Male modesty double standard

[caregiver111]

While working in the trauma room in a large US city I witnessed this scenario of the double standard of modesty for male patients many times.The police would routinely walk in the trauma room and were allowed to stand around and watch as patients were put through the necessary but extremely embarrassing ordeal required in trauma resucitation. If the patient was a female the curtains would be immediately closed and kept closed until the entire trauma procedure was complete. If the patient was a male the curtains were always left open and the police officers which often included female officers were allowed to watch as the patient was stripped naked, under went a digital rectal exam and catheterized. Allowing the police especially female police officers to watch this is blatant patient abuse. I think people should consider suing the hospitals as this double standard of modesty for male patients is an extreme violation of medical ethics and standards of decency that are supposed to apply to all patients. Police should not be allowed to enter the trauma room in the first place without permission or be allowed to " hang out " there while patients are being treated.

[Esme12, ASN, BSN, RN]

Oh and Esme, I really appreciate your taking the time to correspond. I originally came to this site when I was considering a mid life occupation change. I ended up not doing it but am fascinated with what you all do. If I had it to do over and could do anything other than what I do, I think I would love being a nurse. I have made a boat load of money, but not really rewarding on a personal level like helping someone through the challenges you all do. My wife is a teacher, over the years has come to dislike the educational system but still loves those little folks so she stays. With that in mind I appreciate you taking time to enlighten and share with an outsider.

You are welcome...it isn't perfect but I love my patients. Never a dull moment.

[Esme12, ASN, BSN, RN]

Esme12 while we tend to think equal rights means we are the same (between genders). I don't believe that is the case. While we discussed if the genders were reversed there would likely be a lawsuit, honestly neither of us took it as sexual harassment. He took it more as teasing to an extreme. To us it was not a whole lot different that if he was bald and they were teasing him constantly about that. It got old, wished they would lay off but nothing that would warrant creating an issue the magnitude of filing a sexual harassment case. Lets be honest, females can get away with this kind of teasing, behavior, whatever you want to call it because they are less likely to be seen as harassing, and to be honest men are less likely to take it as harassment, heck some would love it. But then men have not endured the ugly side of this like many women where teasing does go into harassment and even physical abuse so it is easier to laugh it off.

Another one of those things that doesn't make it right, but more understandable. His point of bringing up was not that he was offended or intimidated, but more to show what being a guy in the "girls clubhouse" was like. I think it contributes to a lot of problems including in the medical arena where men are taught to suck it up and laugh it off, that's what a MAN does. As a result it contributes to our not seeking help when we should, and contributes to being unhappy with the way we are treated in the medical settings. We suck it up and don't say we are uncomfortable with things, then get ticked at the providers or ourselves because we were uncomfortable. I believe this contributes a great deal to the original post, I would ask the OP how many men complained or protested about it. While we argue we should get the same respect and consideration as the female patients in that example, how many complained or asked for it. Not saying the double standard is acceptable, because I still don't feel it was. Being treated differently because of gender is profiling period. But say nothing and you own part of it. Women are better at it because they had to do it to get even basic rights.

I asked because I used to teach a junior achievement class at the local high school a couple times a year on the value of education and employment options. One thing I noticed is I had only one male in the numerous years I did it hold up his hand when I asked who have considered nursing as a career. He wanted to be a flight nurse so as you indicated, a specialty area. I have heard ER attracts males in nursing as well. The obvious thing I took away was young exactly your point, these young men (8th & 9th grade) saw it as a woman's profession and were afraid they would be called gay if the said they wanted to be a nurse. I was just curious if you saw anything being done to change that perception. I have done some things on my own to plant the seed for young men that nursing isn't a female or male career, it is a good career if helping people is your passion. I didn't know if the profession itself even had this on the radar as something that should be looked at.

I tell you what though if one of the nurses in the units I was managing said those things and I heard her...she has some serious critique coming her way...in my office.

[macawake, MSN]

macawake, I do NOT have a problem. Please STOP trying to diagnose me and recommend a course of treatment!

Just as you have been trying to label me mentally ill because I am not thinking the way that you expect me to or that you have been trained to

None of my posts have been an attempt to diagnose you or suggest a treatment. As a general rule whatever theories on various medical diagnoses, if any, I have about any specific individual posting here or elsewhere, I keep to myself.

[Halfpt]

When we're busy, the patient's modesty, especially for men, is low on the list of priority. One reason for the double standard is that female nurses identify with the woman, and pay more attention. There is the old saying that female nurses are professionals and therefore it is allowed for them to see male genitals and it doesn't bother the woman. I wonder sometimes when no one else makes an effort to provide a towel for the man's groin whether the other women are trying to prove that it's true.

Which explains "we're all professionals here," "you don't have anything I haven't seen before," or "you've nothing to be embarrassed about, I've done this countless times." While undoubtedly true, because she's perfectly comfortable with my nudity, that's supposed to somehow lessen my embarrassment. I can't imagine a male nurse responding to a female patient in a similar fashion for very long and not suffering professional consequences.

[banterings]

references as requested:

Neuhs 1994

Lamb 1973

Lamb 1997

Hanrahan 1997

Thomas 1994

[T-Bird78]

Would chain of custody rules apply? A cop must witness and if any evidence can be collected then they witness it and collect/label/document it, right? I was working in an ER when a 5150 was brought in. Security had to sit with that pt the entire time. I pulled the curtain closed to check vitals and it was immediately opened because the pt can not out of sight at all.

[banterings]

betsyb56,

Your facility demonstrates the new approach. The most recent edition of ATLS recognizes that the ED/trauma experience can be mentally/emotionally traumatic for the patient and have effects lasting long after the body has healed.

I applaud your courage to acknowledge the double standard (I am assuming ) as to what you have personally experienced.

Thinking about the issue, I had some insight. Normally people who do not have initials after their name (and some who do) would overlook such occurrences in the ED/trauma when the preservation of life is the goal. The problem becomes that of (dare I say) PR (public relations not per rectum). When the issue tends to be systemic, occurring in non-emergent situations, then all occurrences are called in to question.

Understandably, if you work in ED/trauma, you have no control over what occurs at outpatient facilities, primary care facilities, etc. Part of nursing that is the "profession" includes the "advancement of the profession." What occurs at outpatient, primary care, and other facilities affects your facility, profession, and the public perception as a whole.

I believe that the majority of providers are caring, compassionate and professional, but a "few bad apples DO spoil the bunch." Let me give you an example unrelated to healthcare; RADICAL Islam. The actions of a few have tainted the majority who are decent, good, respectable, God-fearing people.

To say that you are acting within professional, legal, and accepted standards and protocols is not good enough either. What was acceptable 25 years ago would NOT be acceptable today. As Esme12 pointed out, women had few choices in healthcare. Today, chaperones are SOP. Advancement of the profession also includes questioning what we think that we know today and asking if we can do better.

I guarantee that healthcare 25 years from now will look nothing like it does today. Just as we look back today and say what we thought we knew 25, 50, 100 years ago was so blatantly wrong, someone in the future is going to look back and say the same thing about the present.

Yes I know the reasons deal with our current levels of technology and learning, but we need to keep the perspective that it is "what we THINK we know" and NOT "what we know." I am not saying to scrap what we have because it will change. We are using the best knowledge that we have. We have to look at the possibilities with an open mind.

There seems to be a consensus that more can be done; such as better staffing levels and more male nurses. I read a very good article titled: "How hospitals discourage doctors: A step by step guide." There are questions surrounding whether the "document" referenced in the article is real or not, but the concepts in the "document" are very "real" strategies that are implemented by hospital administration these days.

Every job I had since I was 12 (I pumped gas at a friend's gas station), the people that I worked next to were the "salt of the Earth." The further away people were from actual work, the less they knew and the more their policies screwed things up.

I forget who said it, but earlier in this thread someone said that despite whatever policies administrators set, it is the nurses on the floor that will do whatever needs to be done to protect the patients. I agree. It is the policies from above that create many of the problems.

As to the issue of gender choice, I recommend reading on how the courts have applied Title VII of the Civil Rights Act to healthcare. Again I know that ED/trauma are an exception, but unfortunately (and I am sure that any psych nurses here can back me up on this), human nature creates generalizations and stereotypes.

[Esme12, ASN, BSN, RN]

references as requested:

Neuhs 1994

Lamb 1973

Lamb 1997

Hanrahan 1997

Thomas 1994

These authors wrote many articles I have found none that link the elimination of white uniforms was because of sexual harassment.

[Esme12, ASN, BSN, RN]

Would chain of custody rules apply? A cop must witness and if any evidence can be collected then they witness it and collect/label/document it, right? I was working in an ER when a 5150 was brought in. Security had to sit with that pt the entire time. I pulled the curtain closed to check vitals and it was immediately opened because the pt can not out of sight at all.

Yes...that was talked about around page 4

[banterings]

Esme12,

The original paper is in print. I can't find the original publication. I found those references in one of my personal research journals.

I probably focussed too much on this particular aspect, although it lies at the root of the change. Everything is so fluid and there were many factors affecting the change. Normally I would say the root cause was the nursing shortage that started in the 1990's. The reason that I make this disclaimer is because the root cause would be the cause of the nursing shortage.

Some of the results (solutions, byproducts maybe) of the shortage were encouraging (allowing?) males to become nurses. There was also an effort to make nursing more professional. Those were factors in the uniform change (the overt gender bias and perception of the uniform at the time). The harassment part was in there in response to public perception and the prevalence of sexual harassment lawsuits. There was also a survey from the United Kingdom (at that time) that found nurses the most fantasized professional by men, flight attendants were #2.

The paper also had some other interesting (anthropological) information about the uniform. One such comparing the cap to the physician's white coat as the outward symbol, BUT pointing out that nurses enjoyed a much higher status outside the medical facility with the addition of the cape (that was part of the uniform many moons ago). I refer to the longer wool capes of the US that were more like coats than the short capes of the United Kingdom.

Of course there have been some negative results that may lead to a negative perception of the public and patients by providers: What is your position????

A person in green scrubs, surgeon, physician, PA, RN, LPN, CNA, tech, quality control, janitor, med equipment tech/rep, escapee from a 730 eval? Many people use a generic address and I have seen many providers become enraged at the address or the request. I have stepped in and had to explain that this person does not realize that you are a (insert position here).

No offense to gender, but female physicians are the worst if not addressed as "doctor." I don't mean calling her nurse, I mean addressing her as "miss" or "ma'am." I have even heard a person accused of staring at breasts when he was simply trying to read her position to address her. (Her breasts did not invite stares.)

[ADeks]

My hospital is not a Level 1 trauma ER. We do however get trauma codes and police are there to help identify the patient and help find a contact person. Also if a trauma alert goes south as in the patient dies. Then the patient is basically a crime scene. So the police need to remain there to maintain chain of custody as others have pointed out.

Maybe with what you saw the staff could have done better? I couldn't tell you, but I wasn't there.

[banterings]

Taking the assumptions that patients are treated professionally and according to protocols, it may not be enough. The following are some links to articles on the topic of iatrogenic medical trauma (also referred to as Medically Induced Trauma).

Iatrogenic medical trauma is trauma caused by the medical encounter. Iatrogenic medical trauma is when people suffer emotionally and psychologically as a result of the medical interventions they have received. The physiological impact of such experiences might originate with the medical event itself. We might feel the emotional consequences of medical events immediately after they happen, or years later. Sometimes, medical interventions that we underwent in childhood and even infancy can link up with difficulties we notice in our adult life.

Note: Historically "medical trauma" has referred to "side effects" of medical procedures (infection from a surgical procedure).

This is relatively new "pathology" (if you will...) Most of the new views on psychological/emotional iatrogenic medical trauma applies to children and is a result of the 2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents.

What is pediatric traumatic stress?

Pediatric traumatic stress is a set of psychological and physiological responses children and their families have to:

- Pain

- Injury

- Serious illness

- Medical procedures

- Invasive or frightening treatment experiences in medical settings

These responses may include symptoms of arousal, re-experiencing and avoidance. Symptoms can vary in intensity and are often related to the patient's or family member's subjective experience.

Source: The Children's Hospital of Philadelphia

Notice the last two items: "Medical procedures," and "Invasive or frightening treatment experiences in medical settings." It says nothing about abuse, not following protocols, etc. This statement states that psychological/emotional iatrogenic medical trauma can result from performing procedures according to protocols.

Here is a reference from the National Institutes of Health publication: Assessment and management of pediatric iatrogenic medical trauma.

In a medical setting we have to realize that "everything seems designed to make you helpless." (Scaer, 2012)

There is a more recent understanding and acceptance of psychological/emotional iatrogenic medical trauma in adults from encounters of psychological healthcare. Some have used the term psychiatrogenicosis to describe this. Psychiatrogenicosis meaning: "mental" + "healing" + "generating" + "sickness."

Even more recent is the realization that adult medical encounters can be the cause of iatrogenic medical trauma.

I have made the scientific citations. Simply ask yourself this simple question in respect to these clinical encounters: Is there anything that I could have done to make the patient's experience less traumatic?

Then ask yourself how the patient would answer that question for you.