Bioethics Discussion Blog: Patient Modesty: Volume 80





Sunday, July 02, 2017

Patient Modesty: Volume 80

This Volume's graphic is another example of an attempt to "speak up" when informing the  medical profession of the patient's desires for attention of the system to the patient's modesty and dignity issues. (Thanks to Readers Digest. u.k. via Google Images).  As you may have noticed in the graphic, the patient, while speaking into the stethoscope diaphragm, the ear pieces are not in the doctor's ears.
What I am trying to emphasize is that it is important when telling your concerns to the doctor or the medical system, verify that they are listening!! And, of course, then responding.

For those just joining this blog thread on Patient Modesty, you might want to get introduced to the current discussion by looking at Volume 79 first.. or 78, or 77 or, if you have the time and interest all the way back to 2005 "Naked" which started this blog thread discussion. ..Maurice.


At Monday, July 03, 2017 4:09:00 PM, Blogger Maurice Bernstein, M.D. said...

For those first time visitors to this Volume of "Patient Modesty" and there are a few, I want to write some words in further introduction and a request.

All these years the thread has been published, the topic has been roughly the same and unchanged, essentially, a patient's right for privacy when undressed either in the operating room, procedure room, office exam room or the patient's hospital room. The thread is about the ethical and perhaps legal right for the patient to be able to request and hopefully receive the medical attention by professionals of the patient's desired gender when undergoing a medical examination or procedure. That request to whatever part of the medical system is made should be expected by the patient to be listened to and carried out. If the system is unable to do so, there should be detail information and explanation to the patient provided by the medical system representative. Final decisions through the process of informed consent or informed dissent should be made by the patient and conflicting issues should be attempted to be resolved by and through the medical system involved.

The persons representing the medical system or in part involved in the issue of the patient's need for privacy in medical examination or procedures or nursing involve not only physicians but also nursing staff, scribes, physician or hospital selected chaperones, medical students or even other "guests" in operating or examination room who are "shadowing" the doctor as a "guest", not of the patient but of the system.

Earlier Volumes of this topic contained concerns by patients of both genders but in recent Volumes mainly male patients. Are women now satisfied with their gender requests being followed or what?

For this discussion to be of further value to all, we need more input from our yet "hidden" visitors of all genders and even those whose views are perhaps "conflicted" with those already published and certainly we need here members of the medical profession to present their views. All can be written anonymously but with the use of a pseudonym ending the message.

Please, all "new" visitors here, please participate by writing Comments, it will surely "broaden" the important discussions here.

If the old or new visitors here want to write to me personally, here is my e-mail address:


At Tuesday, July 04, 2017 4:54:00 PM, Blogger Maurice Bernstein, M.D. said...

For those visitors "new" to the topic, here is a reference article from the "Chicago Tribune 2015,"The Naked Patient: The Modesty Movement won't take it lying down" ..Maurice.

At Wednesday, July 05, 2017 6:02:00 AM, Blogger NTT said...

Good Morning:

To all those people who may be lurking in the shadows, please please come out and join us.

There are no personal attacks here.

We’re just people like you who are tired of the medical community’s lack of respect for our modesty concerns.

People trying to effect change that is LONG overdue.

We need ALL the voices we can bring to bear on the healthcare industry regarding this issue so that they not only listen, but make the changes necessary so everyone can have peace of mind and not be ambushed by the medical establishment when they need healthcare assistance.

WE need YOUR voice.

In our case, silence isn’t golden.

Silence in our case is a license to the medical community to leave us unnecessarily exposed in front of people for no good reason, for staff to gossip to their colleagues about us, to basically treat each patient without dignity and respect.

That’s the license you give to the healthcare industry by keeping your mouth shut and staying in the shadows all the time.

If everyone just keeps their mouth shut and hands over their license to their dignity and respect at the door, the medical community will never learn nor change and that is unacceptable.

If you the shadow dwellers here don’t like what’s happening when you visit a doctor then it’s time to come out into the light and put your voice with ours and take a stand.

The more bodies we have, the better the chance to change the system so it’s fair for everyone not just the medical community.

Join us. Let’s make a REAL difference.

Regards to all,

At Wednesday, July 05, 2017 11:43:00 AM, Anonymous Anonymous said...

In an attempt to give truly informed consent, knowing what will happen during medical procedures would be extremely beneficial. Is there anywhere on the web where "complete" procedures can be seen? There are videos of operations, etc.; however, I can find little that shows step-by-step medical procedures from the minute the patient enters the prep room through the entire procedure. Any suggestions?

At Wednesday, July 05, 2017 2:36:00 PM, Blogger Maurice Bernstein, M.D. said...

This may be of interest to new visitors to this blog thread but also I ha"ve a feeling that the majority of those "old" visitors who have written here are not aware of a thread consisting of a series of 3 "Chapters" each with way over 100 responses to the title "I Hate Doctors". The subject is physicians. I am not sure that those who read and write to the Patient Modesty thread would necessarily readily agree with all that is written by visitors to the "hate doctors" thread since I have a feeling that the tone of what is written here is more concerned regarding the medical system itself and not necessarily specifically their own physicians (of course, with some exceptions!). However, I don't think I posted this information previously on "Patient Modesty", so I thought I should do it now for those interested. Here are the links:

You certainly are permitted to write your comments regarding "I hate doctors", in general, in Chapter 3 but let's keep the specific issue of patient modesty and dignity issues of the medical system going on the present "Patient Modesty" blog thread..though you can contrast by writing here what you gleaned from "I Hate Doctors" thread.

By the way, the reason I can write more to this Patient Modesty thread is that I have more time available in my day: no student teaching until mid-August! ..Maurice.

At Wednesday, July 05, 2017 5:19:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, the 3rd link is to Volume 80 rather than the 3rd page of the I hate Doctors thread.

At Wednesday, July 05, 2017 5:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, you are correct. Thanks. I obviously made an error in composing the link, however, the link itself is correct for Chapter 3, so instead of clicking, simply copy the link and paste in address field and then click. ..Maurice.

At Friday, July 07, 2017 8:07:00 AM, Blogger Maurice Bernstein, M.D. said...

I see, via my reader counter program, that a number of visitors who have come to Volume 80 have taken my advice and looked at the "I Hate Doctor" Chapters which link addresses I provided.

What I would like to know is whether the upsetting views of the patient's physicians as described on that thread is really accepted by those who are participating on this "Patient Modesty" thread. Are my visitors looking to their physicians as ignorant and uncaring with regard to the modesty and dignity issues or is it really other parties within the medical system who are really the ones to be accused and upset about? ..Maurice.

At Friday, July 07, 2017 10:11:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I have never fallen into the "I hate doctors" group. I did have one with an ego that made it difficult to ever ask a question but I continued with him out of faith in his competence. Never have I had a doctor that explained to me beforehand what a procedure entailed when sending me off for something that proved emotionally uncomfortable or embarrassing. For example when my doctor suspected bladder cancer he sent me off for an ultrasound. At the time I had no idea what an ultrasound was and was shocked to find out it meant a female tech telling to remove all clothes from the waste down, put on a johnny and get on the table, and then her promptly lifting the johnny and putting a small towel over my genitals before she proceeded to do an ultrasound of my entire abdomen right down to the base of the penis. Did the doctor not care what my experience would be or did he think it would not be an issue?

I have generally avoided female doctors so as to avoid the female chaperone issue. I have also done so in recognition that even when a nurse is needed to assist, that being exposed to two women just feels far worse than just one as would be the case with a male doctor needing a nurse to assist. I am guessing that in most cases female doctors are just clueless about the 2nd female in the room issue. If they are aware, life is then made easier if they convince themselves that medicine is gender neutral and that it is the male patient that has the problem.

At the same time life is similarly made easier for male physicians who also convince themselves that medicine is gender neutral. How could my former urologist (and his several male urologist partners) otherwise manage to never have had so much as a single male nurse or tech in their rather large practice in a major teaching hospital over the course of 11 years? If they tell themselves there isn't a problem then they don't have to solve it.

Generally speaking the medical world seems to equate being polite to the patient with being respectful. That's easy to convince oneself of and hide behind. They are not one in the same. Being respectful would be having at least a minimum contingent of male nurses/techs on staff for modesty reasons. In a small practice, just one might suffice. Being respectful would be at least trying to steer men to where there are male sonographers for testicular ultrasounds.

I can't say whether doctors (male or female) don't think there is a problem to solve or they don't care, but the end result is the same. That said the larger problem lies in the nursing/tech ranks where male patients receive the majority of their intimate care and where men have little choice as to who is providing that care.

It is also where men come into contact with minimally educated people who are not professionals and who have little at stake in protecting their careers. Teenage CNA's/LNA's, Medical Assistants and such are empowered to provide intimate care after 100 hours or so of training, in some States Medical Assistants sometimes receiving no training beyond how to answer the phone, wear scrubs, and look like they are helping when they chaperone. It is at this lower end of medical staffing and also the younger end of the nursing ranks where the most egregious inappropriate behavior anecdotally seems to occur, likely out of lack of maturity.

Coming back to my ultrasound example, lack of respect also manifests itself in her lifting the gown fully exposing me before putting a towel down rather than giving me the towel to cover myself before the gown was lifted. If the medical world cared about modesty issues she'd likely have been trained to do it without fully exposing me.

I suppose I have to say that I don't think the medical world cares about modesty overall. Many individuals within the system may very much care and do what they can, but the system as a whole doesn't.

At Friday, July 07, 2017 1:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I would agree that physicians as physicians are not fully day to day, moment to moment attentive to patient physical modesty since as it has been my experience from my professional beginning and even to my present interaction with patients, no patient (and I mean, as I have written here previously) no patient has discussed their personal issue or concerns about any physical modesty issue they have. Unlike you and the others writing here, the patients have been silent about this to me their physician. The fact that I didn't hear anything in this regard from my patients has never meant that I was unaware of the concept of modesty especially when applied to genital/rectal areas of the body and breasts in the female. And certainly that is why I always had a female chaperone present with female pelvic exams. But, in my mind, since I got no warnings from my patients, was that they looked at the examination value for their diagnosis and health as trumping any personal modesty issue and accepted that as such. Looking back I am not sure that for some of the requests noted on this thread I would have been able practically to fully accommodate the patient's directive.

And finally please don't think that physicians themselves (including my experience with surgical prep by two women) are unaware of some degree of modesty. However, in my case, I saw the need for their thorough and standardized behavior and accepted, without words, their essential activity.

Believe me, if physicians were made aware of their patient's decision of personal modesty distress vs clinical necessity and if the physician could practically accommodate the patient's desires, most physicians would eagerly follow the patient's request. But the patient must, as my patients have never done, SPEAK UP.

By the way, the most easily performed act the physician can do if reminded that an exam door or window is open for access for viewing or entry by the uninvited is to close the door and cover the window. No additional cost to provide that service! ..Maurice.

At Friday, July 07, 2017 6:55:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, yes patients need to speak up but that can only occur if the patient even knows there is something to speak up about. It was just 12+ years ago but in my ultrasound example all I knew was my doctor called me at work, said I had blood in my urine and that he made me an appt. at the hospital for an ultrasound. At the time I didn't even know what an ultrasound was let alone that a procedure like that on a man would be done by a woman. I was like a deer in the headlights when a woman came to get me and then told me to undress. I was also unaware at that point that it was even an option to ask if there was a male sonographer available. Now I am far more aware, know that I can speak up, and I will research what any procedure entails before it ever happens, but how many patients are that aware?

Fast forward two weeks and I am in Boston in pre-op waiting to have bladder cancer surgery. I am sure it was buried in the forms being shoved in my face and the nurses telling me they just give permission to do the surgery and to bill your insurance, but I was utterly unaware that medical students observe surgeries until 5 of them appeared at my bed, 4 women and 1 man. Not only did I not know anything of such practices, I had no inkling that I had the right to say yes or no. They didn't ask me if it was OK to observe. Again I was like a deer caught in the headlights too shocked to speak.

The last piece of this saga is the nurse that would be taking me into the OR telling me moments before I was sedated that she was going to get to know me real well, and there was no doubt but what she meant by the way she said it. Again I was stunned silent for the few moments that elapsed before she put me under. Afterwards I was too embarrassed to say anything about it and back then I didn't really understand that men were entitled to be treated respectfully anyway. All I had ever known was that female medical staff treated males as if they had no modesty because society said men don't have any modesty. And so I had to make believe I wasn't modest either and accept however I was treated. How many men still think that way?

This is why this forum is so important. Men that come here can realize that they are not second class patients and that they can advocate for themselves. Women are much more aware in this regard.

It would be nice if doctors could at least pose a question or two to see if the patient understands what the procedure or protocols entail.

At Saturday, July 08, 2017 7:46:00 AM, Anonymous Anonymous said...

Maurice -- I have to agree with Biker: providers can't assume that patients will know what certain procedures will entail, or how their modesty might be compromised. I had literally never heard the term "chaperone," as applied to medical encounters, until several weeks AFTER my humiliating experience with one. I had absolutely no idea that such a thing existed until my NP used the word in her dismissive response to my complaint. Like Biker, I had no idea about staffing for testicular ultrasounds either. I've now had three, all of which were performed by female techs. Since they did NOT bring in chaperones, and were very respectful of my modesty (draping me before I disrobed, and allowing me to cover my penis before removing the drape), I have no complaints. My particular trigger is the spectator, rather than the sex of the provider per se.

To the extent possible, I would recommend that providers be continuously aware of modesty as a possible issue and make a point of introducing the subject whenever exposure of intimate areas is likely. Simply describing the possible exposure, then asking the patient if he or she has any concerns, could go a long way toward eliminating the nasty surprises that so many of us have suffered.

Thank you for posing the question.


At Saturday, July 08, 2017 11:05:00 AM, Blogger Maurice Bernstein, M.D. said...

RG, I understand. You and the others should know that my teaching point to first and second year medical students (and I am sure the other instructors teach the same) is that the patient should be informed in advance regarding the details of the exam or procedure relating to the "personal experience" (what the patient might experience). That means to the woman patient "To examine your breasts properly, I will have to uncover, one at a time, for me to inspect and feel for abnormalities.. do you have any concerns about that?"

So this is what first and second year medical students learn.. now what happens later when as physicians as they interact with patients but having time limitatins and other responsibilities, well that is for the patient to observe and respond to.

I don't want any of my visitors here think that there exists limitations of students' communication with patient prior to history taking (e.g. "I am about to ask you some medically important questions about your sex life, is that OK with you?") or physical exam (e.g.-"I will now uncover your abdomen so that I can examine it. OK?"). They do just what I wrote since I am aware of what is going on because my responsibility is to as best I can, with 6 students working in separate hospital rooms, monitor this student behavior. But I virtually always find they follow this requirement.

Thus I am convinced they start their medical history and physical exam relationship with a patient with attention to this important communication matter.

If the limitation of the medical system later make the physician behave without the attention to this communication with the patient, it will be up to the patient to "speak up" which it appears from the postings many here are doing just that. ..Maurice.

At Saturday, July 08, 2017 1:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Looking back at the previous Volumes of "Patient Modesty", for example..even back to Volume 67 a in 2014 and subsequent Volumes, I find writers who wrote and wrote but have stopped returning to write or maybe dropped back in briefly.
Remember names like "A.Banterings", "don","belinda", "Hex","Jason K", "Kevin", "Ray",
I am sure you can find more.
What does this tell us about the interest or value of either returning to this thread or even taking time to post a comment. Do you think we can reach a point when these Volumes begin to lose their interest or value. We are now at Volume 80 with perhaps 150-180 Comments in each Volume.

So my general question is what do my visitors think of the value of this thread. Has it reached its maximum value or because of new visitors, they have something to be gained by even glancing through perhaps one Volume? ..Maurice.

At Saturday, July 08, 2017 5:47:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, there is value still in that new readers are surely coming by even if only to read. You had been at this for many years before I found it a year or so ago. I learned a lot and am now a better advocate for myself. I still come here because I learn from the experiences of others and it serves to remind me that I am not alone in how I feel about these issues, and perhaps more importantly it is not me that has a problem. It is the medical system that sees men as second class patients.

I understand if it has lost its excitement for you after all this time, but it is still valuable to your readers.

At Saturday, July 08, 2017 7:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, what I wrote should not imply my interest in this thread is diminishing. It is clear from the volume of written responses, by a variety of commentators over the years that there is a widespread interest in this topic. My concern is why those who comment (as identified by their pseudonyms) stay for a while and then leave. (Please note that an example of one exception, the persistent, long participating and welcome commentator is PT) but the others stop or almost stop writing. Is this because of boredom with the topic? I doubt it. Maybe because they feel that they have contributed and now it is time for others to do so. Or maybe it is because beyond a certain point the "movement" is going nowhere and there is nothing more to contribute.

Yes, I am interested that this blog thread is helping to "spread the word(s)" but if I know why (and you can skim through all the fairly ancient Volumes) these contributors have left us or just are not writing again then maybe there is some editorial improvement that could be made.

Biker, do you think based on your experience here that all has been "said that needs to be said" or what?

Again, my posting now is not to demonstrate personal disinterest in the topic but to discover here at Volume 80 what could be made better both for my "old" contributors and the "new" visitors and, of course, the solution of the problem in medical care that this blog tread is all about. ..Maurice.

At Saturday, July 08, 2017 7:42:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, perhaps it has all been said, but some things need to be said over and over if the problem is still happening.

There have been a couple times that I asked if people see a difference now vs years ago. It does not generate much response. Personally I think medical protocols and societal norms for male exposure have come a long way from the way things were done back in the 50's/60's/70's. Guys growing up today would be shocked if they were suddenly treated in the manner we were back then.

At the same time we have gone backwards by virtue of the medical world adopting the "medicine is gender neutral" mantra. Gone are the male orderlies to do male catheters for example and in have come female doctors bringing female chaperones into the equation. Women now having equal access to medical school was a good thing for women's rights, but it came at a cost for their male patients who have been treated so disrespectfully with the chaperone issue.

So we've gotten better and we've gotten worse and maybe that's why the dialog here needs to continue.

At Saturday, July 08, 2017 8:21:00 PM, Anonymous Anonymous said...

Blog is useful but perhaps in a rut wrt prescriptions (lawsuit or individual patients speaking up). Might be time for the moderstor to allow some slack in the reins to stimulate new ideas; just a thought. REL

At Sunday, July 09, 2017 7:43:00 AM, Anonymous Anonymous said...

Maurice -- Thank you for your response. Having come to this blog less than a year ago, I can assure you that it is immediately relevant to anyone just encountering the problems described and discussed here. Like Biker, I learned a great deal from posts I read before contributing my own experience, and I continue to learn from posts made after mine. I'm certain that most of us would say the same -- and that's not counting the individuals who participate only by reading, who have not (and may never) contribute their own experiences, but derive the same benefits of learning and validation from reading about ours. The value of this blog as a public service shouldn't be under-estimated.

Regarding the issue of providers' "modesty awareness" eroding over the years of actual practice, I see your point from the provider's perspective: the need to take time to discuss the issue with patient after patient might start to feel redundant, particularly with the time pressure to see as many patients as possible.

But from the patients' perspective, the issues of privacy and modesty are not old hat; in the case of Biker and myself, the lack of advance warning led to traumatic encounters for which we are still, to one degree or another, feeling the effects. If we, as patients, don't know what could happen in procedures we haven't experienced before, how can we speak up before something happens that we didn't want to happen?

I don't know what the fix is -- how to encourage providers to follow through on their medical school training about modesty -- but I think that should be happening.

At Sunday, July 09, 2017 9:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks to Biker and for the 7:43 am writer with the missing pseudonym identification.

This "Patient Modesty" is the longest running thread on this blog with almost daily input compared to all the other 900 ethics topics that one can find here. It is on the basis of this activity that has motivated me here now at Volume 80 and 12 years after beginning the thread topic to wonder whether what has been transpiring here at this point is of the best value to a goal of providing gender equal attention by the medical profession regarding the issues of dignity and modesty.

Look, as I wrote above, I fully agree with REL's last post that the perhaps to the approaches to a solution as presented here may be currently in a "rut" but I am certainly not attempting to discourage the discussion of alternate approaches. That is why I called,at this time, for the consideration of why over the years there has been a "dropping out" to various degrees of previous "energetic" identified writer visitations to this blog thread (hopefully not related to their own ill health).

Yes, there could well be more than "speaking up" to the individual healthcare providers. It may require political or legal mechanisms or perhaps creation of a more energetic system of encouraging acceptance, entry and teaching nurses, techs and office workers with financial and management equality for both genders just as over the decades such equality has been accomplished gender-wise regarding physicians themselves.

So, let's go to it here to encourage active participation in this thread by more visitors and presentation of wider views and approaches if change is warranted and should occur.
To get more visitors, maybe each current visitor should through various approaches inform and encourage others about this blog thread and promote interest in their active participation.

This blog is non-profit with no attempt to "sell" anything except to discuss and promote ethical understanding and behavior. ..Maurice.

At Sunday, July 09, 2017 11:21:00 AM, Anonymous Anonymous said...

My apologies. The 7:43 AM poster was me.


At Sunday, July 09, 2017 12:10:00 PM, Blogger Maurice Bernstein, M.D. said...

RG, your apology is, of course, readily accepted. But it is a worthwhile reminder to all writer-contributors to this or other threads how important a consistent use of a terminal pseudonym (if not formally signed in with some name in It's all about "continuity" of message.
Again, RG, thanks for your responses. ..Maurice.

At Sunday, July 09, 2017 7:41:00 PM, Blogger Dany said...

Hello Dr Bernstein,
(and, of course, other readers)

I'm still reading this blog, although I haven't posted since my initial contributions (when was that, volume 76 or 77?). I've been tempted to comment a few times since then but wasn't sure if I should.

Since you called out, here I am.


At Sunday, July 09, 2017 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Dany, thanks for responding. As one who wrote here in the past but not recently until today, maybe you could explain why though "tempted to comment a few times" you were "unsure" to do so. Since continuity and progressive development of conversation here is important for the education of other visitors but also for the development of solutions to achieve goals of remedy to the problems being discussed, I would say that followup comments by visitors here are always welcome and is part of "discussion" which is in the title of this blog.

We can always learn from each other-- and over the years of this thread I can state (as I have in the past) that I have "learned" about the full meaning and expression of "patient modesty" as expressed not in a medical school setting but on an open blog thread. It does make a difference. ..Maurice.

At Monday, July 10, 2017 11:33:00 PM, Anonymous kiko1024 said...

I find all these comments interesting as to how individuals deal with issue of personal personhood/modesty Being a survivor of brutal sexual attack when a minor by 2 female medical staff to teach me a lesson as to who was in charge and thousands in counseling, I learned that I had to set limits- no female care, female doctor nor any intimate contact by female staff period. I have been verbally and psychologically abused by doctors as it "Suck it up!" Currently I had this discussion with my doctor who has moved mountains to work with me. A few years ago I was rushed to the ER after hours of a duodenal ulcer bleeding. Between passing out and flat lining numerous times I got my story to the doctors who arranged/moved a male nurse to ICU and made sore a male nurse was on duty the week I was there. Now, bear in mind that by Federal law you do not have to discuss or have present anyone you do not wish. As a survivor and is true of many survivors we wold and most likely refuse any care from opposite gender rather than reliving the trauma and nightmare. For men needing a scrotal sonogram if a male tech is not on staff request a male Dr. of radiology. I will go over anyone who steps in my way preventing what I need and how it must be handled. I will not accept the demeaning or insulting response that "we are professionals or we have seen it all". I certainly taken a few female medical staff aback saying that for their next breast exam they have a 23 year old male tech! Don't wait to be asked and insist on what you want. I asked a male radiology Dr. why don't they inform men that they can ask for a male radiologist. His response no one has asked-but never thought to offer when an appointment is made as the booking staff already know what the appointment is to be for. So hospital staff and doctors are also responsible, but the client bears the burden for looking after his best interests.

At Tuesday, July 11, 2017 7:14:00 AM, Blogger Dany said...

Dr Bernstein,

One reason that held me back from making comments was that I wasn't sure if they would be meaningful and/or relevant. One of the common theme that seems to bind many - and I would suggest perhaps all - of the posters is that at some point in their life, in some form or other, their modesty in a medical setting was compromised (in either a very unpleasant way, or simply too casually).

However I do recall you asking posters to move on from simply retelling their experiences to how to change things, how to improve the situation. Finding the right balance seems to be what is holding me back.

I have learned a lot from reading other posters' comments (Biker in Vermont easily comes to mind, having recently dealt with a similar situation). And maybe I will share some of my experiences with this.

Lastly, to the poster named kiko1024, I hear you. You will find you're not the only one here in a similar situation. Wish it wasn't so but, there you have it.


At Tuesday, July 11, 2017 8:48:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, I have been encouraging my visitors for years to move on from their presentation here mainly of their "true-life" descriptions of their psycho-traumatic modesty experiences within the medical system whether as a student or as a patient and switch to presenting here approaches to rectify the system. And I have repeatedly used the request to "speak up".

Just to give my readers an idea of when, perhaps, I first used the expression, I did a word search through all the Volumes and found my first "speak up" in Volume 36, November 2010 where I wrote in the introduction to the Volume: "And the patient modesty issue continues with concerns about which gender is more at risk for modesty abuse and which healthcare provider and provider gender is doing or not doing what.
One solution to the concerns continues now to appear and that is the importance of any patient with modesty concerns to SPEAK UP to the providers and to the system. I can't believe that any patient should find it necessary to avoid a necessary medical workup and treatment because of concerns that their modesty issues will not be attended by the provider. If it ever should come to that, and according to some writing here it has, there is something drastically wrong with the system or perhaps the initiative of the patient to make their wishes known."

So, though I admit that for my visitors to express their own personal experiences may be therapeutic for them and supportive of the experiences of other visitors here, I think we all agree that there is a giant medical problem for many who visit here and now the goal of this blog thread should be methods and mechanism of resolution of the problem. And the emphasis should be on advice and the results of attempts by my visitors to independently act upon their dilemma.

In other words, by now, our Volumes have been well documented with the "moaning and groaning" and it's time now to emphasize how to resolve this over all the Volumes, this "well-documented" problem.

So Dany, maybe you can resume posting and tell us what you did to make the system work for you. ..Maurice.

At Tuesday, July 11, 2017 10:43:00 AM, Anonymous Anonymous said...

Would a website with amazon-type product reviews of medical offices, clinics, and hospitals (focused on patient modesty aspects; sorted by geography and medical specialty) do any good?

At Thursday, July 13, 2017 12:53:00 PM, Blogger Biker in Vermont said...

As noted previously I have had a couple dialogs with the local hospital about their policies concerning high school student shadows. This was after I learned that students as young as 9th grade are allowed in the OR as observers. I have not been able to get any policy statements other than students wear name badges that say Student (but not what kind of student they are), that students are well supervised, and that patients can refuse to have students present.

My specific queries as to whether there are any age-based limitations on student presence when patients are intimately exposed, whether students are allowed to observe when patients haven't had an opportunity to specifically say yes or no (emergency surgery, certain ER scenarios etc.) or whether patients are specifically told students are in high school (vs allowing patients to assume the students are adults in nursing or medical school). No answers to any of those questions.

I thought to do a "student doctor" search to see if anything has been written on this topic and in doing so I came across a large forum Student Doctor Network. There are numerous subforums, including for high school student shadows. I could not find any discussion about patient intimate exposure to high school kids and thus posed a question myself. I should note that in threads I did read that the focus of the students is far more on what the students need that it is on how the patient feels.

A key discovery is that hospitals appear to allow each doctor to decide what students can observe. A couple doctors responded to my query and didn't seem to understand why I would be concerned about young high school girls observing me being catheterized for example. Though the high school kids can't participate in patient care, as observers doctors are OK giving high school kids the same access as licensed medical professionals.

There is also a prevalent sense that because the word "student" is buried in the consent forms that the presumption is that patients have specifically agreed to any and all student presence, including that of high school kids. I did not see anywhere any perceived obligation to differentiate for patients a 9th grader from a 3rd year medical student. The onus to be properly informed is entirely on the patient.

Bottom line is for anyone who might object to 14 year old girls observing your surgery, including the prep, the onus is on you to surface their status because it is assumed you agreed to their presence when you signed the consent forms.

Dr. Bernstein, if the opportunity arises you might ask your students about their high school shadowing experiences. Some of them may have already learned it is OK to deceive patients if it benefits the medical staff. I read some comments where high school kids were referred to as colleagues so as to garner patient agreement to their presence.

At Thursday, July 13, 2017 2:59:00 PM, Blogger NTT said...

Hi Biker:

To negate the facility to in their mind legally allow anyone the doctor wishes to watch what they do, the patient would need to write something along these lines on any and all consent forms they sign.

"I hereby do NOT consent to any observers of any age or sex observing any preparations, testing, and/or treatment(s) done on my person at any time while I am a patient at this facility."

It's getting to be you have to take a lawyer along with you if you want to protect your wishes. Sad.

I've also been speaking to local urologists & a few urology depts.

To a person not one of the doctors and staff I spoke with ever gave it a thought that just maybe a man would feel more comfortable with male nurses and technicians attending them when intimate procedures are being performed instead of females.

One doctor commented that maybe that was why some of his male patients never came back after their initial consult.

I bluntly told him that many men would rather walk away now after the way they've been treated rather than hand their dignity over at the door.

We had a good back and forth conversation.

I usually start out with statements like "With all due respect to the qualifications, professionalism, and the high level of care your female nurses are providing your male patients." then go from there but be diplomatic. It usually opens then up to talking.

Urology is a key area for all men. We need to get more male personnel active in all facets of the field. Urology has to be told in no uncertain terms, that not all men want women being involved in their intimate treatment.

To many men are suffering in silence because they think female nurses are the way it's going to be and that's the way it is. They're afraid to speak up for fear of retaliation from the nurses and being labeled as weak. Sad.

That's all I have for now.

Regards to all,

At Thursday, July 13, 2017 5:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I am not happy with college or high school or earlier student "shadowing" to whatever degree and for whatever the formal "purpose" is said to be. Not only is the patient's medical history at unnecessary risk for "distribution" and the patient's control of their "physical body" is open to "non-therapeutic inspection" which I don't think is ethical when the primary goal is the best professional diagnosis and treatment. Also, importantly, is the physician's responsibility and devotion of interest at the time of the patient=doctor relationship and activity is purely to the patient and not to some other individual or the physician's own personal life. None of these concerns, however, apply to a student who has already become a student in a school of medicine, however the patient should always be made aware that such a student is present with the informed consent of the patient and is a "medical student" and not a "student doctor" or even "doctor".

What I want to remind or inform my visitors to this "Patient Modesty" thread is that in 2014 I began a thread titled "Shadowing a Doctor: A Benefit or Harm"

with contributions by visitors who have written to our "Patient Modesty" thread.

Of interest for me was another point against "shadowing" prior to medical school education and that was the introduction to those "to be medical students" an inappropriate education by those outside of a medical school environment regarding the ways and means of the sub-culture called the "tribe of medicine". That is the stuff of medical practice but indoctrinated to the "possible to be med student" from a different era and not the approach or technique of patient attention, diagnosis or care which they will be taught in current medical education.

So go to that thread and see if the comments there add something to your view of "shadowing". By the way, you can contribute to that thread since it is still open for Comments. ..Maurice.

At Thursday, July 13, 2017 9:12:00 PM, Anonymous Anonymous said...

A few points based on my 35 yrs in medicine. First, not all institutions cover the possibility of the presence of young (non healthcare program enrolled) observers in surgeries, exams, etc. in their informed consent documents. I’ve seen some that are overly broad and do slip it in. At my institution, up until my departure we did not allow any “student” observers unless they were formally enrolled in one of our documented healthcare training programs. If not, each patient had to explicitly consent in writing for the presence of the “outside” observer. This is the higher standard way to comply with HIPAA and patient personal privacy, but not all institutions take the high road.

My experience was that EVERY student vacation time period (Spring Break, Summer, Xmas break) there were medical center physicians wanting to have young adults of high school/college age shadow them. These young adults were children of friends, their own children, children of colleagues, etc. They did not see anything wrong up front with this shadowing, certainly not with reference to the patient’s feelings or preferences. I told them its possible, but you must get written consent from each patient and we would need a copy of that written consent. Or they could formally establish a shadowing program for the institution with admission criteria, screening, etc. That ended the matter always. My point being from my extensive experience physicians in this matter physicians just didn’t think about the patient’s perspective - but after years under HIPAA they did have a sense thankfully to check whether it is ok.

As a patient you need to be aware that if you are having a surgery or procedure during student Spring Break, Summer Breaks or Xmas break you have an increased chance of the physician having a young shadow. You always have the right to decline the presence of observers. You need to read the informed consents given to you (in the physician’s office and/or at the hospital). Decline to agree to the presence of observers. Under HIPAA your care CANNOT be conditioned on the presence of such observers. Unfortunately some of these forms are given to patients at the wrong time, when they are nervous, stressed about the upcoming procedure/surgery and really not able to carefully read the whole document and feel brave enough to question the content.

Finally, in small private outpatient offices physicians often bring in the young adults noted above (at the time periods noted). Even though you won’t sign a form for an intimate exam and some intimate procedures you have the right to refuse the presence of non healthcare operations observers. Its not a matter of being rude, manly, a bitch, or whatever, it is your right - so speak up. — AB

At Friday, July 14, 2017 5:24:00 AM, Blogger Dany said...

Dr Bernstein,

Thinking about an earlier post you made regarding the “I hate doctors” thread, I too do not think I “hate” them. To me, what it comes down to is trust. And I have yet to come across any physicians whom I could say I fully trust. I am always wary, cautious and definitely on high alert (expecting and dreading the worse) when I'm with one, due to some unfortunate experiences in my past. And I do not mean to single out doctors; I feel pretty much the same with any PA, NP, RN or other health professionals.

I've learn to compartmentalize things in my head to make it easier on me. I'm usually okay with anything not requiring me to take all my clothes off, but anything else gets a lot more nerve racking for me. I have mentioned in previous posts that I do not enjoy physical examinations (and that's putting it mildly). One consequence of this is that I always have to explain that I'm pretty nervous around doctors and that it will affect any vital readings they do or revue. To this day I still have (new) providers concerned over my BP readings and I have to explain to them that, no, it is not hypertension, I just suffer from “I-don't-like-doctors-itis” (call it white coat syndrome) and if they give me a few minutes to “settle down” the readings will go back to normal (and they do).

I can convince myself to accept of physical, only because I know I can (and almost always do) put a stop to it when it gets to the genital or rectal examination. This is where I draw the line, regardless of who the provider is. I have had to be quite vocal on a few occasions (it is still surprising to see how many military doctors / PAs will not take 'no' for an answer, or will do their level best to pressure/argue with you to get you to comply). I have noticed a similar trend (although perhaps less intense) with “civilian” professionals as well. While things won't get to an all out shouting match (usually), they'll try to convince you, to get you to change your mind (and, for all I know, maybe they believe they are doing the right thing there, for the patient's own good). It's unfortunate that, as a patient, I have to be firm and sometimes angry just so the person I am dealing with will back down and respect my choice. This might be a biased opinion on my part, but it seems to happen more often when the care is offered by a woman. Perhaps it is perceived as a personal insult by them.

But to me, the primary reason I don't easily trust providers is because I feel I am often being manipulated by them. I won't say outright being lied to, but... You know, a little missinformation here and there, things not said but implied instead, the witholding of imformation that might impact a patient's decision, that sort of things. Let's call them “little white lies” sprinkled here and there just so the patient can be nudged (or persuaded) to agree to the care. All of this, of course, being for patient's best interest (if it wasn't readily apparent, I am being being sarcastic here).

A classic example would be someone rushed to the ER (for whatever reason), and being told that “something has to be done” (whatever the procedure). Patient asks if it will hurt, and is told that no, it won't (or “just a little bit”). Turns out it did hurt (or more than a little bit). Quite upset, patient asks why he wasn't told and the answer given is “would you have agreed if you knew it would hurt?” as if it is justified to lie to the patient if the end result is to get him to agree (consent) to the procedure.

Perhaps it is only me, but I find myself more and more on the look out for these things, almost as if I expect that sort of behaviour from the health professionals I go see. I often pay more attention to what isn't said, wondering how and when am I being deceived by them. My past experiences have taught me that, no, “doctors” cannot be trusted (not implicitely anyway). That for me, to earn my trust, is a long and slow process.


At Friday, July 14, 2017 10:47:00 AM, Anonymous Anonymous said...

As retired 30 year high school teacher, I believe I can write with some authority that the vast majority of adolescence under 18 do not have the mental and emotional maturity to shadow a practitioner at any time during which sensitive patient information is discussed or any intimate exposure takes place.
To avoid this happening at hospitals and some offices be certain to read carefully any “consent to treat forms”. My wife has had several emergency room visits and one hospitalization and each time we were asked to sign such a form. The receptionists were in each case somewhat irritated when they realized that we were going to take the time to read the entire full page form instead of simply signing it. Obviously, most patient simply sign and hand back the form.
All three forms had one paragraph granting blanket permission for any number of observers to be present and another allowing for videotaping or the taking of pictures. The Massachusetts Patient Bill of Rights guarantees the right to refuse both observers and pictures and I find it extremely dishonest for the medical profession to use a tactic like this in an attempt to circumvent state law.
Each time, we crossed out and initialed these two paragraphs. On receptionist told us we couldn’t do this but I informed here that the document involved informed, not coerced consent, and I would gladly talk to her supervisors(s) if necessary. At that point she relented and accepted the form. In all three cases the receptions gave me a copy of the form giving permission to bill my insurance but they had no intention of giving me a copy of the consent form until I demanded one.
Even after this, at one ER visit, after my wife had seen a doctor, a young women walked in and without saying who she was asked to examine my wife. After I inquired and found out she was studying to be a nurse practitioner, I informed her that her learning for that day should involve reading consent forms so she would know which patients she was allowed to see. At that point, she gave me a hostile look and without a word stormed out of the exam room.
In summary, in dealing with the medical profession you must be continually vigilant if you care about you your bodily privacy and the privacy of your medical information because they so frequently place their concerns over those of the patient

At Friday, July 14, 2017 1:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks to AB,Dany,MGG and the "regulars" for their participation in the discussion regarding "physician shadowing". Yes, in my opinion, there is a host of ethical issues the examples of which have been already noted here by my visitors. And the topic is important since it does appear that medical schools are encouraging or requiring some "shadowing" to be part of the admission evaluation for applying students.
My main ethics concern about such "shadowing" is a true ethical benefit for which party.
In all physician-patient relationships when the ethical principle of "beneficence" is carried out: who should be one primarily receiving the "good"? It has always been my understanding of the history of medicine that it should be the patient. The benefit for the physician or the shadowing adolescent should be secondary. interaction between the medical system and the patient should be based on the principle of patient autonomy. And that is why all decisions involved in non-life-threatening, non- emergency situations should be based on the principle of patient autonomy--the patient makes or has made the decision. The patient consents to the participants in the patient's care and consents to the tests and to the treatments.

Of ethical concern, however, is what is the role of the health of society with regard to individual patient autonomy and beneficence particularly with respect to societal benefits said to be gained through "physician shadowing"? If the "shadowing" promotes entry into the medical system of needed students to become doctors, nurses or med-surgical technicians for maintaining a healthy society should that trump concern about"shadowing" and the individually affected patient? Do we know, based on valid studies, whether this behavior actually, in the long-term, increases the population of healthcare providers who will be satisfied with their professional occupation and be a value toward the health of society through their presence or behavior.(Does anyone have statistics on this point?) This is important since the primary motivation for "shadowing" is student education about a possible occupation.And this is where the principle of ethical justice is considered. Is the value of "shadowing" to society sufficiently great enough to override any apparent losses of autonomy by the individual patient involved in the "shadowing"? Are those potential losses considered just when considering the potential benefit to society as a whole? Any answers? ..Maurice.

At Friday, July 14, 2017 2:33:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, medical or nursing students shadowing physicians and nurses can be a valid part of their education and in ensuring that there is a steady stream of qualified medical professionals joining the workforce. There is something in it for society. I accept that.

High school and college kids who are merely wanting to see if it is something they might like holds no societal benefit. I'm not so sure that there is anything so special about the medical field that kids in high school need to get a test drive before pursing education.

While I would not knowingly agree to a 14 year old girl observing me in the OR, some people would. At issue is each of us giving informed consent. There are very clear terms that if used would not confuse the general public. This includes medical student, pre-med student, college student, and high school student. Yet the standard term used for all of them is student doctor, and sometimes no term is used at all but rather "Mary is part of my team", "John is assisting me today", or "my colleague Sally". Each of those non-descriptors is a purposeful misleading of the patient for the benefit of the student. Until I learned better I didn't realize anyone other than a medical or nursing student was allowed to observe or otherwise interact with patients. My guess is few people know that student doctor that just observed their physical might have been in high school.

Great improvement would be seen as concerns informed consent if the medical world was simply required to make everyone wear name badges that clearly identified their status.

At Friday, July 14, 2017 5:25:00 PM, Blogger Dany said...

I agree there are benefits for future health professionals to shadow someone else for a while (it might even be part of their clinical rotation) but that benefit, in no way, overrule or supersede the patients' concerns or objections regarding said shadowing.

No patient has an obligation, be it civic, legal or moral, to accept to be a training dummy for anyone else. And this is something that might creep up on anyone unnoticed, because some facilities will not go out of their way to let you know training is taking place and you've been roped in, want it or not.

I know there are still places who, for fear of being told 'no' by the patients (or because it has happens and they aren't happy about it), will adopt a don't ask, don't tell policy where patients aren't informed. This is extremely insidious and misleading. These professionals are playing on their patient's naivety and ignorance, betting they won't be able to tell some extra staff have been added to the roster.

(this issue happened to me last year and I'm still kind of pissed off about it.)

In my opinion, if you aren't there in direct support of the patient's care, you don't belong in the room. Period. And if a provider, or institution, is going to bring in a student or observer, have the decency and respect to ask the patient if it's okay first.


At Friday, July 14, 2017 7:38:00 PM, Blogger Maurice Bernstein, M.D. said...

Continuing a bit more on the matter of physician shadowing by adolescents and beyond, I recommend you read the opinion of a physician written in the Albert Einstein College of Medicine "The Doctor's Tablet" website
but most interestingly the volume and variation of Comments the opinion received. The unifying part of this whole discussion with conflicting opinions is that though we are not all physicians or nurses, we are all potential patients. ..Maurice.

At Saturday, July 15, 2017 6:10:00 AM, Blogger Biker in Vermont said...

It should be noted that it is not just doctors that are being shadowed. High school kids are shadowing nurses too, and given nurses provide the majority of intimate care, it behooves patients to clarify exactly what that young girl tagging along with your nurse is. The "student nurse" may in fact not be enrolled in nursing school but rather high school. That said, in States like Vermont and New Hampshire where 16 year old high school drop outs can be licensed as LNA's, those girls do their clinicals with real patients and are not shadows, so it can be tough to avoid minors providing intimate care.

At Saturday, July 15, 2017 7:52:00 AM, Anonymous Anonymous said...

To the extent that "shadowing" is an expected prior experience for medical school admission, I think it probably shouldn't be resisted. However, I agree with those who believe the line should be drawn at age 18 as a minimum -- HS students really aren't mature enough, on the whole, to handle the possibility of intimate exposure (either physical or verbal; i.e. description/discussion of symptoms and patients' emotional responses).

From my own perspective as a patient, true informed consent would have to include full disclosure of the student's name, current educational status (undergrad pre-med, med-school) and the name of the school. "Student doctor" may be a standard term academically, but patients aren't going to understand it in the intended sense.


At Monday, July 17, 2017 9:12:00 AM, Blogger NTT said...

Good Afternoon:

If the medical community wants patient’s to allow doctors and nurses to bring along observers on their rounds, then the medical community has an obligation to the patient’s to be up front and honest with the patient’s as to the identity, education level, and the age of the observers.

The healthcare industry cannot assume by signing an intake piece of paper that the patient automatically agrees to allow observers.

The patient alone has the right to say who will and who won’t participate in their care.

There are many people who do not mind allowing observers on their case.

At the same time, there are people who don’t want to discuss their case in front of anyone but their physician.

The medical community must respect these people’s right to say NO.

People that don’t want observers should try to stay away from teaching hospitals as you are more likely to be exposed to more people in one of them.

The more sneaky the industry is at trying to push observers on patient’s by calling them doctors or nurses when they are still in high school or haven’t had any medical training, will just serve to create more mistrust between the healthcare industry and the public they serve. Something nobody needs right now.

Regards to all,

At Wednesday, July 19, 2017 1:03:00 PM, Blogger A. Banterings said...


I am still here. I had to take a break from your blog. Reading on the topic brings back bad feelings and anxiety.

I have also seen some of the unique phrases that I use beginning to appear in policy. Being vocal makes a difference. The other problem was that this was almost a full time job with the research that I was doing to back the assertions that I have made.

The discussions that we all had got into some really deep psychological concepts. Even with my background in counseling, this was a lot to process. But myself, Ray, Kevin, Charles, and others were able to defend our position and assertions.

Basically I am burned out, as I am sure that others are.

Then there is life; it happens. I have not forgotten about the issue. I am working on a project that will bring change.


At Wednesday, July 19, 2017 7:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I appreciate your return today to the thread to which you have certainly constructively contributed in the past.

What I have found particularly of need to express appreciation was certainly your support of your discussion with valid and appropriate references in the form of accessible links. I express the same appreciation to a number of others writing comments here to their reference links too. References are always of potential value in all discussions as a method of supporting or rejecting a viewpoint.

Hopefully, "burnout", including yours, is reversible by "rest".
Banterings, also hopefully we will hear more from you about your project. ..Maurice.

At Wednesday, July 19, 2017 9:13:00 PM, Anonymous Anonymous said...

Hello Dr. B, and thanks NTT for your encouraging posts.

I am a long time follower of this forum, and I had intended to post under volume 79, but that one has now closed. I wanted to share my own recent real life event and interaction with local hospital staff. Back in 2014 I had sustained a perforated diverticulum, from long standing diverticulitis. From my perspective, I thought that I was having a major diverticulitis attack..., but I was slowly slipping into renal failure. Anyhow, I was still able to drive myself to the hospital, and was perhaps starting to become distressed a bit, but did indicate to the attending physician (female), that I would not feel comfortable with a 'catheter' being inserted. The attending proceeded with having me sign the consent for procedure, with laparoscopic approach, which had to be reverted Hartman's. However, when I had awoke from my ordeal, a catheter had been inserted against my wishes, and as it turns out by a female nurse. Now I have to ask you, do you think that my wife would ever want any female inserting such a hideous device? Nope! And do you think that I would ever withstand any male inserting such in my wife? Hell no! My wife would not even ever electively go to see a male obgyn. I can't help but to be curious what the spouse of any nurse would think of such a thing. After all, I was coherent, and expressive, to which I now understand that the attending had an ethical obligation to engage my concerns. While I have physically bounced back from this event, it has left a deep emotional scar. In my case, the end doesn't always justify the means. I even additionally had to go through this same hurdle during the take down process, which my doctor was supposed to insert this supposed standard of care. I had even asked the anesthesiologist to remain awake until I hit the OR, which wasn't relayed to the anesthestist. I had even requested that the medical center require separate auths for catheters, which apparently their Compliance Dept was interested in pursuing, which is interesting considering that most med auths have verbiage regarding blood transfusions in 'bold' print to appease certain groups..., but not for all of us which have concerns. Additionally, their auths also have photos, videos, etc., which I also always mark through.


At Thursday, July 20, 2017 5:31:00 AM, Anonymous Anonymous said...

I'd like to echo Banterings' comments about needing to take a break from the blog. I too have had the experience that "reading on the topic brings back bad feelings and anxiety." For me, in fact, too much contact with this and other modesty blogs can trigger obsessional thinking and web-surfing on the topic, which I then have difficulty getting back under control.

I do think this reaction is important to acknowledge as another harmful side effect of modesty violations. Thanks to Banterings for mentioning this.


At Thursday, July 20, 2017 7:37:00 AM, Blogger Maurice Bernstein, M.D. said...

I fully agree with RG and Bantering. What we have here on this 12 year thread is 12 years of "moaning and groaning" about each participant's personal experience or knowledge of experiences of others "in the news". And while I do recommend "ventilation" to my patient's various emotional issues which they bring to my office, I think there has to be a more effective therapeutic approach beyond expressing to others ones emotional history. That therapeutic approach should be "active attempts to FIX the system" and bringing others together to help. I think that spreading the word to others about approaches to the "fix" and personally doing something to attain that "fix" of the system should be invigorating methods to attain both personal relief and relief for others with the same upsetting experiences.

So, as I have written about this here previously, let's move away from personal descriptions of
previously experienced emotional harm and more on to specific approaches, with intent to carry them out with help of others, that will make further distressing experiences less likely or virtually absent.

Yes, "speaking up" to the various healthcare providers, as we have repeatedly written is of value but it is important that system changes are made-- system changes which involve education of patients to "speak up" but also system managerial (including provider education changes) also with attempts to legal and political awareness and actions.

So, let's talk about specifics regarding what can be started, how can it be carried out to a final result which will prevent the emotional trauma repeatedly and consistently describe here one Volume after another.

Let's talk here about this. Otherwise, writing and reading about this "moaning and groaning" by others will only produce fatigue, not be therapeutic and will accomplish nothing. This, what I wrote above, is my professional prescription. ..Maurice.

At Thursday, July 20, 2017 8:21:00 AM, Blogger A. Banterings said...


You hit the nail on the head with "obsessional thinking and web-surfing."

Let me also add the sensations that the body "remembers." For those of you not familiar with this, it is physical tactile sensations that are the result of memories and not a current, present, physical stimulation.

Classic PTSD symptoms.

One of the changes that the contributors have made is that these "side effects" of encounters with the healthcare system have been validated on this blog. Our assertions are no longer questioned on this blog for the validity of our claims. We are no longer considered outliers. Indeed the tone has changed. For that, I commend Maurice.

Slowly, the profession is also SSSSLLLLOOOOWWWWLLLLYYYY changing their view on this as well.

I have also kept an eye on the blog, mostly skimming the topics (as I am sure that many others do as well). I felt that it was important to chime in and let people know we are still here.

Maurice, thank you for the recognition of the contributions that I and others have made, and you are very welcome.


At Thursday, July 20, 2017 9:43:00 AM, Anonymous Anonymous said...

Hello H.,

Your experience sounds horrible. As others on this site have done, please try to affect change by speaking to the hospital personnel (nursing staff, doctors, admin.) If this is too draining for you, maybe your wife could do this. Everyone concerned must be notified that your requests were completely ignored. Please be adamant. The industry will not change until it is confronted with a need for change. Without your follow-up, business will continue as usual; and, many others will face the same indignities. Express your views in writing and in person. Write negative reviews. Notify appropriate agencies. This will take time and effort; but, change can happen, if enough people are willing to expend the effort.

At Thursday, July 20, 2017 1:57:00 PM, Blogger Biker in Vermont said...

I have noted these things over time in different posts, but here are things I have done. None are profound, and for the most part don't do anything but plant a seed that increases awareness in a small way, but any input the medical world receives is cumulative.

I contacted the local tech high school LNA program and an area college RN program to pose the question as to whether their programs include male students, and if not do they have any outreach to attract male students. I pointed out that their websites only feature female students and that by doing so they are sending prospective male students a message that only females are welcome. Both responded with a "good idea, we never thought of that" type response.

I contacted the local hospital twice asking questions about their policies. The first time was about the high school LNA students doing clinicals at the hospital, including working in the OR. The second time was specific to high school student shadows. In both cases I was looking for policy statements as concerns their identification, patient informed consent, and access to patients that are intimately exposed. I did not get full answers but I know I caused a conversation to be had at the hospital.

I wrote an article for the Dr.Linda blog. She tells me it has been one of her most popular articles and in my discussions with her she admitted to not having been aware of the issue, and that she agreed with me on everything I said. I expect she now approaches her own patients differently.

I have spoken up. When I changed hospitals for my annual cystoscopy, I first posed certain questions about male nurse availability for the prep, and when I went for my first one I was not shy about saying I wanted a male nurse, which is what they gave me.

I have insisted on not being sedated for 3 procedures (two being colonoscopies) and will not be sedated in Sept. for another procedure. For this upcoming one it included voting with my feet and going to a different hospital when they would not do it my way. For one of the other procedures they initially said no but quickly relented when I said I would go elsewhere. Along the way I learned that sedating patients is a lucrative billing opportunity. They had billed as if I were sedated and tried their darndest to say it was for something else when I contested the bill despite the bill being very clear. As an aside, a colonoscopy without sedation is not a big deal. It was a non-event comfort-wise, and I retained control of my body and exposure.

Again, nothing profound here but it all helps.

At Thursday, July 20, 2017 11:04:00 PM, Blogger Dany said...

I think, for the most part, men aren't aware of the modesty issue, or how it might relate to them, until it stares them in the face (so to speak). And by the time that happens, it's usually too late. Shock, surprise, fear of ridicule or reprisal often keep us quiet.

I recently (as of last year) had to deal with some urology issue. All in all, it was relatively minor (hematuria, which turns out to be fine) but I did have to go see a urologist. Among the tests he recommended was a cystoscopy and ultrasounds.

I had next to no knowledge about this beforehand (other than what I had researched myself, which wasn't that much useful for me). Thanks to some of bloggers here I had some information to go by.

The urologist took it as a matter of course that I would be under sedation for my cystoscopy. I nearly missed that fact, only cluing in when he added that I might feel confused after the procedure. After finding out he was planning on using Versed (which I wanted nothing to do with), I told him I did not want to be sedated for this. He did not agree.

I eventually managed to get my way but it wasn't easy. He was really insistent and didn't back down until I got angry with him (in fact, I'm pretty sure my sudden outburst scared him a little).

The procedure itself went well (not pleasant, by any stretch of mind, but not as terrible as I had anticipated), other than being greeted in the room by not just one nurse, but two and both were women. As it turns out, one of them was under formation and the other was "supervising" her. No one told me that was going to happen. No one asked me if I wanted to be used as a training aid either. The forms I signed prior to the procedure didn't mention that detail.

I didn't think of saying anything at the time (for one thing, I didn't know how many staff were required, and for another, I was too frazzled and concerned about the procedure to focus on this). Now, after realizing I was played for a fool, I'm kind of kicking myself for not speaking up right then and there (I had a nagging feeling "something" wasn't right).

The ultrasounds had me concerned as well (I didn't want any more "surprises"). So I had the doctor list for me all the organs he wanted to see. Much to my relief, it was only going to be kidneys, ureters and bladder (KUB). I will only add that, as I suspected, the image tech was a woman. I'm glad I knew ahead of time what the ultrasounds were about (and that I wouldn't have to remove any piece of clothing). I honestly don't think I would have agreed to do it otherwise.

Now that I have gone trough this once already, I am better prepared for an eventual next time (there shouldn't be one, or so I have been told, but...). I would even go see the same urologist (if he will take me on). Only next time, we're gonna have a little chat about staffing before I agree to do this again.

There is more I could say, but I do not believe it would add anything meaningful so I will simply conclude by saying don't be scared to put your foot down if you have to. It worked for me (although I had to get in a doctor's face to get my point across, which is unfortunate).


At Friday, July 21, 2017 8:16:00 AM, Blogger Biker in Vermont said...

Dany, you are correct that often times men (and women too) don't realize what they are about to experience until they are in the midst of it, and then are too embarrassed to say anything. My guess is most don't realize that they can get a pretty good idea by going online beforehand.

Guys, look it up beforehand, even before you go to the doctor if you suspect where your situation might be leading.

Having had a couple dozen cystoscopies at this point I can tell you there is no reason to be sedated. A little numbing gel a few minutes ahead of time is all that is needed. I am referring to a flexible cystoscope here, not the rigid kind used for surgeries. I also had at least a dozen treatments administered the same way. No sedation is needed. Neither of my urologists even offer sedation.

The time for a chat is not when you are approaching another procedure. It is the rare urologist that hires male nurses or techs. Best to inquire ahead of time. When I was switching to a different hospital/practice, I called, told them I was considering switching and posed a couple related questions to what we talk about here. At the time they had one male RN in what is a large practice. I told them that was one more than most had and that it was a good start. She said they are trying to find more males. I approached the conversation in an upbeat manner while being clear many men are uncomfortable having females prep them. In doing my homework prior to calling I knew that they take on two new Urology Residents each year, one male and one female, and so I asked about whether I could only have a male doctor and male resident if the doctor is including residents when I am there. She said just say so ahead of time and it won't be a problem. Again, I kept the conversation positive, but clear on my concerns.

At Friday, July 21, 2017 8:57:00 AM, Anonymous Anonymous said...

Thank you so much Reginald for your encouraging comments. I have taken some constructive steps to express my frustrations with this facility, and also for the 2nd surgery I had needed.

On the issue of constructive thinking, I have seemed to notice a huge double standard amongst society standards. For example, I was glancing at some TSA videos, where they have same gender pat-downs. And when law enf does checks, same thing. But wait, when it comes to medical..., oh wait that's apparently different. All of a sudden, the medical world is apparently magically immune from all of this. Each of these can be argued that they're skilled fields. So, what makes the medical world any different from this standard? Here within I believe is part of the dilemma.


At Friday, July 21, 2017 7:41:00 PM, Blogger Biker in Vermont said...

Good points H about the differences between TSA & Police same gender pat downs vs medical care. Why is one group considered gender neutral but not the others? TSA and Police certainly receive more training than do CNA's and Medical Assistants.

At Friday, July 21, 2017 8:00:00 PM, Blogger Biker in Vermont said...

"We have no modesty here" can be added to the list of passive aggressive bullying techniques used to engender compliance of male patients.

I am just back from visiting a good friend at a rehab facility in NH. He is recovering from Guillaume Barre Syndrome and on his first day there they send in a young woman to assess his capabilities. She required him to completely undress, dress, use the bathroom and shower for her. He apparently must have hesitated or otherwise showed his embarrassment so she tells him "We have no modesty here", and so he complies rather than add to his embarrassment.

In telling us the story he tried doing the usual male bravado "this didn't bother me" kind of thing that I myself used to do, and certainly others here have done too. Having been best friends with him since we were college freshmen 46 years ago, I saw through it and could tell he was very embarrassed. I know him all too well. Regretfully a female co-worker of his was there as was my wife, both of whom saw great humor in his embarrassment in the way women tend to do. Their modesty is to be taken seriously but not that of men. Perhaps they really believed it didn't bother him but they enjoyed it nonetheless.

For me to have pursued the issue with him with the two women there would have only added to his embarrassment so I let it drop. Before doing so however I did make one comment that most likely that young woman would never have allowed for the reverse had she been the patient and a young male came in to assess her in that manner. Neither his co-worker of my wife got it. Had I been alone with him I would have told him it is OK to advocate for himself and demand to be treated with dignity. At some point down the road I will when we are alone.

Guys, this is something else we can do. We can tell our buddies that it is OK to speak up. I can tell that it has not occurred to my friend that he can do so.

At Sunday, July 23, 2017 3:30:00 PM, Anonymous Medical Patient Modesty said...

It has been a while since I’ve posted here. I wanted to share a very encouraging testimonial from Really prefer to keep that private (Female Patient) From Minnesota submitted on 7/21/2017 who fought for her rights to have an all-female team and her husband present for her hysterectomy at I am glad they found Medical Patient Modesty's web site and it encouraged them. Many hospitals will not allow you to have your spouse or personal advocate not employed by the hospital and I am so glad she successfully fought for that. I really appreciate this lady's courage and how she looked for another doctor who would accommodate her wishes after the 1st doctor rejected her requests. This case confirms how important it is for patients to not give in and fight until they find the right hospital and medical team willing to honor their wishes. The female gynecologist who operated on this lady is very compassionate and caring.


At Monday, July 24, 2017 4:07:00 PM, Blogger NTT said...

Hi Biker:

I'd just told the young woman at the rehab facility in NH I am a functioning adult male if I need assistance I will ask and let it go at that. What she did to him was a bunch of BS.

Oh and by the way young lady, modesty concerns will be adhered to.


At Monday, July 24, 2017 5:41:00 PM, Blogger Biker in Vermont said...

NTT, just coming out of the hospital with GBS, he needs to learn to walk again at age 63 and is suffering from other muscle weakness. The assessment was necessary so that the physical therapists can mold his therapy to his specific capabilities & limitations.

One issue is that nobody told him that he would be assessed in that manner so for all intents and purposes it was an ambush. The other issue is that the rehab facility treated him in such a dehumanizing and demeaning manner by sending in a young woman to observe him undress, use the bathroom and shower, made worse by her "We have no modesty here" bullying tactic.

That facility will perhaps do a great job helping his physical recovery, but they will have killed a piece of his soul in doing it. Why doesn't the medical community recognize this rather obvious dynamic? That female staff in medical settings can successfully bully most men does not make it right.

This morning I told a young woman I work with about this to get her reaction. She told me that a few years back when she was 1st married her husband in his 20's developed a leukemia. At one point in the process he needed to get a sample taken from his hip bone I think it was. She was present for the process when the young female doing the procedure told him to drop his drawers. There were several additional young females there observing the process. My co-worker said it didn't even occur to her that he should have been afforded more privacy until afterwards when he told her how embarrassing it was to have all those women there watching him with his drawers pulled down. That she herself didn't see anything wrong with it until he pointed it out to her afterwards says a lot.

It is too late this time to help my friend understand he can speak up but I can help him understand it for the next time he goes into the medical system. This is something we perhaps all can do selectively. Last year I spoke with my son telling him that he can advocate for himself in this regard because the medical world will not treat him as the equal of female patients.

At Monday, July 24, 2017 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Anyone want to respond to the following "bump in the road" to accomplish the goal of nursing provider selection by the patient?
Read the following and then return and respond, if desired.

Here is the link to the article:


At Tuesday, July 25, 2017 3:49:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I read the article and was disappointed that it lumped race, gender, religion, and sexual orientation all together as if they are comparable. To the extent they differentiated gender it was only in a very minor way and even then only directed at women's privacy.

Another disappointing aspect of this is that they only see patients as discriminating by having a preference. That hospitals only hire female mammographers, sonographers, and L&D staff for the comfort of their patients but do nothing in that regard for the comfort of male patients gets no mention at all. I posit that it is the medical world that routinely and rampantly discriminates based on gender in their hiring practices.

At Tuesday, July 25, 2017 5:02:00 AM, Anonymous Anonymous said...

Re: the article "Providers Must Tread Carefully...."

The first thing I noticed was how far down in the mix the issue of modesty was. "Gender" of provider as a preference was usually in the middle of lists of preferences ("race, gender, or religion"), and the issue of male modesty in particular wasn't even mentioned. The example given was a female patient requesting a female provider.


At Tuesday, July 25, 2017 11:02:00 AM, Blogger Maurice Bernstein, M.D. said...

With regard to patient physical privacy concerns and the United States 1964 Civil Rights Act, it would appear that gender selection by the patient would trump and be accepted in contrast to the other factors such as race, national origin, disability or age with regard to requests by the patient in any argument regarding employee discrimination.
Another point supporting a patient's request to their physician rather than an institution for care by a specific gender is the following. As noted in the referenced article: Accommodating the request can be seen as the "physicians deciding among themselves how best to meet each patient’s needs, courts generally give physicians wide latitude in that regard." Physicians’ willingness to accommodate is “likely due to the unique nature of the physician–patient relationship."
So, my conclusion from reading the article is that you will not be requesting an illegal act by speaking up to your physician regarding your interest in obtaining nursing by a specific gender. ..Maurice.

At Tuesday, July 25, 2017 11:18:00 AM, Anonymous Anonymous said...

Hello Biker,
"We have no modesty here." - Should this be placed on every hospital window in the country? How would the general public react to this? Had your friend been a woman, would she have been told, "We have no modesty here?" This is absurd! Is there a need, in the education of medical personnel, for lessons in Respect For The Individual (whether male or female) - Body, Mind and Spirit? This sounds like the Middle Ages. When did an individual become solely a body? Whatever happened to "holistic" medicine? Is there any other profession which would utter, "We have no modesty (i.e. respect for your dignity as a unique human being) here?" Shouldn't simple common courtesy have been applied? Maybe common courtesy has become anachronistic? One can only hope that this is an isolated instance and that higher standards still shape the practice of medicine.

At Tuesday, July 25, 2017 1:24:00 PM, Blogger NTT said...

Good Afternoon:

Or hand your dignity over at the door as you will not have any once you're checked in.

I don't know if they already do this but what about some sort of character assessment test taken before people enter med or nursing school to try and weed out the undesirables or on the job diversity training on a permanent schedule while you are under their employment.

Biker I agree, every male who has suffered through the healthcare system nightmare has an obligation to spread the word as far and wide as he can to warn every man he knows about the nightmare they will face if they need healthcare services and are not prepared for the onslaught they will face.

I warn anybody who will listen to me every chance I get.

It is funny on how very little is ever written up on male modesty yet they'll always talk about women's modesty

I can only hope something rocks the healthcare industry to the core and forces a change in attitude towards male patients before the next generation starts really needing care.

They way they treat male patient's, I don't wish this crap on any guy.

Regards to everyone,

At Tuesday, July 25, 2017 7:12:00 PM, Anonymous Anonymous said...

The article “Providers must tread carefully…” is quite misleading. Interviewing Emergency Physicians is flawed because emergency care is a very special category where providing the care timely is of paramount importance. In addition generally the ED physicians aren’t hiring the staff that are present in the ED and/or do most of the intimate care.

The Hospital/Medical Center with the emergency department is hiring the staff. Many have commented here on this so I apologize for repeating but a Medical Center (an equal opportunity employer) can hire one gender preferentially for providing care under an appropriate BFOQ exception to discrimination laws. In almost every case US hospitals do (tacitly) assert they will use the BFOQ argument for same gender care because they only hire females techs, staff, nurses, etc. for departments serving females, like Mammography, U/S or Labor & Delivery. What that means is males have a right to same gender care also at these facilities - its just they rarely demand it or know they can demand it.

My experience has been most hospital Risk Managers, CFOs, HR directors, Nurse Executives and Regulatory people do not appreciate that by hiring exclusively female staff to “minimize risk”, “meet modestly concerns of the women” etc they are actually committing to doing the same for males. There also is a default belief the gender of the care giver it is not an issue for males, hence it is okay to preferentially hire females who can “cover” both genders. That misconception has no factual basis and the contrary has been expressed in court cases about the same gender BFOQ for urology staffing.

Now and then we did get requests from patients for same race providers or at least no providers of a specific race. We could NOT accommodate these requests because of discrimination laws. Generally we would inform the patient of this and offer to transfer them if our care was not going to meet their needs, etc.

Individual physician offices are different. There the physicians are hiring the staff into their own business. It is their prejudices that determine who is hired and how patients are serviced. I think such physicians are influenced by their training at larger medical centers, where women are preferential hired and they tend to propagate this behavior. Here the patient doesn’t have much leverage other than commenting on evaluations, the internet and voting with her/his feet. For this reason, as I’ve said before, I tend to utilize providers at large medical centers that have arranged their (female) service lines to provide same gender care. They then have committed to arguing in favor of a same gender privacy BFOQ and thus male patients are entitled to that if they demand it (or in extreme cases sue for it). — AB

At Wednesday, July 26, 2017 8:45:00 AM, Blogger Maurice Bernstein, M.D. said...

AB thanks for your contribution to the discussion on this thread. I assumed from your comments that you are a physician. A physician, beyond myself, writing to this thread is, unfortunately, a rarity. I wonder if you could describe a bit about your professional activities and affiliations, remaining anonymous and without identifying institutions names or locations. All this would help put a personal professional perspective to your comments.
Again, thanks for your participation here. ..Maurice.

At Wednesday, July 26, 2017 8:41:00 PM, Anonymous Anonymous said...

Dr. B,

Sorry, not an MD I’m just a PhD who worked at three large urban medical centers, one very well known on the East Coast, one very well known in the NW, and one very well known in the SW. Originally entered medicine as an imaging scientist and supported Radiology and Nuc Med departments during my 35 year career in Medicine. But about 20 years ago I became in charge of everything regulatory, including Compliance, Risk Management, Safety, Accreditation, Licensing, etc. I was at my final medical center for the past 20+ years until I decided to retire early this past year.

Generally any real time patient complaint or unusual request would involved Risk or Compliance so I had *excessive* experience with any and all things unusual or dealing with patient rights, safety, etc. that happen in a very large medical center. I’ve dealt with every State and Federal regulatory agency there is in medicine, the Joint Commission surveyors many times, and of course many thousands or nurses and physicians and patients over the years. Also I’ve dealt with dozens of CFOs, Nurse Executives, CEOs, hundreds of clinical Managers, etc. And I’ve inspected hundreds of clinics and physician offices, licensed them as well as licensing Hospitals. So when I contribute it tends to be from this frame from reference (and my own experience as a patient too). FYI. — AB

At Wednesday, July 26, 2017 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

AB, there is nothing wrong with a PhD and your medical administrative institutional background is just what has been apparently missing in those contributing to this blog thread. (PT, I don't want to ignore you. I assumed you have had an institutional background too but"ground looking up"-- obviously different than AB.)
AB, I hope you stick around a bit (such as PT has done) and continue to present your experience and knowledge despite preserving your necessary anonymity to the concerns of my visitors here. ..Maurice.

At Thursday, July 27, 2017 5:13:00 AM, Blogger Biker in Vermont said...

AB, based on your experienced/knowledge, what do you see as the best way to make modesty based requests? I personally am a polite and courteous person by nature and pose any questions or requests in a calm manner (while my stomach is doing flip flops on account of fearing a bullying or dismissive response), but is there a best way to say it? Thanks

At Thursday, July 27, 2017 10:13:00 AM, Anonymous Anonymous said...

Biker in Vermont,

Let me first preface my comments with saying that when I was working I always wanted to hear about issues directly, rather than having them become complaints to the Joint Commission or CMS or the State licensing agency. It is much easier and *cheaper* for an organization to deal with complaints directly than let them escalate to where an oversight agency comes unannounced to investigate. That said, the institution has to be committed to rectifying the nature of the complaint, not just doing a one off appeasement of a single patient. Sadly many centers just do the one off appeasement and don’t address the larger issue. Because I dealt with so many complaints in my career I tend to give a medical center that I’m a patient at one chance to correct the deficiency directly rather than complaining about them to the licensing agency, Joint Commission, etc. I’ve had good luck with this (dealing directly with Administration first), but of course I can point out how they have violated various standards and laws because of my experience and perhaps threaten them a bit more realistically.

For the general patient my experience was they got effective change in the organizations I worked at by one of three ways:
1)lawsuit, usually class action about something discriminatory
2)complaints to State Attorney General, or the Joint Commission or CMS or the State Licensing Agency (as applicable and appropriate)
3)Complaining to their physicians, who as members of the medical staff, hold tremendous influence in the medical center. A one off complaint here probably doesn’t accomplish much, but complaints from multiple patients were often brought up by physicians to leadership. They want a smooth running clinical service and satisfied patients - so chronic issues get brought to Leadership.

And in the past few years, because $ was tied to it, the patient surveys became a focus of medical centers and the reasons patients were dissatisfied starting being tracked carefully. So until the CMS reimbursement scheme changes again, it does pay to complete patient surveys, provide comments and let your providers know (as much as you can) why you are dissatisfied.

All that said, there is no magic way to *quickly* change the health care system. There must be consistent demands to provide equitable service to all patients and consistent complaints, comments, about inequitable services.

Finally, from my experience very few in health care (e.g., in HR, CFOs, Nurse Managers, etc.) actually intellectually recognized there might be a problem hiring only female nurses, techs, CNAs, etc. They somehow know it must be ok because that is how hospital and medical centers have been staffed but they can’t articulate the BFOQ exception for patient privacy. They don’t appreciate if they defend hiring exclusively females for female patient privacy they have set up a legal complication if they don’t provide the same opportunity for males. And since they use Patient Rights words indicating that ALL patients are entitled to patient centered care where their values & privacy are respected they really have created a problem for their organization only focusing on females & “assuming” it doesn’t matter for males. One needs to point this out to them. FYI. -AB

At Thursday, July 27, 2017 5:32:00 PM, Anonymous Anonymous said...

AB. -- I believe Biker is asking whether a courteous complaint is preferred to some slternative. There is nothing courteous anout an ambush so asking about the best tone for speaking up seems like a good question. My guess is that causing a scene (nothing illegal of course) that gets noticed by other patients and staff at a facility can change a business model. I once witnessed a scene caused by a customer at an auto dealer service center that did exactly that. Your opinion would be especially valuable on this issue. REL


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