Male modesty double standard

psu_213, BSN, RN · Sep 29, 2014

As for PTSD, do you think that Justina Pelletier is not suffering PTSD from her treatment in a hospital? PTSD resulting from ill treatment by healthcare providers is very real. Here are some links:
medical trauma
Post-Traumatic Stress Disorder After Genital Medical Procedures
PTSD in children

Justina Pelletier may have PTSD, however, is there anything to suggest that her basic dignity/privacy was violated by expose of her genitals or by performing of some sort of an exam of the genitals while there was an "unnecessary" stranger in the room?

It is pretty obvious that a woman who experience some type of sexual trauma can be further damaged emotionally by a sexual exam, and I imagine it can contribute to a woman's PTSD about the trauma; however, women who have experience sexual trauma make up a very small percentage of individuals who have genital exams/procedures, and this has nothing to do with how male modesty is protected in the ED.

I have no arguments re: the link of PTSD in children. However, this is talking about general PTSD in kids. It mentions PTSD can be the result of "invasive medical procedures," which certainly does include genital exams/procedures. With children, staff is going to be extra careful to protect the dignity of patients. However, especially in the setting of a major trauma, these exams have to take place. While they may add to a child's PTSD, they are likely not the sole cause.

caregiver111 · Sep 29, 2014

Since police are non-caregivers their presence in the trauma room is un-necessary and constitutes a breach of the confidentiality, privacy and modesty of all patients male and female. Many times a patient would be undergoing treatment in a private room that involved the police. Do the police have the right to just open the door and walk in and stand and watch. The answer is NO. The trauma room is no different. Very few patients were prisoners. In one incident a male MVA patient was brought in. One male and one female police officer came in and watched his entire trauma resucitation. There was another male patient who had fallen down his basement steps lying naked on the next bed uncovered with a catheter in place. The 2 police officers saw him as well. What about his modesty and dignity.

Many hospitals today have the police wait outside and do not allow them in the trauma room unless they have a valid reason for being there. At the Capital Health Regional Medical Center in Trenton, New Jersey they rarely allow police in the trauma room. That policy should be mandatory for every hospital in this country. Sometimes a female patient would being lying there naked and one or two male policemen who where involved with her case would walk in and they would see her before the staff had a chance to close the curtains. Even clerical staff or security guards were not allowed to stand and watch unless they had a reason for being in there. The clerical staff or sometimes a security guard would come back to get the patients name, emergency contact information and personal effects and then leave.

psu_213, BSN, RN · Sep 29, 2014

Since police are non-caregivers their presence in the trauma room is un-necessary and constitutes a breach of the confidentiality, privacy and modesty of all patients male and female.

Unfortunately you keep offering sweeping generalizations that are not always true. Sometimes they have to be there. I think pretty much everyone would argue that the man who fell should not be left there uncovered while something is happening right next door. No one is in supporting a group of police officers (or anyone for that matter) standing in a room gawking while a naked trauma patient is being resuscitated. They shouldn't be in the room without a good reason, but, sorry to say, I don't think you are the one to determine if the police officers do or do not have good reason to be there.

macawake, MSN · Sep 29, 2014

caregiver111 good for you for showing concern for a patient and humanity (that seems to be lacking in healthcare).
caregiver111 was the only one who showed any concern for the emotional and mental well being of the patient.

Are you a healthcare professional? I don’t agree with your conclusions. It’s been my experience that a majority of healthcare professionals do care about the welfare of their patients and try to protect patient’s dignity whenever possible. However being exposed to a lot of human suffering on a regular basis, like you are in a high stress environment like an ER, can sometimes desensitize you. That’s a reaction, it’s not the same as not caring.

I always try to keep in mind how I myself would like to be treated if the roles were reversed, and how I would want my loved ones to be treated and try to act accordingly. I must admit that sometimes during traumas, my focus on the task at hand has been so intense that the “softer”, more intangible aspects of patient care might have slipped my mind momentarily. That’s not because I don’t care, it’s because the job I’m doing at times requires all of my concentration.

I try to protect/preserve my patient’s dignity (as well as their integrity and autonomy) whenever I can. However, in the scenario with a violent offender my safety and the safety of my coworkers take precedence. I’m sorry if that offends you but I can’t concentrate on treating my patient if I’ll also have to worry that he’ll attempt a Count Dracula move on me. Yes, I actually had one fool try to bite me in the neck, and it wasn’t exactly intended as an amorous nibble..

if this person is a victim, then they are being victimized again by having gawkers in the room.

Law enforcement officers seldom hang around voluntarily in order to “gawk”. It’s been my experience that an ER is one of their least favorite places to be. People in general don’t love being in hospitals unless necessary, it’s not the most uplifting experience or environment. Also, most law enforcement officers are very respectful of victims.

let me pose this to you; police accompany a trauma patient in to the ED. for sake of argument we will say that she is female and they are male. ed staff is a mix of male and female. there are clerks present as well. they stay in the whole time and no one questions why they are there. it is later found that she was the victim of an accident, not a suspect, not in custody, no evidence to collect from her. you are present throughout this whole ordeal. she also expresses that she does not want to be exposed and refuses treatment. as a result of the experience, she suffers PTSD.

I’m not sure I understand your hypothetical scenario, it seems far-fetched to me. Is the patient subsequently diagnosed with PTSD because she refused treatment? That seems to be what you’re saying but it doesn’t make sense to me. If a patient refuses treatment, healthcare professionals will attempt to identify the reasons behind the refusal. If there are obstacles that hinder treatment and are within the healthcare staff’s power to remove, they will do so as long as it’s the patient’s wish.

the PTSD is a result of the accident and the ed. ptsd is funny, there is no set formula because we are all different. generally there is a "cumulative threshold," a "shock threshold," and a combination of both. for example; the accident caused 20 points of mental trauma. the paramedics 10 pts, in the ed being needlessly exposed, 10pts, clerks there 2pts, etc... when we get to 100 pts ptsd interferes with a normal life. (i know that ptsd is not on or off, there are degrees. let's assume i am talking about the point that it interferes with a normal life)
OR if a person experiences an event with a value 75 pts, ptsd interferes with a normal life. a cumulative of 60 pts and a shock value of 50 pts, and ptsd interferes with a normal Life.

This points “diagnostic tool” seems a bit convoluted to me, I think I prefer the DSM5. I honestly don’t understand the various points you’re assigning. The only conclusion I’ve drawn, is that we should probably staff ambulances with clerks instead of paramedics, since paramedics apparently are inherently five times as traumatizing as clerks

Welcome back OP. Police presence in a trauma room is sometimes necessary. I wish it wasn’t so, but it is reality. Personally, I’ve never had police present with any patient when there wasn’t a clearly defined need for it, as well as legal justification.

Why was the man who’d fallen down the basement steps just lying naked on the bed, it sounds highly unusual. Normally patients are covered, modesty is just part of the reason, maintaining body temperature is even more important. When I work I uncover the parts I need to see and examine at the time, otherwise the patient is covered.

The things that you’ve described in your posts, isn’t something I recognize from my own experiences. I’m sorry that you perceive that healthcare professionals have acted less than professionally.

SionainnRN · Sep 29, 2014

Bottom line in cases of resuscitation: alive and naked, or dead but covered? If we are trying to save your life, most of the time you are going to be mostly naked. We've got leads, ECG's, pacer pads, chest tubes, foleys, etc going into you. Plus constantly getting/keeping lines in you. We try as hard as possible to keep the pt, no matter the gender, covered and the curtains closed, but our priority is keeping you alive.

No one is standing around gawking at pts, whether they are nurses, techs, docs or LEOs. We are all there to do a job, and sadly the life in the ER usually involves the pt having less clothes on than they would prefer. And that's all pts, no one like gowns that show off your butt. But to think that cops are standing around checking out male pts junk for fun, only makes it seem like you are prejudiced against cops and haven't really spent a lot of time in ER rooms.

caregiver111 · Sep 29, 2014

I agree if the police have a good reason to come back they should be allowed to. But at the hospital were I worked like many hospitals in this country the police did not have to have any reason to be in the room. They could automatically come back and watch. The trauma room staff did not like that either. When I mentioned that to some of them the answer was " they really don't belong back here ".

psu_213, BSN, RN · Sep 29, 2014

The only conclusion I’ve drawn, is that we should probably staff ambulances with clerks instead of paramedics, since paramedics apparently are inherently five times as traumatizing as clerks

:roflmao:

Love it! Especially since, in the end, keeping patients fully clothed is way more important than saving their lives.

psu_213, BSN, RN · Sep 29, 2014

like many hospitals in this country the police did not have to have any reason to be in the room

Maybe in the some of the traumas you witnessed, police did not need to be there. If so, that is wrong of them. However, how do you know what it going on in "many hospitals in this country?" No one is saying that the police should be there just "hanging out," but I think it is pretty unfair to accuse the police in most of the country in engaging in such a behavior.

banterings · Sep 29, 2014

macawake,

i have worked with survivors of sexual assault. they have told me going to the ED feels like a sexual assault all over again when the urgency to "save their life" neglects their dignity.

as for the point scale, ptsd can result from a single event, multiple (cumulative) events, or a combination of both. it is almost impossible to point to a single event and say it was the MVA or it was the ED. i am simply saying, make the ED less traumatic. most people who work in the ED see the life saved, you don't see the person who avoids healthcare the rest of their life because they were held down and their clothes cut off. if they are a survivor of sexual assault, the effect is multiplied upon them.

A perfect case is that of Brian Persaud.

One thing that I have heard here is " sweeping generalizations that are not always true." You do that by assuming all prisoners are violent. I understand safety, but dignity has to come first. The problem with creating exceptions to a rule is it becomes too easy to invoke them to the point the rule is useless. ED staff doesn't feel safe, just call in the police/security. It is a slippery slope. Where does it stop?

We are in a urban area with high crime rate, call in security with everyone. What about the mentally ill?

Brookline psychiatric hospital is the poster child for the safety excuse, link here:

A Brookline psychiatric hospital is again accepting patients, but on a limited basis, after the state gave preliminary approval to the hospital’s plan for correcting serious safety and human rights violations found by inspectors, including the forcible strip-search of a patient.

As for the comment:

Nurses are professionals. The police officers are professionals. The nature of the jobs require that those professionals see some things that may be considered "sensitive" and things that may make non-professionals uncomfortable. So there is a female officer in the room while a male trauma pt is evaluated (including cath, rectal exam, etc….oh, to the OP, there are multiple reasons why a urine or rectal are done--not just to check for bleeding). That officer is not there to be a peeping Tom--she is a professional and she has a reason to be there. The same way a professional male nurse can straight cath a female and a professional female doctor can do a rectal exam on a male patient.

US District Judge Michael A. Ponsor wrote that even the nearby presence of a male guard during a search can be a “deeply humiliating experience.” Link here:

A death in restraints after ‘standard procedure’

I was also berated for saying that the police are over zealous, does anyone remember last week, Dashcam video shows a police officer shooting an unarmed man (for a seatbelt violation)? Link here:

Do not say that any of my examples are isolated, not the norm, or a one time event. Any time, even one time is one time too many.

However being exposed to a lot of human suffering on a regular basis, like you are in a high stress environment like an ER, can sometimes desensitize you. That’s a reaction, it’s not the same as not caring.

Either way, it is the patient who pays the price. Apparently you find it acceptable as long as you still care.

Let's all be honest here, abuses happen and dignity is commonly overlooked for convenience. You may not do it, but we have all seen it, and we all know it happens. This is learned not in the class room or in books, but in healthcare settings. I am not going to place links to these occurrences. If you want to argue the point and say this is not a common occurrence, then you are only deluding yourself.

When you say: "

I’m sorry that you perceive that healthcare professionals have acted less than professionally.

You are blaming the OP because they are not seeing things your way. How many times was it stated:

I must admit that sometimes during traumas, my focus on the task at hand has been so intense that the “softer”, more intangible aspects of patient care might have slipped my mind momentarily. That’s not because I don’t care, it’s because the job I’m doing at times requires all of my concentration.

Nobody is saying that you don't care (I give you credit for trying to be sensitive to your patients), but you admit it does. What I am saying is that it happens AND it should NOT. Nobody would say "it just happens" about surgical pads or instruments being left inside an OR patient. It does just happen, but it shouldn't.

Here are 2 very interesting reads from the United Nations Human Rights Council:

Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez

Thematic Report on Torture in Healthcare Settings

5 March 2013 – An independent United Nations human rights expert today unveiled a new report in which he calls for an international debate on abuses of patients under medical supervision ranging from compulsory detention of drug users in rehabilitation centres to refusal of treatment for HIV-positive patients.
“Medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement and specific intent, it is torture,” said Juan E. Méndez, the Special Rapporteur on torture.
The report analyses all forms of abuse labelled as ‘health-care treatment’ which try to be premised or justified by health-care policies, according to a news release.
“There are unique challenges to stopping ill-treatment in health-care settings due, among other things, to a perception that, while never justified, certain practices in health-care may be defended by the authorities on grounds of administrative efficiency, behaviour modification or medical necessity,” he noted.

The conceptualization of abuses in health-care settings as torture or ill-treatment is a relatively recent phenomenon. In the present section, the Special Rapporteur embraces this ongoing paradigm shift, which increasingly encompasses various forms of abuse in health- care settings within the discourse on torture. He demonstrates that, while the prohibition of torture may have originally applied primarily in the context of interrogation, punishment or intimidation of a detainee, the international community has begun to recognize that torture may also occur in other contexts.

Finally psu_213, if you are going to quote me, don't take half a thought: I did not say "PTSD id funny," i said "ptsd is funny, there is no set formula because we are all different." Not funny as in "causing amusement or laughter,"

BUT funny as in "curious; strange; peculiar; odd."

adjective, funnier, funniest. (source here:)
1. providing fun; causing amusement or laughter; amusing; comical:
a funny remark; a funny person.
2. attempting to amuse; facetious:
Did you really mean that or were you just being funny?
3. warranting suspicion; deceitful; underhanded:
We thought there was something funny about those extra charges.
4. Informal. insolent; impertinent:
Don't get funny with me, young man!
5. curious; strange; peculiar; odd:
Her speech has a funny twang.

Esme12, ASN, BSN, RN · Sep 29, 2014

what if it was your sister, mother, daughter, what would you say to the ED staff?

what if it was you, what would you want?

even if the ed performed life saving measures, even if the patient was male, do they not deserve dignity? remember 2 things:
"do unto others as you would have done unto you,"

AND

"karma is a *****!"

Well caregiver is a student. Many students are confused and unsure of the necessities of some protocols. Are you a nurse, doctor, paramedic, resident, intern in the ED?

police accompany a trauma patient in to the ED. for sake of argument we will say that she is female and they are male. ed staff is a mix of male and female. there are clerks present as well. they stay in the whole time and no one questions why they are there. it is later found that she was the victim of an accident, not a suspect, not in custody, no evidence to collect from her. you are present throughout this whole ordeal. she also expresses that she does not want to be exposed and refuses treatment. as a result of the experience, she suffers PTSD.

Well we don't "suddenly" find out later about presentation to the ED. It comes over the radio that the "patient was involved in a MVA. Patient was ...passenger...driver, front seat, back seat, ejected out of a vehicle"...what ever over the radio. They will state "patient is in police custody" which means they are in police custody

even prisoners are human beings possessing basic human rights such as dignity. where does everyone work, gitmo?

In 35 years....every patient I have cared for and have witnessed being cared for by others EVERY EFFORT has been made to protect their dignity...I resent the implication and generalization that we do not. Frankly there are so many people i the room we are constantly telling people to get out.

as for the police, does anyone bother to inquire why they are in the room? just because they say they need to be does not make it so

Of course we do. There are no gapers block in most emergency rooms a majority of the time....as we are all held to HIPAA.

generally there is a "cumulative threshold," a "shock threshold," and a combination of both. for example; the accident caused 20 points of mental trauma. the paramedics 10 pts, in the ed being needlessly exposed, 10pts, clerks there 2pts, etc... when we get to 100 pts ptsd interferes with a normal life. (i know that ptsd is not on or off, there are degrees. let's assume i am talking about the point that it interferes with a normal life)
OR if a person experiences an event with a value 75 pts, ptsd interferes with a normal life. a cumulative of 60 pts and a shock value of 50 pts, and ptsd interferes with a normal life.
saving her life is no excuse because mentally she is a mess.

what about the staff? Are we not valued as well? I have been in a room where a gang member returned and shot the patient. I couldn't hear properly for a week. I have been slapped, punched, kicked, bit, scratched, strangled, choked, and armed robbed for narcotics to name a few. I have to bear witness on the DEA and smugglers when they use body orifces for smuggling and are brought to the ED for the removal of those drugs. I have had patients shoot up/OD in the Bathroom from drugs in body orifices. I saw a man over six feet strapped to a stretcher high on angel dust rockl that stretcher to get up andlleave...butt naked with the stretecher on his back. There are reasons that we take the precautions we do.

We are there to care for everyone the very best we can. Are there bad doctors, police, and care givers? Yes. It it the norm? NO!

A perfect case is that of Brian Persaud

Brian Persaud was injured from a fall t work with a head injury. Many patients are combative with head injuries. It is impossible to know at the time if they are head injured and can't make a logical decision, too intoxicated to make a decision, or just being their normal self however undesirable that may be. The medical team need to make split decisions about patient care. A head laceration and head injury from a fall is highly suspect of a spinal cord injury and a rectal exam is a key feature of that exam. A jury trial found no fault of the medical team.

Do things need to "change" in some instances? Yes. I don't condone electro shock...tazing the mentally ill for behavior...it is barbaric. But those are the exceptions and not the norm.

macawake, MSN · Sep 30, 2014

i have worked with survivors of sexual assault. they have told me going to the ED feels like a sexual assault all over again when the urgency to "save their life" neglects their dignity.

You don’t know me from Adam, or Adele as the case might be :)

I too have come in contact with victims of sexual assault. I’m a second career nurse, previously law enforcement (10+ years). Apart from my nursing degrees, I have a Master’s degree in Criminology. I’ve met victims of sexual assault in both capacities as well as in my private life. You have no idea of how I treat a rape victim, but I can assuage your fears. It is with respect and compassion. This isn’t just my opinion of myself, it’s what I’ve been told by many of the rape victims that I’ve met.

most people who work in the ED see the life saved, you don't see the person who avoids healthcare the rest of their life because they were held down and their clothes cut off.

Most rape victims are fortunately not so physically hurt during the attack that they require immediate life-saving interventions in the immediate aftermath. I have never encountered the scenario where a rape victim is forcibly held down by healthcare professionals while they cut her or his (they exist too) clothes off. Rape victims in my hospital are treated by nurses who have special education/training, in order to offer the best care for this specific patient category. I can confidently say that forcibly holding someone down will never happen in a non-acute situation in my hospital.

But if this were to happen in a life-or-death situation, what is your solution? Let a person for example bleed out from a trauma rather than risk adding to a pre-existing trauma? I’m not in any way minimizing the devastating effect a sexual assault can have on an individual, but at least with emotional trauma we have ways to try to help that person recover and heal. Death, not so much. If they die because we fail to treat, the options for recovery are as I’m sure you agree rather moot. You seem to scoff at just “saving a life”. I’m actually quite happy when I’m part of a team who manages to do that.

One thing that I have heard here is " sweeping generalizations that are not always true." You do that by assuming all prisoners are violent.

I assume no such thing. Not all criminals are violent, but some of them sure are.

I understand safety, but dignity has to come first.

You are being awfully cavalier with my life. Even if you don’t value it at all, I do. I value my life higher than the dignity of another person. The reverse is of course also true, another person’s life is more important than my momentary loss of dignity. I’m not sure why you find the idea that healthcare professionals should risk their physical health and even their lives, an acceptable notion? Personally I think that we should do what’s necessary to maximize our chances of making it home alive at the end of the shift.

Nobody is saying that you don't care (I give you credit for trying to be sensitive to your patients), but you admit it does. What I am saying is that it happens AND it should NOT.

In a perfect world I would notice every little detail about my patient at any given moment, but the reality is that when my patient doesn’t have a patent airway and we’re busy intubating or their blood pressure is bottoming out I may not notice (or even care to be honest) that the blanket or towel that covers them has slipped out of position. I may even be so focused on my patient that I don’t even notice if there are other people in the room apart from the trauma team that I’m communicating and working with. To me it’s clear that you’ve never worked a trauma and I find it annoying that you try to tell people who have, how it should be done. Another thing, when trauma patients are doing their “best” to die on me, they themselves usually don’t give two hoots about modesty at that particular moment.

It doesn’t make a difference that you proclaim that this should NOT happen, as hard as I try I can’t do a dozen things at once or split my attention in too many directions. In an acute situation I will prioritize, the actions necessary to preserve life will be my primary focus.

Either way, it is the patient who pays the price. Apparently you find it acceptable as long as you still care.

I find this statement judgmental. You know, the fact that I could be a bit jaded and desensitized (please note that I didn't actually say that I was, in my last post) from all the misery I’ve witnessed doesn’t mean that my patients wouldn't receive good care. It would really primarily be my loss on a personal level.

What price do my patients pay? Have you met a single one of them? The vast majority actually express that they are very happy with the care they’ve received. You seem to think that just because I’m not capable of paying attention to every single detail for every single second (which would make me Supernurse Ta DA DA DA!), that my patients have somehow been or felt neglected or abused. That’s not the case.

You are blaming the OP because they are not seeing things your way. How many times was it stated:

Actually, that is an inaccurate interpretation. I’m not blaming OP, that would be silly of me. I used the word “perceived” because I wasn’t there to witness any of the incidents that OP has witnessed and have no way to judge if s/he in my opinion made a correct observation. I don’t know the particulate details surrounding the incidents either.

Everything I, you or OP observes is seen and processed through a lens affected by our previous experiences, our biases, our cognitive ability and many other factors. OP may have given an absolutely accurate account of what s/he has witnessed or maybe a flawed one. This is coming from a person who has interviewed thousands of witnesses, by the way. I have no earthly way of knowing what OP has actually witnessed, but I don’t automatically disbelieve him or her as you seem to assume.

It’s been a bit of a challenge to respond to your post since you’ve mixed my quotes with other posters as well as external links but I hope that I’ve addressed all salient points.

I admit that I’ve passed on reading your links about “torture and other cruel inhuman or degrading treatment or punishment” as it’s not part of our SOP at the hospital I’m employed. We (staff) do however regularly engage in discussions on ethical behavior and dilemmas, discussions that I find important, valuable and productive.

banterings · Sep 30, 2014

I was referring to a sexual assault surviver brought in 4 years after her assault from a MVA. All the progress she made was for not after a visit to the ED. She did not have life threatening injuries.

As for Brian Persaud:

Many patients are combative with head injuries.

I ask you what about those such as him who do not have a head injury? What do you say to those people? It is a darn if you do, darn if you don't situation. Do you just write him off as saying "I was doing my job?"

Answer this: a person is brought in suspected of having a head injury, but he does not. The attending follows ATLS protocols. The patient protests and refuses. What would a person who is not injured do? There is a term for that; fight or flight. In that situation patients without head injuries would be combative too.

So again I pose the question, what does the attending owe Brian Persaud morally and ethically? (He did not even get an apology.)