positive step. Nursing organizations, schools and hospitals need to do more to encourage men to enter the field. There are a myriad of opportunities.

MER said...

Here's something we can do to improve medical and modesty privacy rights. Patients can carry this poem with them and share it with caregivers. It speaks to communication, and I think it should be read and practiced by patients and caregivers alike.

"It is un-attributed but it is understood to have been written during the 30 year period that the author was held in a mental institution. It speaks volumes about the need for us to change the way in which we treat our fellow human beings. NOTE -- The line breaks are not accurate below, but you can check the original site to see how it should look.


Listen – a poem
by Michael Skirving

When I ask you to listen to me, and you start giving me advice,
You have not done what I asked.
When I ask you to listen to me and you begin to tell me ‘why’ I shouldn’t feel that way,
You are trampling on my feelings.
When I ask you to listen to me and you feel you have to do something to solve my problems,
You have failed me, strange as that may seem.
Listen! All I ask is that you listen; not talk, nor do – just hear me.
And I can do for myself – I’m not helpless.
Maybe discouraged and faltering, but not helpless.
When you do something for me, that I can and need to do for myself,
You contribute to my fear and weakness.
But when you accept as a simple fact that I do feel what I feel, No matter how irrational
then I quit trying to convince you and can get about the business of understanding what’s behind this irrational feeling.
When that’s clear, the answers are obvious and I don’t need advice.
Irrational feelings make sense when we understand what’s behind them.
Perhaps that’s why prayer works sometimes for some people;
Because God is mute and does not give advice to try to ‘fix’ things, He/She just listens, and lets you work it out for yourself.
So please listen, and just hear me, and if you want to talk,
wait a minute for your turn, and I’ll listen to you.

http://www.brefigroup.co.uk/corporatecoachblog/2009/11/13/listen-a-poem/index.html

Joel Sherman said...

I like the poem MER. It's worth rereading several times to get all the subtleties.
Unfortunately I don't think very many providers would read it on rounds. It's a rare doctor who's contemplative enough to study it. You could always post it by your bedside.

Anonymous said...

Frankly, I feel there´s not much I can do, short of eschewing health- care altoghether, which is what I´m doing..... Luckily, I´m out of their clutches...Still, I would like some advice regarding what can I do in emergency situations, wich may be pretty awful, for I cannot imagine what it would take for me to ever go to a doctor again....

Anonymous said...

My problem is that I want to work with my local hospital, ask questions, send letters, make demands, etc but I would have to do it anonymously. I have an aunt that works there as a nurse and is one of the most experienced and most respected nurses there, and she shares the same very uncommon last name as me. Anyone that sees my name would know I'm related to her and I don't want to cause her any problems. Do you think they would take anything seriosly from me if I refuse to give them my name? I guess I could make up a name for a phone call or a simple letter, but if I ever need any care there I can't use a made-up name.

If I end up there for some reason I want to make sure that I'm treated with my version of respect, which means no females around my nudity, but I'm afraid I'll damage the family name if I do. In this hick town I'm afraid what I do really might turn people against her, even those she considers friends. Having her working at the only local hospital might help me but probably will hurt her. I'm just hoping they don't have a problem with my morals from the beginning so neither of our reputations have to be damaged.

CC

Joel Sherman said...

CC, you can ask questions anonymously but as you say, if you're ever hospitalized there, your name will be revealed. I assume you don't have an option to go elsewhere. I think that it is fairly common for residents of small towns to go elsewhere to retain some degree of anonymity.
The best would be to tell your aunt what your problem is and to ask her advice. I'm sure she could help you achieve your needs. Not knowing her I of course don't know if that's a practical solution for you.
In any event, asking for same gender care is not something to be embarrassed about. You can be sure the question pops up occasionally with women patients. It's no different for you.

MER said...

Here's something else to consider, CC. Local hospitals are always trying very hard to get the locals to use them. There's often a tendency, as Dr. Sherman said, for locals to go to other hospitals for various reasons -- including privacy. So -- I would think that if you were honest and open with your aunt and/or hospital staff -- that is, if you confided in them that you really wanted to go locally, but were concerned with modesty and privacy issues, they would most likely be very open to your concerns. It would be to ther benefit. If not, then they're hurting their own financial interests -- you could could remind them of that as you make an appoint at another hospital.

swf said...

CC:

My concern is that it is going to be a lot harder for you to talk to strangers about this subject (when/if you go to the hospital) than it would in privacy with your aunt.
Hospitals can be intimidating, and things happen quickly. It's really just best to find out how she feels now, let her know this is just how you feel about your body and is no reflection on her.
Maybe she can advise you about your concerns, or at least get a heads up on the fact that you will be seeking information.
If it helps, I spoke with my daughter who works at our local hospital (phlebotomy) and she asked around to see what caregivers there thought about my requests. Not only were these requests more common than I imagined, no one ever thought ill of her or said (at least outloud) that she had a crazy mom, and she remains a well respected member of the team.

Anonymous said...

Thanks for all the great suggestions. Maybe I'm making too much of this situation.

CC

Anonymous said...

I'm concerned about the full body scanning that will start happening at international airports shortly for flights to the States.
This has been prompted by the man carrying explosive material in the crotch of his underpants.
I have no complaint if women operate the scan, but don't want men operating the unit for women. There has already been one incident at an airport resulting in the dismissal of three men.

Also, women use sanitary napkins and older people use incontinence pads...it seems they will be further scrutinized to check they're not explosives. How on earth can that be done in a dignified way?
I won't be travelling to the States any time soon.
Is anyone else concerned?
Leanne

Joel Sherman said...

I have copied Leanne's post to the 'non medical modesty' thread where there are other posts on this subject.

Anonymous said...

Okay -- here's a group we need to support. It's called "Women Against Prostate Cancer." In their "Take Action" link, you'll find this as one of the causes they support:

"Passage of a Bill to create an Office of Men’s Health within the Department of Health and Human Services (HHS); this Office will mirror the fine work of the Office on Women’s Health. You can learn more about how this will impact prostate cancer and take action at: http://menshealthpolicy.com/OMH/index.html"

So -- here we have a group of women who are dedicated to working with men. Check them out. You'll find the group at:
http://www.womenagainstprostatecancer.org/
MER

Joel Sherman said...

Thanks for the references MER. The pending house bill is the same one we commented on about a year ago and was noted on Dr Orrange's website. I guess not much has happened to it, but I used their automated letter to send again to my Congressmen.
I have some mixed feelings about your second reference, Women Fighting Prostate Cancer. What a strange mission statement, a prostate cancer support group geared towards helping women and families affected by prostate cancer, wants to make sure every woman knows the facts about the disease. It's like the men with cancer are irrelevant, the group exists to help women and families. Ever heard of a group of men fighting breast cancer whose mission is to help men cope with it? I'd certainly check them out further if I intended to donate to them.

Anonymous said...

Joel:

Interesting. Someone on Bernstein posted a similar comment. Guess I just don't see it that way. I see it more as a family issue, women worrying about their families and how the death of their husband affects that, emotionally and financially. It's like the men's health bill we're talking about -- that was framed in terms of family healthy, too, to help get it through.
I would think that if you talked with these women, they're very concerned about their individual men and their health. Many women left behind without husbands, though, tend to have it rough, as do their children. Especially those with less financially, less insurance, small salaries. It's not uncommon for some families to be thrust into poverty when the father dies.
That's my take on what this is all about.
MER

Anonymous said...

MER,
As long as we don't end up having this group defining prostate treatement, for example, the issue of testnig itself which is increasingly being questioned, especially for those who have no family history etc.
I would want to be clear what this groups policiews are on this and other issues before I would give them general support. I also strongly object of having in some way to link specifics in relation to mens health to some " family health". That simply places male health as second class compared to womens health, in my view.
Chris

Joel Sherman said...

MER & Chris,
Not too many men dying of prostate cancer have young families. Prostate cancer is rare until you're in your 50's and not common till the 60's. So not many families need support with young kids. I just get the feeling that this blog is not about helping men face prostate cancer; it's about helping their wives. That would be fine if it's a sub-part of their message, but as is I would not be tempted to give them my support.
I also note that they link an article about a young man 'saved' by prostate screening. Well as every man should know, a high PSA is not synonymous with aggressive prostate cancer. Just like cervical cancer screening, these stories should be looked at with suspicion.

Anonymous said...

Joel:

You do present an interesting perspective on this site. But, let me ask you to do this, if you haven't already. There's a link on their home page to "Share Your Story." They have three stories written by women whose husbands developed prostate cancer. Can we assume these stories represent the site's thinking about this topic?

Read those stores and then let me know what you think. I'll hold my opinion until I hear your response.
MER

Joel Sherman said...

Read the stories MER. I have no problem with them. Cancer is a devastating illness for all involved. It's a woman's view of her spouse's major illness and how it affects her. But it’s not intended to help men.
I just can't avoid thinking about it from the opposite view. Breast cancer kills thousands and causes similar problems with intimacy in many of the survivors. Still I've never seen a website raising money to help men cope with their wives’ illnesses (never looked either). I doubt it would be a success, though I'm not sure that this website is either. Maybe it's all about women being from Venus and men from Mars with different thought patterns and priorities.

Anonymous said...

No Joel,
I don't think its a women/men "difference" thing; I think its about a sense of women thinking they know best. Perhaps I am being harsh, but isn't this all about if only those silly men went and got tested etc etc? After all its womens needs in all this that is paramount! I know I am probably exaggerating, but its to make a point. Its in the same league as Dr Orange only pulling on the heart strings.
Chris

Chris

Anonymous said...

Had another look at this site Two cooments:
- Follow the link on the sexual issues section, notice how its all women sex therapists.
- Why is it women and families. Don't we mention men?
Chris

Anonymous said...

I guess I just see this issue differently. You won't see a group of men "Men Against Breast Cancer" because men just don't organize the way women do. You also won't see many groups "Men Against Prostate Cancer." That's male psychology. Put men in uniform and send them off to war and they organize and accomplish much. They're socialized to look out for others and fight for others, their wives and families and countries. But they don't often organize well to fight for themselves.
Look at how women organized to help girls that were having problems in our schools. Now the data is clear that boys are having just as many problems, many worse -- but do you see men organizing to help those boys? Not many. But you do see women organizing to help those boys. Why is that?
I think we all look toward our own self-interest, unless were saints and fully altruistic. Of course these women look at the affect the husband's illness will have on their sexual and other relationships, and the affect it will have upon the children and the family. That doesn't mean they don't care about their men and look out for them. I don't see it as "the women are in charge or want to be," or "it's all about me."
I'm encouraged to see more women concerned with men's health.
MER

Joel Sherman said...

I agree with you MER. Nothing wrong with women trying to help women. It's not a site a man would go to though if he was suffering from prostate cancer.
A quick search came up with an analogous site of men fighting women's breast cancer. (there's a website on everything.) Haven't gone through it yet. It will be interesting to compare.

Anonymous said...

Well MER I guess we will have to 'agree to disagree'. I am not in the US and I don't think there is a similar site in Australia. (but I will look just in case).
My broad point is this, your view is that it is great that women established this site as it shows they are concerned etc. You further argue that this site and what it shows is not a 'take over'.
I agree with you that I am sure that this is not the groups intention, my concern is that is what will happen in practice.
Prostate cancer will be seen as a couple or family disease, policies will be put in place that "encourage" men to involve their partners in all decison making, even if this is not what men want. (Witness a discussion I put on line a while ago where doctors and nurses were discussing how to interact with male viz female patients and the coersion and double standards that applied)
All cancer, mine included which was bowel, have impacts on the family and for my treatement sexual function also. But I made the decisions about treatement, after in my case discussing this with my partner.
No i think that the reason we have this site is because it is a 'male cancer' and some women want a say in how it is treated and/or tested. To say that they do not is misreading the intent of the site I think.
Chris

Joel Sherman said...

It has been commented that what is needed for prostate cancer is a support group of men for men. Well there is an official program of the American Cancer Society that does just that. There is greater equity here than I was aware of.

swf said...

I would just like to point something out before some are too harsh in motives.
The "Relay For Life" ad just mentioned joining the 'women and men'in fighting the devastating effects of breast cancer.
Either they are finally acknowledging that men get breast cancer, or they are asking us to help men deal with the aftermath of loosing their female loved ones. Choose your motive.

Now, should we as women be offended that men want to take action in 'our' disease?
Or should we set aside gender motives and realize action begets action.
Take the opportunity to let this group know that modesty is keeping men from getting tested. Try a little to get them on your side before you consider it a worthless cause to men. Trust me....women would much rather have their husbands living than the support needed to cope with them dying.

Anonymous said...

"They're socialized to look out for others and fight for others, their wives and families and countries. But they don't often organize well to fight for themselves."

That's very true. We prove that with the fact that we let women walk all over us in health care. Most of us anyway.

I am very skeptical about that woman's group too but I have seen a few women, like swf that seem to really care about male modesty for unselfish reasons. I wish there were more like her.

Anonymous said...

Here's a good article in today's L.A. Times about how to make complaints about hospital or rest home care. It's somewhat California oriented, but the advice is good.
MER

http://www.latimes.com/features/health/la-he-practical-matters-20100315,0,2670976.story

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 MD said...

Here's the other side of the coin, improving the doctor's privacy rights. A new trend asking patients to sign a confidentiality agreement which in essence tries to stop a patient from criticizing the doctor's care. I suppose the idea is to stop negative public reviews of the doctor. This is possibly illegal; hasn't been tested in court yet. Be interested in your reaction. I'd certainly never consider asking patients to sign such a statement.

Anonymous said...

Interesting article, Joel. Seems like the organization that's "selling" doctors these legal documents is the real culprit. But doctors need to get independent legal advice before forcing patients to sign something like that. Unfortunately, most patients don;t really read the documents they sign. Most of the time, the secretary
or receptionist summarizes them for the patient and then the patient just signs. If the explanations are like the ones offered in the article, they are indeed not telling the truth. I wouldn't sign one myself. It's a tricky situation -- but doctors and dentists can't expect patients to trust them and then not trust the patient. The trust has to be mutual.
Doug/MER

Joel Sherman MD said...

Good point Doug. The real issue is one of trust. If your doctor doesn't trust you, you're best off seeing someone else.
That's similar to my feeling about unnecessary chaperones as well.

Anonymous said...

Avoiding the Doctor
The male patient, during a physical, was told by the nurse…,
“Remove ALL Clothing, Doctor will be in, in a few minutes…”
When the man balks at her request… Nurse says,
“Oh! We Don’t See IT That Way.”…
Without removing a single piece of clothing… The man asks the nurse to follow him to the waiting area… Once in the Waiting Room… The man announces to all awaiting patients…
“Everyone… the nurse is going to REMOVE ALL HER CLOTHING… for you!”
The nurse, astounded at the statement the man made, was even more astounded at his next remark as he turned to look the nurse right in her eyes…,
“What…You uncomfortable naked in front of people too?
Didn’t YOU say, YOU don’t see IT that way!?”
“We DO! And… WE are just (pointing at her facial expression) that uncomfortable… with your request!”
“Don’t tell MEN, you don’t see IT that way… WE DO!”

This is just one of the reasons; tens of millions of INSURED, STRAIGHT, MONOGAMOUS, MARRIED MEN avoid doctor’s offices… Doctors’ incessant need, for complete nudity… not all… but enough to be a problem!

Women must? That’s women… Men are a different gender….
If you haven’t noticed… not seeing IT… that way.
Temporary exposure, or brief examination, of a man’s genitalia is one thing (IF it’s necessary)… but… Made to stand totally naked… before anyone… other than one’s spouse… is not acceptable… by the majority of men… which will not see a doctor…
UNTIL ABSOLUTELY… UNAVOIDABLY… NECESSARY!

And photographing male genitalia… albeit medical… is totally forbidden!

It’s not how you (the medical staff) see anything… it is however, how the man sees himself…
that matters to the man!!! Period!!!

It’s not sexual… it’s private!

For your information;
Just in case,
YOU didn’t know!

Joel Sherman MD said...

Anonymous reposted the above adding a small change which I've copied:

And photographing male genitalia… albeit medical… is totally forbidden!

It’s not how you (the medical staff) see anything… it is however, how the man sees himself…
that matters to the man!!! Period!!!

Hey, Nurse Cratchet…. It Ain’t About YOU!
It’s not sexual… it’s privacy!

For your information;
Just in case YOU didn’t know!
Not seeing MEN… that way.

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