Patient modesty concerns pertaining to surgery

tbrd450 · Apr 20, 2010

My third and fourth cent: Just like in any profession I imagine in the medical community there are good, concientious professionals, mediocure ones, and bad ones. However, the medical field has to maintain a particularly high standard. Their mistakes or inconsiderations hold the potential to be far more damaging than the accountant's. They deal with with human suffering, pain, embarrassment and life and death situations. There is absolutely no legitimate excuse for not ensuring that a patient's privates are not covered at all times, unless medically necessary. It is really that simple, isn't it? The unnecessary doctor in the operating room or ER room or whereever, just to talk about a TV show, is just stupid, idiotic and unprofessional. There is nothing, however, about that made it necessarily "abusive." However, if he popped in under the pretext of talking about a show, and in fact was looking to check out some breasts to feed some perverted desire, then it is not only abusive but probably criminal on some level. But, to go there we need to enlist the thought police. Aint going to happen. I think the problem is that patients are never quite sure if something is medically necessary and, consequently, never really know if their modesty is being fully respected. Often we are left to assume the best intentions or, the worst. We don't know. Does my genitals need to be exposed for you to listen to my stomach? We turn our own, our daughter's, our son's, our husband's, our wive's bodies and very lives over to strange people we never met when we enter the hospital or emergency room. I would love to be able to say, upon entering, who in this room graduated from the most prestigious medical school? ... I want you working on me.

Granted, Yes, of course, our main concern is living and getting better. But, believe it or not, even very sick people are concerned about their modesty -- the human mind isthe most powerful force ever. A mind at peace is one of the most powerful healing agents available. The psychologicl impact of our experiences stay with us, effect us and help to shape our outlook.

As exists in every walk of life, I'm sure some small percentage of nurses and doctors do get a thrill out of humiliating a patient unnecessiarily -- just as there some bad cops and correctional officers that drop an extra knee on a compliant arresstee just for the fun of it. With the medical community, we need to rely on the vast majority of the good ones out there to speak up on our behalf -- to tell the nurse to throw a blanket over somebody, to tell the doctor the comment or joke he just made about the patient's body was not funny and totally unprofessional regardless of whether or not he can hear you, to insist on advocating for the patient. I don't care if the excuses coming back are "just letting of a little steam," .. "I've seen a thousand lady partss and memberes," etc. Just remind the bad apples out there that it is not about them. They should be embarrased for how they fail to care for the patient. Embarrass them when they act stupid. You guys and gals sort of have to police yourselves on our behalf. There should be one consistent standard that applies to patient modesty and followed by everyone. That would be to keep a patient covered unless necessary to not be covered. period. That should be the standard for male patients, female patients, and anything in between.

My own experiences with the hospital, emergency room, operating room and doctor's office has been very good.

TDCHIM · Apr 21, 2010

Please don't make excuses for her actions, as they truly were INEXCUSABLE. She should know that her job entails explaining to you what she is doing, and why. This same nurse also snapped at you regarding pain medication, and she should know that giving pain medication is her job, and not a "when she has time" thing...you MAKE time for something like that, in that situation. Covering you up, rather than leaving you exposed and restrained, is a matter of common DECENCY (and is, indeed her job), and there is NO way to justify her actions. You said it was traumatic for you, and I have no doubt that it was, very much so....so don't make excuses for her! It saddens me that her actions made YOU feel humiliated, when SHE'S the one who should be ashamed and not you.
People have bad days, and may not have a sunny, wonderful attitude all the time, but that nurse's actions that day went far beyond that. They were not ok, by any stretch of the imagination.
Edited to add: I WOULD go so far as to call it assault. I don't see any reason, before you're sedated/anesthestized, to have restrained you, especially without telling you why. I couldn't just walk in to a patient room, put on wrist restraints, and walk out again, ESPECIALLY if they are alert and oriented (even when they're completely confused/combative, etc, you tell them what they are doing, whether they comprehend it or not). It doesn't sound like there was a reason to have them placed at the time that they were (and if there WAS a reason, you deserved to know why). Technically, I guess, it's not assault, but battery?

I'm just not all that great at calling people utter jerks, even when they deserve it. She was horrid, but I have no way of knowing whether she thought the doc was coming in from his emergency case before mine right away. I kind of thought I was being a wimp about being trussed up like that - I'd never had a child before, so I had no way of knowing whether it was perfectly normal. I don't like to make a fuss unless I'm absolutely sure I'm in the right. I don't want to be one of those people who freaks out over nothing. In fact, before I read this thread, I actually never knew for sure whether it was just business as usual to treat people like that - though after some of my classes, I was pretty sure the restraining a perfectly normal, calm patient for nine minutes with no explanation business wasn't appropriate.

So I guess you can chalk up my rationalization to me being something of a shrinking violet in that department. But I really do hope she was nailed for it and pushed to change her way; I hate to think of anyone else being treated in such an excruciatingly embarrassing manner!

cherrybreeze, ADN, RN · Apr 21, 2010

I'm just not all that great at calling people utter jerks, even when they deserve it. She was horrid, but I have no way of knowing whether she thought the doc was coming in from his emergency case before mine right away. I kind of thought I was being a wimp about being trussed up like that - I'd never had a child before, so I had no way of knowing whether it was perfectly normal. I don't like to make a fuss unless I'm absolutely sure I'm in the right. I don't want to be one of those people who freaks out over nothing. In fact, before I read this thread, I actually never knew for sure whether it was just business as usual to treat people like that - though after some of my classes, I was pretty sure the restraining a perfectly normal, calm patient for nine minutes with no explanation business wasn't appropriate.
So I guess you can chalk up my rationalization to me being something of a shrinking violet in that department. But I really do hope she was nailed for it and pushed to change her way; I hate to think of anyone else being treated in such an excruciatingly embarrassing manner!

I totally understand what you mean and how you feel about calling people out....I am very bad at it, myself. In any given situation, I just tend to bite my tongue, since it's easier. Everything you said, about not wanting to make a fuss, not wanting to appear to freak out over nothing....I completely understand. I am the exact same way!

I hope she got nailed for it, too.

tbrd450 · Apr 25, 2010

tbrd450 wrote: "he probably wasn't thinking anything about the naked patient. he probably wasn't looking at it from her perspective."

morte: "but he should have been.....he had no business being there, certainly didnt have patient consent.."

tbrd450: morte, i couldn't possibly agree more with you. you are absolutely correct. but, honestly, how do we ensure sensitivity without resorting to criminal charges? there are a lot of insensitive dopes out there (and it is amazing when they turn out to be doctors or nurses), but that doesn't make them criminals.

i think i have an idea, tell me what you think: if you feel the need to pop into a room to discuss a tv show with your colleagues in a hospital or doctor's office settintg, and the room as a naked (or partially naked) patient, you can do so but you, yourself, must first remove all of your own clothing!! such a policy/law would ensure the insensitivities cease immediately.

GadgetRN71, ASN, RN · Apr 26, 2010

One of my pet peeves is we go to great lengths to preserve a person's modesty in pre-op & then they come out of the OR w/their gown off or down around their waist, betadine on everthing- blankets in a jumble-- and they're waking up exposed!! It seems the OR crew doesn't have to be in THAT much of a hurry & so worried about turnover times.

We try to cover them many times but some people are fidgety when they wake up-you can fix the gown all you want but if they keep pulling it off, not much you can do.

And yes, we are in that much of a hurry-not by choice though.

GadgetRN71, ASN, RN · Apr 26, 2010

but he should have been.....he had no business being there, certainly didnt have patient consent..

This is a gray area-read some of the surgical consents. Often, it'll mention that there will be various people in the room. At any rate, while we try to keep the traffic in the room to a minimum, often those who don't start the case or who aren't involved in the case end up in the room. This could be for lunch breaks, a doctor or a nurse needing to ask a question of a scrubbed person, or the charge nurse poking his/her head in to see how things are progressing. Really not a big deal..

I do get the feeling that people who know nothing about the OR or who aren't nurses or healthcare providers, are going to proceed to flame me. Feel free-you can think I'm horrible, insensitive etc. I know that I do right by my patients and that's all that matters.

CFitzRN, ADN · Apr 26, 2010

This seems like a good thread to convey the horror I, as a nursing student doing an OR rotation, felt when the OB surgeon, once the patient was under, called everyone over and pointed to her private area (labia, etc) and started asking questions about it. "Why do you girls shave that way? Why do you think she didn't shave THERE? Did you know labia minora can be very asymmetrical like this?" etc etc. I was ABSOLUTELY MORTIFIED. This is a guy who has been in practice in our area for many years, and who had done a D&C on me when I miscarried many years ago. I was in absolute disbelief. As a student I felt way too "inferior" to say anything, but in retrospect I could kick myself in the @ss for not speaking up and objecting to his utter lack of respect for the patient. During the procedure he accidentally popped out her Nuva Ring - it went flying across the room onto the floor - and I said "will someone notify her of this?" and the doctor just laughed and said "if we remember to".

I still can't believe what I witnessed in that room.

GadgetRN71, ASN, RN · Apr 26, 2010

This seems like a good thread to convey the horror I, as a nursing student doing an OR rotation, felt when the OB surgeon, once the patient was under, called everyone over and pointed to her private area (labia, etc) and started asking questions about it. "Why do you girls shave that way? Why do you think she didn't shave THERE? Did you know labia minora can be very asymmetrical like this?" etc etc. I was ABSOLUTELY MORTIFIED. This is a guy who has been in practice in our area for many years, and who had done a D&C on me when I miscarried many years ago. I was in absolute disbelief. As a student I felt way too "inferior" to say anything, but in retrospect I could kick myself in the @ss for not speaking up and objecting to his utter lack of respect for the patient. During the procedure he accidentally popped out her Nuva Ring - it went flying across the room onto the floor - and I said "will someone notify her of this?" and the doctor just laughed and said "if we remember to".
I still can't believe what I witnessed in that room.

Yes, that was way inappropriate. :eek: This may be OT, but many OB/GYNs are weird ducks-just one of the many reasons I despised GYN surgery and my maternity rotation in NS. It sounds like he was "showing off" because there was a student in the room and the circulator should have spoken up..I've done so in the past and it was for that reason this one particular OB/GYN surgeon disliked me..I wasn't afraid of him like many people were.

morte, LPN, LVN · Apr 26, 2010

This is a gray area-read some of the surgical consents. Often, it'll mention that there will be various people in the room. At any rate, while we try to keep the traffic in the room to a minimum, often those who don't start the case or who aren't involved in the case end up in the room. This could be for lunch breaks, a doctor or a nurse needing to ask a question of a scrubbed person, or the charge nurse poking his/her head in to see how things are progressing. Really not a big deal..
I do get the feeling that people who know nothing about the OR or who aren't nurses or healthcare providers, are going to proceed to flame me. Feel free-you can think I'm horrible, insensitive etc. I know that I do right by my patients and that's all that matters.

but not one of those extra persons you mention would have been the doc mentioned....not one! to invade a surgery to talk of a TV show!

CFitzRN, ADN · Apr 26, 2010

Yes, that was way inappropriate. This may be OT, but many OB/GYNs are weird ducks-just one of the many reasons I despised GYN surgery and my maternity rotation in NS. It sounds like he was "showing off" because there was a student in the room and the circulator should have spoken up..I've done so in the past and it was for that reason this one particular OB/GYN surgeon disliked me..I wasn't afraid of him like many people were.

I wish I'd had your courage.

tbrd450 · Apr 26, 2010

"Yes, that was way inappropriate. :eek: This may be OT, but many OB/GYNs are weird ducks"

Yes, this is different than popping in to talk about a TV show. I would think the guy would, himself, be embarrassed to behave so unprofessionally in front of the others in the room. It is very juvenile and immature. How does a person then speak to the patient a day or two later with a clear conscience? Somebody should have just told him that he is an idiot, inconsiderate, juvenile moron for degrading the patient (asleep or awake) in this manner. Ah, then the worry about retribution, right?

There was a TV show on years ago -- a hosp show. In one episode, the patient on was on the OR table supposedly in dream-land. The doc made a comment about the patient and said some derogatory things to those in the room (about the patient). Well, as it turns out the patient was not fully under, just paralyzed. He heard the whole thing. He sued the hosp and the hosp settled. I don't think anything really happened to the doc except she was very embarrassed. But that was a TV show. However, I suspect that is possible -- patient not fully out ??

~Mi Vida Loca~RN, ASN, RN · Apr 26, 2010

I know this is an old post but " How do you handle pt that is concerned about students practicing pelvic exams on them without consent?" WHAT THE?!?!?!?! Please tell me this doesn't really happen?

I am a HUGE stickler for modesty for my patients. I have had to many surgeries and unwanted exposures and to many Docs calling in all kinds of people to see stuff that was so unusual with me that it has always irked me. It's also the one area I have always had trouble asserting myself in. Thankfully my step mom knows how I am and during my deliveries she made sure the blanket stayed up to my knees when I was pushing so I wasn't just exposed to everyone.

I will never forget having a lapraoscopy, it was either my first or second one, but my gown was on backwards. I don't know HOW I thought they did the surgery without undressing me, I guess I was under the "outta sight outta mind" perceptions, but seeing the proof I was, just was mortifying.

When I was having my first son and was pushing I was in the Naval Hospital and a man walks in in sweats that were all sweaty so he had just went on a jog, he came in and started talking to someone else and here I am young and scared and trying to have a baby. My mom said I was talking tongues when I turned yelling who the hell was that man in my room, he turned beat red and stepped out with his colleague. It's the only time I had no issues asserting myself LOL.

Anyway, because of all this, I think I am aware of my patients modesty probably more then anything else when I am doing anything. If I am ever in a room watching a nurse as well and it isn't necessary for me to look at whatever area is exposed, I won't, I make sure of it and I always make sure the curtains are pulled if they are exposed even if the door is shut in case someone walks in.