Patient Dignity 08: "I am a professional," and "I have seen everything before."

How many times has you as a provider said, or you as a patient heard "I am a professional," or "I have seen everything before" when (you as) the patient has been apprehensive about undressing or exposing a body part.

This is unprofessional, demeaning, uncaring, and offensive. These may produce some positive results for the caregiver but not the patient. One thing they do is shut down the dialogue prematurely.

Newsflash: It's NOT about how you feel, I is about how I, the patient, feels!

Unless I, the patient, am a work as a "standardized patient" or (perhaps) a porn star, I am NOT a professional and I have NOT shown it to a bunch of strangers. These statements nullify my feelings and marginalize my dignity as a human being. 

This demonstrates that you are as a incompetent as a provider, and borders on malpractice. 

Healthcare providers (physicians, nurses, PAs) are taught observation, auscultation, percussion, and palpation. The first two are look and listen! The patient is alerting you to a problem. Perhaps the patient does not understand the procedure, it has not been explained, or the patient has an underlying emotional trauma.

One never knows who has been sexually abused, (so please do not ever trivialize a patient's need to avoid unnecessary exposure). Missing the signs of possibly being a surviver of sexual abuse are no less egregious and incompetent as missing a tumor on a thyroid.

It is easy for you to dismiss the patient's feelings, fears, and anxieties about dignity and modesty when you are the one in the room wearing clothes. 

Nurse Ratched was a professional too...

"Operational efficiency" is not an acceptable answer. When it is genuinely argued (as opposed to disingenuinely justified) that patient exposure is necessary, then it is a valid reason. On the other hand, simply for the purposes of efficiency is NOT a valid reason.

"Because that is the way it is always done," is NOT a valid reason either. For years black people (not just of African decent) and white people were not allowed to legally marry "because that is the way it is always done." If you are going to site data or research, it better be current and it's premise (thesis) not called in to question by other research.

Consider the the standard procedure for prepping a patient for all surgery, including outpatient: naked wearing only a gown, wheeled into the OR on a gurney. Consider what LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal

If you further reason infection-control has not studied this, that is NOT valid either. Other providers are looking at this, why not you. Patients will not accept "not your responsibility." Part of your job as a provider is to advocate for the patient, if you are not pushing for a study on this, you are not doing your job.

If you have initials after your name (MD, DO, PA, RN, LPN, etc.) and you use phrases like "I am a professional," "I have seen everything before," "because that is the way it is always done," or "operational efficiency," that only marginalizes you as a professional and nullifies all the time, money, effort, and study that you put into your education. If you are so smart and educated, how can you NOT understand my feelings and my point of view?

You are the professional, patients are NOT. Patients are real, live people who in all probability have never been in a hospital in their entire life and what happens is pretty distressing. This is your job, some would even say their home. You come here everyday, you are familiar with the sights, smells, and sounds.

You are not totally devoid of any curiosity, emotions or feelings.  You have the same feelings that we do, so you can't deny that to us as much as you try, and simply saying that you are a professional does not negate that.

First and foremost you are human. The patients are human too. We know what human reactions are. You can probably control them a little better than us, but you WILL have them.

It would help if you were naked while invading our privacy, but I guess thats just realistic.

One could say we have seen it all also so why not be naked in there with us? I know its stupid, but perhaps your getting the idea. It is soo much easier to be the clothed one while we have our gentiles exposed, worked on, and pontificate on our childish behavior.

If they’ve seen it all before, then they DON’T NEED TO SEE MINE!

This is how we really feel. When you refuse to acknowledge our feelings, you are lying to us. Why do we have to justify our feelings to you? It is common sense, we cannot understand why educated, intelligent people do not understand why we feel this way.

When we say things like "It would help if you were naked while invading our privacy," we are only trying to get you to understand us. Obviously you know what we say to be true, or you would not be so offended when we suggest this.

I have always stated: "Medical treatments and procedures would be radically different if the providers had to be in the same state of exposure as the patients."

You cannot argue that point. You would have to have a major mental defect or cognitive disability to believe otherwise. The tolerances for infection control would drop. Questioning of is that exposure necessary would predicate every protocol. Here is proof:

In the above example what  LDS Hospital in Salt Lake City, Utah, the WSJ article stated that a 15 year ER nurse saw behavior in patients that did not make sense. To understand the disconnect, she needed additional education (an MBA) that her nursing degree did not give her.

The healthcare system cannot comprehend that what they perceive as the patient's priorities, in fact are actually NOT the patient's priorities. They blame the patient for not having the (expected outcome) priorities that they expect. Physicians (providers) are to make decisions with out emotion, so that the decisions are based on sound, scientific principal. That is why they can not understand why a patient has an issue with being helpless and naked in front of a room full of people when they are undergoing a lifesaving procedure. All they think that is important is that your life is being saved.

 In the case of LDS Hospital, cost  and an increasingly competitive surgical market were the driving force for change. It was not about the patient, it was about money. Why was the option of patients keeping their underwear on not looked at when the initial infection control study was done? Answer: "Because that is the way it is always done."

Further proof: The Endoscopy Camera Capsule (info at: NY Daily News). This is another advancement that further preserves patient dignity. This was developed because many people were opting to forego the undignified process of a colonoscopy. Again it was "money first, not patient first." The PillCam costs $500, significantly less than the roughly $4,000 rate for colonoscopy.

Speaking of professional...

What was considered appropriate and professional 25+ years ago, would be UNACCEPTABLE today. Remember "strip-as-you-go" exams?

The fallacy of "Patient First"

How many times have you told a patient this? How many times have you said this to people who were not patients? Do you really believe this? If so, does your facility have a written policy that allows outpatients to keep their underwear on? No? I thought you said "Patient First?"

If you counter with something can go wrong, incase of emergency, ...blah...blah...blah, remember what I said about being up to date? As of 2014, despite thousands of outpatient procedures, not a single patient has died as a result of wearing underwear during an outpatient procedure. Confirmed by: LDS Hospital. 

Do Not Dismiss My Experiences

I know through my experience what happened to me and how I was treated. Trying to dismiss my experience tells me that I am wrong to feel the way I do. I do not choose my feelings, they are what they are.

Saying "that can never happen because medicine is a profession" or "that is impossible in a professional setting" only further undermines our trust in you and the system. Is it that you just don't believe me? Perhaps you are complicit in the cover up and system-wide denial that this does happen.

Even worse is saying that "never happened to you." Just because it never never happened to you does NOT mean it didn't happen to me.

You are not me, despite how deep you pry into my lifestyle, history, an my past (while vehemently protecting your privacy) you do NOT know what I experienced, how I reacted, or how I feel. Does it matter, you are dictating my feelings to me anyway.

Do No Harm

Do you think that dismissing me as childish, nullifying my feelings, marginalizing me as a patient, or making this all about you does no harm? 

It is this attitude that has caused me not to trust the healthcare system or anyone in it. Before my previous first bad experience, I walked in trusting you. The subsequent bad experiences only reinforced that in me. I will not let myself get hurt like that again. Now I assume that you are bad. You can either reinforce what I know through my experience, or you can win back my trust.


Tips on How to Be a Better Provider

Here is "An open letter to all hospital staff" by  Carolyn Thomas,  a heart attack survivor> The letter details how she was treated and how providers can better serve the patient. She says,  It’s not so much that they were openly rude. It was their insufferable lack of people skills..." 

I wasn't born a difficult patient....I was turned into one

Thank you for thinking.

--Banterings