Monday, July 7, 2014

Patient Dignity 00: Preface


I am doing a series of posts about "Patient Modesty." I don't like the term "Patient Modesty," I prefer "Human Dignity" This is the Preface where I will use it to explain the writing conventions used,  use it as in introduction to this series of posts, and give you the ground work and foundation to critically evaluate what I propose.

Most people are going to hate me for these posts. They will be inflammatory, using the most extreme examples. They will make you think.

If you disagree with me, do it in a respectful way. I am not perfect, my faults are many. I am harder on myself than you can ever be. If I am wrong, then persuade me to change my mind.

I will respect you more if you tell me that you don't care about people only money and reputation than if you just call me names or accuse me of other motives.

I also do not have any sexual medical fetishes. In discussions, I present situations that doctors could not defend, so they accuse me of having a sexual medical fetish. I have fetishes, and I can assure you that none of them are medical related.

I know that my views here are extreme, but the need to be. What patients are offered in terms of dignity and modesty has improved, it is not what a dignified human being deserves. 


I don't know how often people are traumatized from exams or procedures. Does it matter? How many are too many?

Like any other "disease,"one IS too many.

I am not saying that this happens to everyone, but it does happen. It does not happen from every procedure either. For some it is a visit to the trauma bay, having your clothes cut off, getting a DRE, and being (forcibly) catheterized. For others it is a curtain of door not being closed during a procedure, or a parade of medical students "gawking."

Sometimes it is not intentional, but sometimes it is!

Insult is added to injury when the healthcare system that did this to us, refuses to recognize our trauma.

This blog is an attempt to get healthcare providers to understand that you were taught in school may be incorrect. While most people may be comfortable with the protocols for treatment, some of us are not. You went into this profession because you were compassionate and wanted to help people. That person is still in there, somewhere. Look through our eyes, feel what we feel, and let that person out.


Be honest. I will be brutally honest. In the previous paragraph, I warn you that the situations will be extreme, but the only way to test a system is to push it to it's limits, to the extreme, and the almost absurd.

It is amazing how when I reference a topic such as people making sexual comments about coworkers, customers, patients, etc. that all the responses are "I have never seen that happen." I know there are some who may be the only physician in a small town, but you went to an undergrad school and a medical school, did a clerkship and a residency somewhere, and in 12 years NEVER heard an in appropriate comment???

Be honest. I think them, and on occasion I have slipped. Being professional means that we acknowledge them, try to control them, own up to them and apologize when we slip. We are after all only human. 

I will also present situations that seem improbable, but are NOT impossible. Sometimes my scenarios may seen absurd. The only way to test a system is to push it to it's limits. You will see more in the "What Would You Do?" posts.

I also have a good sense of humor, sometimes it is a little dark. I will offend you, many times. For that I am truly sorry. You can not offend me, but are welcome to try. 

You will accuse me of being a "dick." Yes, I can be a "dick." I admit that.  I am a horrible person who has done horrible things. I am trying to make amends. I am brutally honest.

If you need help, I will do everything I can to help you, even if I don't know you. I am trying to make the world a better place. I don't just say that, I do that. I do something every day to make the world better. It may be as simple as picking up garbage that someone was too lazy to dispose of properly.

Eloquence, OR My Lack of...

I know that I am not as eloquent as the contributors of my favorite blogs like Dr. Maurice Bernstein, Dr. Joel Sherman, or the contributors on KevinMD, and I ask your indulgences with that. I am going to be brutally honest.

I will take the truth, write it on the back of a shovel, and hit you over the head with it. I want you to think!

I assume that you have at least a moderate intelligence, especially if you are in the medical field. Don't knit-pick about my grammar, use of "toward" and"towards," take away the point that I am trying to make.


I will site studies, statistics, axioms, and generally accepted principals (such as every person  is inherently entitled to Human Rights). I will also create posts called "What Would You Do?" 

My views are not based on conjecture, but rather research on a topic that the medical community tends to ignore, and my own experiences. 

I will cite Wikipedia, but only for definitions or explanations of terms that may be vague (such as the Kobayashi Maru Scenario mentioned below). I will not rely on Wikipedia for scientific research, statistics, etc. 

I will try to make this as interesting as possible. I will try to add graphics to help illustrate my points and keep this interesting.

I will take you at your word. If you say you are in the medical field, I am not going to dispute that although other commenters may.

A word about perverts; every blog has them. This will be no different. You may disagree with my position and feel that "pervs" taking your side may make you look bad. But that only strengthens my position that you, as a provider, may need to reexamine yourself, these generally accepted rules that you defend, and question "what was the intent of the people who wrote these rules."

 I will ban anyone who is threatening, posting spam, etc. I will NOT ban you for disagreeing with me or other posters. These topics are controversial, and some of you may find the topics, how they are presented, examples, possible scenarios, etc. offensive. 

I do not advocate for sexual assault in any form. The examples presented are to make you examine your own values and way of thinking. 

I do this as an advocate for patients and providers. Just as many humanitarians may not be experts in the causes they advocate for, they do know the difference between what is right and what is wrong. I am no different. I do this out a sense of right and wrong. 

I am not Anti-Doctor, Medical Personnel Should Support this

There will be those that say I am anti-doctor, bashing the medical community, etc. I am NOT! I am simply exposing a topic that has been long ignored, the reasons (and potential reasons) the consequences of (both seen, unseen, and ignored), and solutions to the problem. 

I acknowledge that doctors and all medical personnel are placed in a situation that creates one of the most hostile work environments today. They are torn between:
  • insurance companies and government offering lower and lower reimbursement rates, increasing premiums for liability related insurances (malpractice),
  • government offering lower and lower reimbursement rates, requiring more regulation and paperwork,
  • corporations buying up medical systems as a means of profit generation and trying to run (historically) human interactions like an online shoe store, 
  • patients who are demanding their fundamental rights as well as their rights as consumers,
  • and a teaching system that offers little support, saddles most with enormous debt, and fails to recognize Human Dignity of doctors, nurses, all medical personnel and patients. 
The first step is admitting there is a problem. The longer the medical community denies the problem, the longer the solutions that return control to doctors, nurses, all medical personnel and patients.

A Warning to Doctors, Nurses, and All Medical Personell

The overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000 (Council on Scientific Affairs: Results and implications of the AMA-APA Physician Mortality Project, Stage II. JAMA 1987; 257:2949-2953). Physicians (as well as other medical personnel) are subject to a myriad of other psychosocial problems as well.

When you have that aha moment, it will not be pleasant. As you read these posts and come to the realization that I am correct, you will be overcome by guilt, self hatred, anger, depression, and a variety of other negative emotions.

If you are in crisis, call 1-800-273-TALK (8255) 
National Suicide Prevention Lifeline

I will also be posting an entry called "Absolution." I am not offering absolution, but I found this to be an appropriate title of some things that you can do to reconcile yourself with this issue.

If you have no one else to talk to and do not want to call the NSPL or any other agency, I will talk to you. I can't say that I am the best option, but I will not deny you this hospitality.


Human Dignity -- As previously stated, I don't like the term "Patient Modesty,"Patient Modesty seems to be something that is afforded to patients, where convenient and not cost prohibitive. Human Dignity on the other hand is  Fundamental Human Rights, that each person has (brings with them.  Human Dignity is not given to us by any person or institution, cannot be limited, controlled, or negotiated, but is absolute. Human Dignity protected under Common Law,  and provides for an individual's right to self-determination, bodily integrity, freedom from battery.

Medical Personnel -- I can not list all the different positions that fall in this category, it is a collective. It includes (in no particular order)  doctors, PA, LPNs, RNs, EMTs, technicians, prehospital care, etc. I do separate doctors out  because they are at the "top of the food chain." They have the most authority and the most liability. I will expressly mention a position (such as prehospital care) when referring only to that position. I equally respect the work that all medical personnel do.

Patient -- This is self explanatory. 

Medical Provider -- This is the person "laying hands" on the patient, providing care; doctor, nurse, EMT, etc. 

Non-Medical Personnel -- These are people who may work at medical facilities but are not medically trained; security, administrative people, janitorial staff, etc.

Third Party -- This is anyone other than the Medical Provider or the Patient. This is an insurance company, government, law enforcement, etc.  

Note: Some entities can be a Medical Provider or a Third Party depending on their roles in context to the situations that I present. The hospital that medical personnel work at, or another department in the hospital (radiology) are Medical Providers in reference to them caring for a patient. They are Third Parties in reference to instances when care is not being provided ("hands on"), such as when they dictate policy (such as quotas). 

"What Would You Do?" "What Would Jesus Do?"

You will see a number of posts titled "What Would You Do?" These posts are designed for you to be presented with an extreme situation that is improbable, but NOT impossible. They are designed to foster critical thinking, push the boundaries of the current system. It is to get you to question your own beliefs and the current system. 

"What Would Jesus Do?" is a single post where I present three benchmarks for judging the current system. This section will contain three monikers that may seem absurd, but just like the moniker "What Would Jesus Do," it is designed to put in perspective the current system and the right thing to do. 

I will also present Kobayashi Maru scenarios. (This is where the geek in me comes out.) If you are not familiar with the Kobayashi Maru scenario, read on:

It is a Starfleet training exercise designed to test the character of cadets in the command track at Starfleet Academy...  The test's name is occasionally used among Star Trek fans or those familiar with the series to describe a no-win scenario, or a solution that involves redefining the problem.  Source: Wikipedia

Spread the Word

I am going to invite some of the leaders on the topic of human dignity to read and comment on my posts. I will be happy to promote their blogs and ask they do the same for me whether they agree or not. If you have stumbled upon this, please pass this along to colleagues. 

Thank you to everyone who reads this blog!

To Those Who Wish Me Bad Karma or Ill Will...

If you don't believe that I am NOT anti-provider, anti-doctor, etc., and you wish to wish me bad karma or ill will, consider my reality:

I have a severe medical phobia. I fear doctors, hospitals, needles, dentists, everything medical. I do not fear pain, my lifestyle may be referred to as "risk-taking." I climb mountains and frozen waterfalls, I do whitewater rafting, I use to race cars.

I am in my 40's, my wife goes with me to hold my hand when I get blood drawn. I have skated through life, never having had a complete physical (at least since I was 10). I always had friends who would return the favor and sign off on my medical forms.

On more than one occasion I have stitched myself up or "superglued" a wound for fear of going to the ED. I limped for 6 weeks once when I may have fractured a bone in my ankle or foot. I kept an ace bandage on it and wore tight lacing wild-land firefighter boots which have excellent support.

I also have a Generalized Anxiety Disorder (a severe phobia) of being on the receiving end of healthcare. (I am fine on the other side.) I have had some bad experiences with receiving healthcare (mostly as a child). I can only remember bits and pieces of them. I am sure that is what shaped me to be like this. 

I have also had some very good experiences with providers who built trust and a relationship with me. 

I have accepted the fact that at some point something really bad may happen to me. I will refuse to go to the hospital and attempt to treat the condition myself, as I have done before. If really severe the situation, I will also have to hide to avoid pressure by loved ones or an involuntary committal. I have all the instruments I need, and access to most medications. Anything that I don't have, I could compound myself from the medications I have, common household chemicals, or flora.

It will be slow and extremely agonizing. Does that make you feel any better? Maybe you would like to watch? So I ask, what can you wish upon me that is any worse than this reality that I have accepted?

At least when I check out, it will be on MY own terms, WITH DIGNITY, and I will probably make it look good.

In writing this, I have realized one thing that would be worse; being admitted to an ED against my will. For those of you who wish me that, you can stop reading now because by your own admission, the healthcare system lacks dignity and is the equivalent to torture.

Are you ready? Here we go.... 

May all those who I offend forgive me. If I don't offend you, I must be doing something wrong. If I am wrong, may I see the error in my ways. 

I warned you....

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