Thursday, July 31, 2008

More on Modesty

First, I'd like to bring readers' attention to two physicians' blogs. The first, Bioethics Discussion, is by Maurice Bernstein, whose questions go well beyond end-of-life issues to the everyday interactions that can affect patients. Recently he's continued a conversation on patient modesty. The other is a blog on patient modesty by a recent commenter here, Joel Sherman (read through the comments for the full discussion on each issue).

While I love the disability blogging community (so many of you have given me more than you realize in the past year), I worry sometimes that our issues as people with disabilities or with chronic health issues aren't getting out there enough, that we're talking amongst ourselves too much (which also holds true for the majority of medical blogs I've looked at, which seem to lack any patient perspective). I'd like to see more dialogue between doctors and patients about the issues that concern us. I am hopeful that there will be more changes in medical practices, more patient-centered rather than authoritarian care, but I think such change is most likely to occur when such physicians who listen to patients teach their colleagues and students what they've learned, modeling more empathic care.

Something I've heard from others, which thus may or may not be true, is that Americans are considered overly modest and when in Europe, there's no gown or blanket. That's treating someone like a medical book specimen rather than a person, further objectifying the body and strongly reinforcing that doctors rather than patients control bodies, health, and knowledge. It says that patients are powerless, that the body lying on the table is just that, a body, a body removed from "its" everyday contexts and life and subjected to the will of someone else. A body that doesn't have a say in what's done to it or control over its own functions or choices. What I'd like to ask doctors to do, whether the issue is patient modesty in the exam room, the filming of a medical procedure, or the treatment of a person who is sedated, is remember that body has a family, a life, a spirit, a memory that extends beyond that single point in time.

The body is never just a body, and science is never just science. What is science without humanity?

There are additional privacy or modesty issues I've come across that I think are in no way unusual, but rather representative of what most patients experience at one time or another:
-A physiologist at the surgery center who would not close the door when I was changing (my husband and I both told him to leave, after telling him not to come in yet when he knocked). He came in again when I still was not done. That is not just rude, it's unthinkable.
-Doctors dictating medical records in hallways or other areas where information can be overheard. You can't assume people don't hear or understand. And I have run across many, many people I know at doctors' offices, which sometimes really unnerves me. When I was young, my orthopedist posted all the x-rays on long light tables in the very long hallway right outside the exam room and dictated the records there too. Hearing your record dictated makes you feel like a physical object, reduced to parts.
-Doctors leaving doors open for all of their patients for quick follow-ups because they're in a hurry. That means I'm less likely to ask questions I need to and feel more intimidated about being judged by additional people.
-Offices with walls too thin. Twice I've heard way too much of very personal exams, once while in the waiting room because an exam room was right on the other side, once while waiting on the doctor. One of the patients was someone I knew, and I was horrified to overhear. In general, I can overhear loud conversations I would rather not, even while trying to concentrate on my reading.
-Having to traipse through long hallways after changing for x-rays. While my current doctors use radiology services where this is not a problem, when I was a kid and a teenager I had to sit in almost nothing (paper) outside the x-ray lab for a long, long time.
-Lack of patient privacy where medical procedures and tests are done and you're herded like cattle and branded with your bracelet, etc. for efficiency and your records and medical situation are discussed openly. Again, why is it always assumed no patients know each other?
-Being asked as I walk through a public area whether you could be pregnant, and worse, what my method of birth control is. This happens all the time.
-Having to deal with an x-ray tech who was an apparent pedophile and an MRI tech who touched me inappropriately. Parents, consider yourself warned.
-Gowns that don't cover or tie adequately, or that patients can't reach to fasten themselves. Not keeping patients draped adequately. I want every semblance of modesty at all points, even if we know it's just an illusion.
-Unfastening or pulling anything up or down without warning me first.
-Medical staff who gossip. Don't think we don't notice. Even if it's not about us, it's not right. Don't gossip to me about other patients.
-Refusing to allow someone to have a person present because of "modesty issues." That's about your modesty, not mine. There are people I feel comfortable with (said person) and people I don't (unknown doctor).
and last but not least,
-Objectifying patients and their bodies, neglecting to obtain consent, being abusive in any way even when you think you can get away with it, or failure to report these.

Lest I sound prudish, I'm not. But I want control over what happens to my body. I want the right to say no. Patients deserve as much bodily autonomy and respect as possible. To psychoanalyze myself (always dangerous), I had very little choice about anything that was done to my body or in any medical decisions when I was young, and I see this happen to other children. They, too, deserve respect. I recognize there are situations when much patient modesty is not possible, such as when a nurse was helping my husband with bathing me postsurgery (that time I didn't pass out and learned some helpful tricks). It was awkward and embarrassing but I was glad for the assistance. However, when it is possible, more privacy is what I prefer.


Anonymous said...

Nice column Freda,however,the double standards in healthcare
are stacked against men not women.
In my oponion, its the nurses
(female) that are the greater evil.

FridaWrites said...

I'm sorry you've had bad experiences. Everyone needs to feel empowered about their health. (See my post a couple down about an RN.)

I often decide whether or not I can stick with a practice based on the nurses or office staff. In the hospital, don't hesitate ask for someone different if you need to and can.

Anonymous said...

As a male I don't allow any females
to do ANY kind of personal care to
me. I've had 5 experiences whereby
the nurses (female) were unprofessional. You want people to
feel sorry for you, I won't. Try
going through what you have as a
male patient, then lets see what
you have to say. In my oponion,all
female nurses are pervs!

Anonymous said...

The female nurses on
will give you a glimpse on just how
unprofessional these people are. Do
a search on whoa...inappropriate.The thread is locked but involves a crowd of female nurses going into a male patients room and peeping under the
sheets at his genitals. These nurses were not assigned to his care. Not only is that perverted but ILLEGAL. Do a search called "ever have a patient comment on his size" The author of that thread jlsrn, states that she evaluates every male patient on his penis size. Talk about judgemental and perverted!

yanub said...

Anonymous, you are going out of your way to find examples of abuse. Have you spent as much time looking for examples of the abuse of women? Or of children of either sex? Or of transgendered or intergendered people? Frida never said anything that could be interpreted as meaning that women medical professionals are above reproach. What sort of validation do you need from her? And why do you feel it necessary to discount other people's experiences? There isn't a contest for who is most victimized.

Anonymous said...

Hmmm,touched a nerve didn't I. Deal
with it!

FridaWrites said...

The conversation moved on several weeks ago. We've already discussed your response at length. I doubt Yanub is clicking back on this thread on a regular basis as you have been, and I doubt she sees your response.

You're trying to needle people rather than make a point? That's called trolling. So no more anonymous commenting and trolling here as you've done on physician blogs as well. I expect commenters here to show respect for one another and for me even if our beliefs or experiences differ. You'll never convince someone to your point of view by attacking them; instead you lose credibility. Additional comments in this same tone will be deleted.