Patient modesty concerns pertaining to surgery

[creinkent]

Want to get feedback about how we all handle pt concerns about modesty and/or being naked as part of surgery. Concerns about who sees them and for how long? Why do they need to be naked? When is the gown removed, etc? How much do you tell them? How do you handle pt that is concerned about students practicing pelvic exams on them without concent? How to handle the situation when after the surgery they realize they had been "exposed"?

[tbrd450]

Yes, some male patients would prefer female caregivers for intimate care. And, there are probably some female paitents who would prefer male caregivers for intimate care. It is about choice. Now, generally, female patients have the choice. Males do not have a choice. Even if male patients did have a choice, they would have to exercise their right to use it at risk -- risk of being viewed as "silly," "frivolous," and "unmanly."

[tbrd450]

cul2 "having said all that, i do accept that a certain percentage of men

are homophobic and, though embarrassed with a female nurse, would not

let a male touch them. but that's not all or even most men."

i was just going to say my husband would rather a female than male place his foley. he is not homophobic in the least, just older and if someone is "going to play with his junk, he would rather it be a woman" he's a pig, what can i say???

try something. ask your husband to imagine a hypothetical scenario. ask him to imagine that he was going to have to have a foley placed in the hospital, and he will choose to have either a straight male do it, or a straight female. and, also, ask him to imagine that afterward, both will return to a friend they work with later in the day and make a derogatory comment, in confidence, about his "junk." they won't do or say anything unprofessional in his presence, but later in the day they will each comment to a friend (maybe at lunch, or in the locker room) something to the effect of "hey, the guy in 245 really has a funny looking small membere! ha ha hee hee"..etc.

now ask him to imagine that scenario and ask him again which would he prefer to insert the foley -- the young, attractive female nurse, or the middle aged straight male nurse. and, consider the fact that you -- his female wife -- is asking the question may influence his answer. does he feel secure enough in his own manhood to openly admit that he may prefer a male nurse? i wonder if a confidential survey would produce vastly different results on these types of questions than a simply question answer format.

do you think his answer would change? ask him.

[advo-kate2]

Yes...I agree tbrd450 and here is my point:

If a male prefers not to be intimately touched by a female then we hear "discrimination".

If a male prefers to be intimately touched by a woman, we may call him a pig, but we still call it a preference.

Not the same with female patients.

Either they are both discrimination, and women should not be allowed a choice, or neither are discrimination and we have to work harder on men's behalf. We can't have it both ways.

[jeanart]

I have been reading this blog, along with the blog moderated by Dr. Bernstein, for quite some time. I am very concerned about modesty in the medical setting and must say that the issue is probably the utmost reason I dislike going to doctors (I am female). I have also been thinking of ways to address this "problem", especially as it concerns surgery or sedated procedures, such as colonoscopy. I had to have a colonoscopy recently and I must say that no information was offered as to who would assist in the procudure, what they would be doing, what sedation I would be given and what to expect from it, etc. Being a first timer to a sedated procedure I had no idea what questions to ask. So, the morning of the procedure I am confronted with a male anesthesiologist, his male assistant, a female nurse and female tech. I had NO idea there would be that many people in the room besides my female doctor. No one at the surgery center offered me much information, either, even though I was in the prep area for over an hour. As a result I was left with an extremely creepy, upset feeling after the procedure wondering what happened and who saw what, who was doing what, etc.

One way I see of eliminating this from happening would be for doctors or surgery centers/hospitals to offer patients a DETAILED printout or video of the procedure. Those patients who do not want to know details wouldn't have to accept the offer but those who would like to know more can read/watch something before scheduling the procedure and also could call and ask further questions. It would be more time effecient, also, as staff wouldn't have to be tied up answering a lot of questions. I understand that there are a lot of people that probably don't want to know what happens to them under sedation and I think the medical profession just assumes that they are "saving" the patient from embarrassment by not giving them details. But for a lot of us, we do like to know what happens to our bodies once we are "under". It is creepy to have that feeling of amnesia; just not knowing what happened to you for a block of time.

I also happen to agree that there are probably more people out there that are bothered by the modesty issue, BOTH men and women, but they just don't feel like they are "allowed" to speak up about it. Just my 2 cents worth. JeanArt

[tbrd450]

Yes...I agree tbrd450 and here is my point:

If a male prefers not to be intimately touched by a female then we hear "discrimination".

If a male prefers to be intimately touched by a woman, we may call him a pig, but we still call it a preference.

Not the same with female patients.

Either they are both discrimination, and women should not be allowed a choice, or neither are discrimination and we have to work harder on men's behalf. We can't have it both ways.

Yes... I see your point a little better now. I never really analyzed it from the perspective of a female patient that may actually prefer to have a male caregiver. Doh!.. my male brain doing its thing.

You are absolutely right about the double standard. A man is a pig/pervert for preferring opposite gender care, and he is a silly and unmanly for preferring same gender care. But a woman who prefers same gender care is just modest and exercising her female entitlement to special consideration on intimate care. What, then is a female patient that prefers opposite gender care? Do such women exist?

[tbrd450]

I think I understand this now.

Okay, if a male patient states his preference to receive care from a female caregiver, then he is considered a potential pig/pervert. Nonetheless, we recognize this as a choice -- his preference.

If a male patient states his preference to receive care from a male caregiver, then he is considered silly, unmanly and "all worked up over nothing." Nonetheless, we recognize this as a choice -- his preference.

If a male patient says nothing -- most say nothing -- then nothing is necessarily assumed about him. And, we can safey provide care by whomever is available (mostly female caregivers) while stating that he never requested anything, or never stated a preference.

It sounds like the only good male patient is one that remains silent!

[advo-kate2]

Sori tbrd450...my first post was more sarcastic than serious. That point was....female caregivers should be offended when the male patient takes a supposedly 'innocent' proceedure and makes his preference a sexual one. Allowing/supporting that preference supports the sexual nature, contrary to everything we are told, but probably the most honest.

To the next: If choice is wrong for one gender it should be wrong for the other.

A woman is "understood" for either gendered caregiver choice. A male is "understood" only if he makes the choice that the medical profession predominates. Which amounts to no choice. Pretty handy and we go about our job.

Would you rather to be called prejudiced or be called a pervert? Sadly, only men have to face this decision.

[advo-kate2]

So moving back to solutions: If men realized that they should and do have a right to choose the sex of the person they expose themselves to, they would do what women did....cancel appointments when the choices are not balanced. Only when the medical arena stands to lose money will options change.

That of course is not the only solution, (*disclaimer*)but money is the quickest way to influence a business system.

So you guys...try saying no once in awhile. Women did....and we now have clinics all to ourselves.

[SandraCVRN]

I know plenty of women that will NOT have a female ob/gyn. I have a woman right now but having been in the Navy for 6 years I never saw the same one twice, sometimes male, sometimes female. It's a doctor looking at my junk, I'm sure they get tired of looking at it the same way we get tired of looking at genitals in the OR.

How about cases where the blanket never goes below the hip, the gown never above nipple line and no foley needed, then what? Do we still have to rearrange schedules to do surgery on a wrist or an ankle??

Again I'm not saying pts shouldn't have choices......

[Cul2]

This is an important discussion. A few responses:

-- How much "sexuality" is or could be involved in intimate care? IMO, we need to

look at this from two perspectives -- the patient's and the caregiver's. First of all,

most people are rational and realize sexuality is certainly not the intent of either

party. Having said that, it can be very different for the patient that it is for the

caregiver. The caregiver becomes routinized, has done the procedure many times

before and after awhile doesn't even see the genitals as sexual but as to work

on. But the patient experiences touch, especially with the member and scrotum. These

are aroused sexual parts and, although the patient knows rationally that there is

not sexual intent involved in the procedure, he may feel sexual feelings and arousal.

It's also a matter of focus. What is the caregiver focused on? The caregiver is

focused on the body part and the technical aspect of the procedure and getting it

right, not hurting the patient, etc. The patient is also focused on his or her body

part, but not in a technical, "objectified" way. The patient's response is personal,

visceral. Remember, the caregiver is probably wearing gloves, which prevent direct

contact with the patient's skin, for the caregiver. But the patient feels direct contact.

Side note -- what's one purpose as to why gloves started being worn? It's not just

for disease protection, as important as that is. Gloves started being worn as a

strategy to distance the caregiver from the patient in these especially intimate

-- "If a male patient says nothing -- most say nothing -- then nothing is necessarily assumed about him." I strongly disagree. I think men are often stereotyped by a

female dominated profession, nursing -- just as women are stereotyped who deal

with male dominated professions. If a male is silent, I think it's assumed that he's just

fine with a female nurse, or, if he's not fine with it -- it's assumed that it's fine to go

ahead because he's too embarrassed to speak up anyway so he won't object. By the

way, I think the same applies to females to don't speak up. Too many assumptions

about this modesty issue. That's why we need to learn more about patient preferences,

get the topic out in the open so caregivers and patients can talk about it openly, and

make a patient preference option part of any patient's file.

contacts.

-- I really don't think most nurses think the men who prefer female nurses are "pigs."

Of course, it depends upon the man's demeanor, body language, tone, etc. Assuming

that aren't actually sexually harassing -- then it's just a preference probably based more

on a homophobic reaction than anything else. But, remember this -- some men, to cover

up their humiliation and embarrassment, will revert to what either is or appears to be

sexual harassment or at least sexual comments. It's partly a power issue. The female

nurse has power over him in an especially embarrassing context. To get power himself,

he can try to upset the ritual which will embarrass the nurse or cna. I'm not justifying

this -- I'm just saying this happens more frequently that we think.

-- Advo-kate2 talks about men canceling appoints. That's a technique that will work.

But I also think that men should call ahead to clinics, esp. urology clinics, and ask if

they have any, any at all, male med assts or cna's. Most don't. So -- a man goes in

for an especially urological exam or clinic procedure, selects a male doctor for modesty

reasons, and ends up with a female med asst in the room, too. Call and ask, and if

they don't have a male asst tell them that's the reason you're not using them. Let

them know. Urology now as more women in the field -- in fact urology clinics are

bending over backwards to get at least one female urologist on staff. Perhaps the

should start bending backwards to get at least one or to male med assts on staff.

-- But getting back to the topic at hand -- modesty during surgery. Medicine

needs to remove the mystery from surgery, the hidden aspects of procedures. Now,

don't tell me you can find all kinds of info on the web. You can. But it's all technical.

You won't find anything about draping, positioning, details of prepping, etc. I'd

like to see a hospital or clinic website that even included the word "modesty" or

"patient choice of gender of caregiver." This is unspoken, the price the healthcare

system pays of this secrecy, is some of what you read on threads like this and

other threads about patient modesty. You pay the price of lack of trust by some

patients.

[jeanart]

I agree that the hidden aspects of surgeries/procedures need to be made known. If it is an elective surgery and the procedures are not something the patient can live with then at least they have the choice of whether or not to proceed. After all, whether insurance pays for it, the patient pays a co-pay or the patient pays for the entire surgery, we are basically paying customers.

I do agree, also, that men need to speak up, cancel appointments if necessary, etc. I recently asked my husband how he would feel going in for an intimate exam and he did admit that he would feel more comfortable with a male doctor only present and without a female nurse or any other "assistants". I really believe that if people were pinned down, most of them would opt for a greater respect of their modesty and the ultimate goal of insuring that would be for same gender care. And if that's not possible, the medical staff should work as much as possible with the patient (and ASK them how they feel about things) to reduce any exposure other than what is absolutely necessary.

[CaDad]

Hiyas all:

I have commented on several other blogs regarding this forum and I have to add a few comments on this one. First and foremost I am a rep for a hospital supply company and I see tons everyday! Not only in the Hospital but in Private practice also. I can assure you that a double standard exists for males and females. I constantly strive to understand what I am reading and what I see everyday and it is troubling. I think there are several reasons we are having this modesty discussion:

First of all, I am thankful there are those out there that are taing this issue seriously, it is appreciated.

I have observed a few things that I think contribute to the laxity of adressing the modesty issue.

1- The nurse ( M/F) has been around so long thhey have lost any connection to the PT. Their:eek:opinion is we help you the best we can, take it or leave it! I cannot be bothered by the childish and immaturity of the PT, I'm busy saving lives!

2- I have seen it all comment , really? It's all so much skin right? You don't even notice anymore?

The Female Nurses/Staff have no real Idea on what we males really think about our modesty. And most don't care anyways. The general conscientious is males are not modest and furthermore, modesty for males is a childish and immature concept that neesds to be dealt with immediately. I have actually heard mothers make this statement, and I have many male friends who will not have anything to do with their mothers either because of a total disregard of the male childrens modesty. But I digress,. This issue extends outside of the medical profession I am sad to say.

Your right on several counts though ,about males not wanting to get medical help. How many men in your lives willingly go to the Doctor? I recall reading about the little boy who did not want his underwear removed and he was forced to do so ( they actually fought with him!)... I wonder if he will willingly avail himself of medical care in the future-wanna bet on the outcome? I am the same way I am sad to say, to many memories of utter embarrassment to contend with and I am sorry, I just am not going to go to see a Doctor or go to the Hospital if I can help it. To the female staff, just how would you feel if you knew your Dad, Husband, Brother in Law, Uncle, or son died because of a simple thing called modesty. Now I know I am beating a dead horse, it has been discussed to death, but guess what-it is very relevant as a few of you already have postulated. I don't know a single male who will willingly go to the Hospital or Doctor because of this issue. It is VERY IMPORTANT to us ladies!

3-I do feel there should be a pt advocate, someone separated from the medical profession and staff, someone that can intercede on behalf of the Pt when the pt needs it. What is so wrong with that, obviously the people working in the environment cannot police themselves in many cases. I have read with concernation the concerns voiced by nurses about PT care, but everyone is scared to death to address the issue, intercede, or take a stand.

I think there are far to many instances of " because that is the way it is always done"

a-Like shaving a person when it really is not necessary

b-Haveing nonessential personnel in the room while an invasive proceedure is being done like cathing, or peri care( This is a huge one!)

c-Removing all underclothing for minor operations , like the eye surgery discussed earlier.

d-The general disregard for the pt modesty when it was absolutely not warrented. I recall the woman talking about being nude in stirrups trying to give birth, tied down no less. no covering, nothing.

e-Unnecessary cathing ( Id rather be caught dead than be cathed personally!

I am in the Er and around the Or alot and I see what goes on and it is not a pleasant scenerio.

I will give on one point, there are many times when the PT must have as little clothing on as possible to accomodate a lot of operations, but not all of them. And, there are far to may non-essential people in the room for my comfort, including ER, the most aggregious of all areas!

My vote is for the PT advocate and of course, more male nurses!!!