Let's Talk...
Modesty is becoming a controversial topic of discussion, both in the medical arena and patient culture. We seek solutions to questions. Answers for the most common of concerns. The right to be respected in the most basic of human needs.
Let's figure it out together. Let's talk.....
posted by Suzy Furno-Maricle @ 10:36 AM
33 Comments
33 Comments:
I like no moderation.
A friend of mine always reminded me that if you expect conversation you must initiate it. So here goes.
To answer the e-mail questions of why I did not choose to be part of the other website (hosted by Misty) is the concern for discrimination. Although I have not checked to see if those comments were removed since we spoke, she did post that if it was found that lesbians were working in offices that their website had allowed to advertise as "all female facilities", they would be pulled. Perhaps discrimination is in the eye of the beholder, but that (among others) did not fit my beliefs and mission/goals as an advocate. I believe in working for everyone and not to begin on the foot of discrimination. I also refused to be part of a liabiliy waiting to happen. My choice and I believe we parted on civil terms. Others may have accepted those terms.
I have written letters to the editors of our common newspapers and am interested to see if they are published. We'll see..perhaps if anyone else is successful they will let us all know?
I too started posting on allnurses, and so far the thread is still open and seems respectful. Maybe we are making headway after all.
I still have the 'constructing' blog to keep all of the great info discussed by others. You can all read it, make changes, add ideas, or just discuss where you want to go from here.
"Here's to Hope" (thanx 'a')
swf
So what would we gain or expect to accomplish as a group? How would a group like us have any influance on the medical field? Why would they care what we have to say? Who are we to tell them what we want?
Just trying to be honest. Sounds fine but a big long shot.
Anon:
Big questions: and lots of them.
The simplest answer would be that we accomplish awareness and attention. How seriously they take us? That depends on how much influence we want to attempt. Who are we to tell them what we want? I'm not sure I understand that question...but aren't we just like everyone else who takes a stand on what they want/need?
Don't disregard the learning potential of physicians. They all had a lot to learn in medical school and beyond and most have an interest to do the best for the patient. As I have listened and learned, many other doctors will too.
Hospitals and clinics can also be swayed in their systems by public pressure.
My suggestion: Don't give up until you at least start! ..Maurice.
"My suggestion: Don't give up until you at least start! ..Maurice."
With this in mind what we need is a plan of action, and to delegate tasks to those who want to push this idea forward. Accountability will not happen without a unified force to shake things up.
It seems like there's been a lot of success with teaching empathy in medical school through teaching medical narrative/novels, having med students accompany patients to appointments, etc. So I think one potential strategy is to include patient modesty issues in these courses.
As far as anonymity goes, I don't mind public letter writing, speaking, article writing with my real name. I am just more open with what I write under my fridawrites identity (such as medical details).
Other ideas:
-What physician publications accept public interest/advocacy articles from patients?
-Articles in mainstream newspapers and magazines. Nothing creates fast change like a chorus of complaints in the media--this helped significantly with the pelvic exams under anesthesia issue. There are often medical interest articles in the "life" section of the paper, not just the front page. Journalists love new ideas--contact them and make the suggestion.
-Get Maurice and Joel Sherman or other interested physicians on NPR--local NPR station might be easier first.
-Blogging; patient participation on physician blogs, not just our own blogs.
-Is there a nonprofit patient/consumer advocacy group (or several) that would be interested in taking up patient modesty as part of its lobbying/efforts?
-Public speaking (the patient advocacy groups?); audiences of physicians, journalists, etc.
Also, we'd need to define what issues are included under patient modesty--a detailed mission statement.
FridaWrites:
Wonderful ideas! My personal advocacy interest would be leaning in the public speaking area. I just happen to prefer the influence, direction, and feedback from those present. (It is so hard to read a person's written reaction and tone.)
Actually something I hadn't given much thought to. Thanx...
As to: "So I think one potential strategy is to include patient modesty issues in these courses."
I will ask Dr.s Bernstein/Sherman if they would care to make any further comments regarding this. I know that they have been very clear that modesty in it's general form is discussed (dignity, draping, communication, respect,) but preparing medical student reactions for patient's same gender requests didn't seem to be part of that.
We have so far survived life on the 'allnurses' blog: if anyone has extended the discussion to other medical forums, perhaps they can let us know. (?) The positive is that a few "staff" have expressed interest. Maybe we are less likely to be closed with a staff member on our side.
Hey gotta laugh at the new thread goin on!
http://allnurses.com/nursing-news/helen-mirren-says-485821.html
Actress comments upset nurses cause she said she spent time in a nev. brothel for reserch and some hookers came from the nursing profession.They think THAT comment causes disrespect? Still laughing.
It is sort of amusing. I think they are a little sensitive right now, with all of the entitlement arguements going on. Personally, I would ask my nursing friends to take all of the "sexy nurse" avatars off of facebook. My opinion is that THAT is much more disrespectful. Sends mixed messages....
From DR. Bernstein: Patient Modersty V.34
"I don't know about the other instructors but since reading these Patient Modesty volumes regarding gender selection, in the past several years I have emphasized to my students to what I read and learned. ..Maurice."
Thanx Dr. Bernstein!
From Dr. Sherman: Medical Modesty: A Patient Oriented Discussion:
"I can't speak from personal experience as it has been decades since I've interacted with medical students on that level, in their early clinical experiences. I would think you're right, that they don't talk about how the student should respond.
When I was in medical school, I can't remember the subject of preserving patient modesty ever arising, though it was always taught in nursing schools."
Thanx Dr. Sherman!
There is a survey on AN.com for nurses asking how many people have asked about samegender care in the OR>. Will be interested in seeing how that goes.
Yes. Perhaps it should include patient feedback? "How many times have you asked for same gender care"....maybe ANON could start a thread regarding that?
Remember, we are seeking solutions here.
So, to Fridawrites suggestion: we know of at least one doctor speaking of modesty issues to students!! I would like to think that the usual mathmatics apply to 'spreading the word'.
Yes--I am in the process of writing a detailed letter to one hospital executive--much of it concerns patient modesty and patient rights. Let's see if we can make a change at one place with a significant number of patients.
I want to do public education through my local rape crisis center. I want to volunteer there and become part of the speaker's bureau. I want all the things that have happened to me to stop happening to other people. I want to be the squeaky wheel that changes things. I don't want people to be harmed, psychologically or physically. Sexual abuse in the medical profession is a continuum rather than many kinds of discrete acts, and patient modesty and sexual harassment is part of that. Certainly that can be addressed through the local organization.
To FridaWrites:
Never thought of the rape crisis centers. I wonder if anyone has any idea of how many people get counciling there for medical abuse issues. Could you let us know?
Yes, I will find out! It may take me a week to do so, as I want to find out detailed info in person. One of my doctors said medical abuse is really common; when I said I believe that most doctors are good and wouldn't hurt patients in this way, she said that it's more common than I think. And when I first called the rape crisis center, the counselor there said full sexual assault in medical contexts happens a lot. It may be a problem in our particular area if we have a couple of serial criminals.
You can google various permutations of forms of sexual assault along with words such as dentist, doctor, hospital, nursing home, newly paroled rapists entering hospital rooms, anesthesia--and the cases just don't end. Always something new and horrifying.
National nursing guidelines state what's considered sexually abusive, and this includes even refusing to leave the room when patients change clothing, not draping properly, etc.
I believe that some medical professionals do deliberately humiliate or exert power over patients. And the perpetrators aren't just harming their immediate victims--they're harming the entire medical profession, the family of victims, etc. (I'm using "victims" loosely here--I don't think patients in medical contexts moved to "survivors" yet).
I think I'm starting to see violations of patient modesty as a place on a spectrum/line of sexual abuse--with the mildest being milder comments to patients that are inappropriate and go beyond mutual humor and the most extreme being sexual assault. Or does this take away from basic patient modesty too much? More needs to be done to protect patients.
It seems to me that when someone is requesting a same-sex provider or makes modesty requests (I once told my cardiologist I could not speak to him in the paper shirt I was given--practically pediatric size)--they are not giving consent to what's happening to them.
I am very sensitive to the need for gender equality and nondiscrimination and it would be tricky but not impossible to figure this out to be fair to both employees and patients. In general, I think things would balance out, with some men and some men making requests.
While some people point out that it would be inappropriate to ask for/discriminate against a nurse by race or religion, gender according to the EEOC can be a bona fide occupational qualification for the purposes of modesty, such as hiring only women to be fitting room attendants for women's rooms. Or locker rooms. Gender-based requests by patients, it seems to me, fall under the "bona fide" qualification for modesty so long as it's not a hospital that's discriminating.
I asked RAINN (largest national organization) about medical abuse in particular and they said it hasn't been addressed separately--I will keep asking that they do so or help develop resources myself as I recover enough to be more impartial.
Would this be an avenue for some of us to pursue? Sexual abuse is a continuum, not just the extreme stranger rape.
One more--abstract on BFOQ in healthcare setting, though it doesn't focus on nursing:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1356129
swf I've been following all your comments on what I call the gyno dissident/medical dissident sites, and I appreciate them.
Like many American children I grew up thinking that if I got sick I had to put up with being violated and losing pieces of myself in the process. (Which meant I hid a lot of illnesses.) Fortunately at least my school didn't have genital checks. Of course growing up female meant terror of the inevitable stirrups. I would hear ad nauseum how horrible muslims were for banning male gynos. but secretly envying muslim women.
Until this year I had no idea there was any other option between choosing either my health or my privacy/bodily autonomy. It's tremendously exciting to find out this isn't true, or even necessary outside of emergency situations. I support any attempts to stop further medical violations on anyone, as another poster mentioned. I hope this will someday be a medical dark age more enlightened people look back upon and scoff at.
And yes medical rape is the abuse that dare not speak it's name. Doctors think maybe a child was molested so they actually molest and exploit them with genital/anal checks (20% accurate btw) and photos. There's no one to talk to about it, b/c if you don't like these abuses you're crazy and immature and don't care about your health. I really hope there's a way out of all this. Without busy body pediatric intrusions in my early life I think I'd be a much freer more confident person. (Keep in mind none of these violations did a thing to promote my health!)
Thanx for the post ANON. Many of the problems (unfortunately) related to children and violations is that the parents do not become the advocate. I am hoping that this is the decade that parents will realize that they owe their children medical respect...and if that means speaking up even though it is hard for them then practice with a friend.
I too hope that this is the "medical dark age" and the medical arena catches up with societal ethics.
And yes....practicing with someone works! I have had many people find their voice when they believed they didn't have one.
I am not suggesting that one create a combative countenance...but asking for what you want is actually very easy. (Eventually)
After taking a little time off to review, I believe more needs to be done in the area of encouraging women to support male medical modesty needs. I see a vast amount of men supporting us (women)in our struggle, while many women still seem to either not be aware or unwilling to take it to task. I can only imagine that a united front from both genders will get us where we need to go. Afterall, most nurses are women, and they really need to know that we will support men also in the effort for respectful care.
(swf)
I will always disagree with you swf. If men cannot speak up for themselves they are pretty weak. They dont need our help. They need a backbone.
ANON: NOV. 5th
Have we disagreed before? Perhaps you can reference...
Anyway:
Men could easily say this of women too. But the reality is with either gender that intimidation is in the eye of the beholder. We can attack either gender or attempt to help either gender.
For reasons all our own, most of us have someone we do not easily "stand up" to. It never hurts to have support. And quite frankly once facilities hit the go button, one can get lost in the frenzy, only to be left beating themselves up later for not being able to call it all to a halt.
A little understanding please.
How about something about women's modesty? Everthiing here seems to be about men!! We have those concerns too.
Bea
Bea:
Yes, it is a concern for both genders. I am willing to post any thoughts and continue any discussions posed here. Really, the only way to know how many are concerned with the modesty issue is to speak up about it. So I encourage both men and women......speak up!
When is the next article????
The Holidays have been busy, but I am working on two for the new year. In the meantime, if anyone has anything particular they would like to chat about, let me know! We have not covered many women's issues yet......
While working as an RN in a trauma room were seriously injured people are taken for treatment I witnessed this scenario of the double standard of modesty for male patient many times. The first thing the medical staff would do is cut all the patients clothes off to examine their entire body. A digital rectal exam is performed to see if there is blood in their rectum and then the patient would be catheterized to obtain a sample of their urine to analyse and detect the presence of blood. This is done to all patients male and female. Many trauma's were a result of car accident's or crime victims etc so the police would normally be involved. The police would routinely walk in the trauma room and were allowed to stand around and watch as patients, that is male patients were put through this necessary but extremely embarrassing ordeal . If the patient was a female the curtains would be immediately closed and kept closed until the entire trauma procedure was complete. If the patient was a male the curtains were always left open and the police officers which often include female officers were allowed to watch as the patient was stripped naked, under went the rectal exam and catheterized. Allowing the police especially female police officers to watch this is blatant patient abuse. This double standard of dignity for male patients is a violation of medical ethics and standards of decency that are supposed to apply to all patients. If the police have a reason to enter the trauma room which they sometimes do the curtains should be closed for male patients as well. Many hospitals today have the police wait outside and do not allow them in the trauma room unless they have a valid reason for being there. That policy should be mandatory for every hospital in this country.
Anonymous, I agree whether it be ER or any other area of a hospital everyone knows there is a double standard when it comes to males.
Problem is there is no one willing on the healthcare side to stand up with the male patients and put a stop to this abuse.
Hospitals need to hire an equal number of male & female techs & nurses to meet the needs of both sexes.
All healthcare personnel everywhere need to be trained and re-trained to ALWAYS protect the patient's privacy & dignity 1st & foremost.
That one small step that the nurse and/or tech takes can be the biggest building block of a strong patient/healthcare personnel relationship. Or it can destroy the relationship right from the get go.
Until this happens men and their families everywhere are gonna lose because the lack of concern about their modesty and dignity on the part of the healthcare field is just going to push men away from getting needed care. Wives, girlfriends and children are going to lose their husbands, boyfriends, and dads sooner then they needed to all due to the healthcare industry not paying attention to and correcting the problem they have caused.
Maybe it's time to help the healthcare industry solve this problem.
Create an oversight group consisting of non healthcare personnel to investigate claims by violated patients.
If claim is found to be true, punishment must be such that the violation is not repeated.
This cannot be allowed to continue.
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