How to Create a Sociopath: Part 4

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3

How to Create a Sociopath: Part 4

How to Create a Sociopath: Part 5

I have come across a recent news article that makes the case that students learning procedures on students is a far superior way to learn versus on real patients. It quotes the (in)famous Dr. John Henry Hagmann He retired from the U.S. Army in 2000, and is considered a pioneer in trauma (specifically combat trauma). Source: Reuters via Yahoo News

In the Army, Hagmann practiced emergency medicine for two decades. He rose to the rank of lieutenant colonel and co-authored an influential combat treatment manual.

After retiring, Hagmann founded DMI – also known as Deployment Medicine Consultants. It is based in Gig Harbor, Washington. Following the Sept. 11, 2001 terrorist attacks, demand for his courses grew and DMI emerged as a preeminent trauma-response trainer. The majority of DMI’s government contracts are with the U.S. military – in particular, Army and Navy special operation units.

“The mission of DMI is to train you to save lives in the combat environment, no one matches our ability to do this,” the company says on its website. “We are the single largest trainer of US military forces in operational medicine throughout world, and our record for excellence stands unchallenged.”

The allegations have lead to an investigation by the Virginia Board of Medicine and Defense Criminal Investigative Service. The allegations against against the good Dr. Hagmann (scientist and saint) are described as:

...During instructional sessions in 2012 and 2013 for military personnel, Hagmann gave trainees drugs and liquor, and directed them to perform macabre medical procedures on one another, according to a report issued by the Virginia Board of Medicine, the state agency that oversees the conduct of doctors.

Hagmann, 59, is accused of inappropriately providing at least 10 students with the hypnotic drug ketamine. The report alleges Hagmann told students to insert catheters into the genitals of other trainees and that two intoxicated student were subjected to penile nerve block procedures. Hagmann also is accused of conducting “shock labs,” a process in which he withdrew blood from the students, monitored them for shock, and then transfused the blood back into their systems.

...In one case detailed by investigators, Virginia authorities allege that Hagmann boasted to a student “about his proficiency with rectal exams” and took the student to a warehouse on his property. There, the report claims, the two “continued to consume beer” and Hagmann asked the student “about the effect (the student’s) uncircumcised penis had on masturbation and sexual intercourse.” The student told investigators “that he was inebriated and felt that he could not refuse Dr. Hagmann’s request … to examine, manipulate and photograph his penis...”

In his defense, Dr. Hagmann said, "...the Virginia board is applying the wrong standard in assessing his conduct: He said that his trainees are "students," not "patients" as the board calls them, and therefore he may have them perform procedures on one another as part of the educational process.

...the courses and procedures in question were all reviewed and approved” by officials at the Uniformed Services University of the Health Sciences (the government-run medical school that trains and prepares health professionals to support the military)."

The dirty little secret is that the double standard to discriminate (and abuse) males is taught in the formal medical curriculum....

"Genitalia: Boys always; girls when indicated (e.g. all sexually active girls and those with any symptomatology) should have an external inspection and an internal pelvic examination. Desirably, all adolescent girls should have pelvic examination at some time as a matter of routine." Hofmann, A and Greydanus, DE; Adolescent Medicine, 2nd Edition, 1989.

...and everyone wonders why men avoid healthcare.

Previously I have focused on (basically) how physicians and other providers objectify and harm (psychologically) patients while being unaware that they are doing so. There is another part to my research that The Stanford Prison Experiment bridges into. That addresses the issues such self-policing and, AND why they have guidelines based on ritual and not science (annual pelvic exam) and are designed to subjugate patients to a subservient role (PPC).

I am referring to a real incident at an American high school in 1967 that shows the horror of mob psychology and group pressure. I am referring to "The Third Wave;" in 1981 it was made in to an ABC after school special titled "The Wave," and remade in 2008, titled "Die Welle" (the original German title).

The Third Wave was an experimental social movement created by high school history teacher Ron Jones to explain how the German populace could accept the actions of the Nazi regime during the Second World War. While he taught his students about Nazi Germany during his "Contemporary World History" class, Jones found it difficult to explain how the German people could accept the actions of the Nazis, and decided to create a social movement as a demonstration of the appeal of fascism. Over the course of five days, Jones conducted a series of exercises in his classroom emphasizing discipline and community, intended to model certain characteristics of the Nazi movement. As the movement grew outside his class and began to number in the hundreds, Jones began to feel that the movement had spiraled out of control. He convinced the students to attend a rally where he claimed the announcement of a Third Wave presidential candidate would be televised. Upon their arrival, the students were presented with a blank channel and told his students of the true nature of the movement as an experiment in fascism, presenting the students with a short film discussing the actions of Nazi Germany.

...The experiment took place at Cubberley High School in Palo Alto, California, during the first week of April 1967. Jones, finding himself unable to explain to his students how the German population could have claimed ignorance of the extermination of the Jewish people, decided to demonstrate it to them instead. Jones started a movement called "The Third Wave" and told his students that the movement aimed to eliminate democracy. The idea that democracy emphasizes individuality was considered as a drawback of democracy, and Jones emphasized this main point of the movement in its motto: "Strength through discipline, strength through community, strength through action, strength through pride.

Here is a link to the video "The Wave" (administered by Israeli Educational Television).

Healthcare has proven again and again that they can not be trusted.

A new report finds that the American Psychological Association gave federal officials what they wanted when it came to torture: an ethical policy that aligned with government interrogation techniques. The APA has issued an apology and said it will ban psychologists from participating directly in interrogations.

US psychology group colluded with govt 'torture' program: report

Washington (AFP) - The US's top psychology association colluded with the Pentagon and the CIA to devise ethical guidelines to support post-9/11 interrogation techniques that have since been labeled as torture, a report said Friday.

Some members of the American Psychological Association (APA), including senior staff, sought to "curry favor" with defense officials, according to the 542-page probe commissioned by APA's board.

These individuals issued an ethics policy that aligned with government interrogation techniques after the September 11 2001 terror attacks, such as waterboarding and sleep deprivation.

The association colluded with several government agencies, including the Pentagon and the Central Intelligence Agency (CIA), to devise ethical guidelines for the interrogation program under former president George W. Bush, according to the review.

The government agencies "purportedly wanted permissive ethical guidelines so that their psychologists could continue to participate in harsh and abusive interrogation techniques being used by these agencies after the September 11 attacks," the report said.

"APA's principal motive in doing so was to align APA and curry favor with DoD (Department of Defense). There were two other important motives: to create a good public-relations response, and to keep the growth of psychology unrestrained in this area."

The findings come after Democrats on the US Senate Intelligence Committee in December released a damning report detailing brutal and previously unknown interrogation techniques, including beatings and rectal rehydration, used by the CIA on Al-Qaeda suspects post 9/11.

APA Apologizes for “Deeply Disturbing” Findings and Organizational Failures; Announces Initial Policy and Procedural Actions to Correct Shortcomings

The APA board apologizes, recommends: participate in human rights activities, create committees, and maybe sing Kumbaya...

I mentioned (above) the 1967 social experiment "The Third Wave." Where Milligram's experiments were with individuals, The Stanford Prison Experiment was a bridge encompassing both individuals and organizations.

I linked to the ABC After School Special that was made about it. I believe that this shows how an organization adopts an "us and them" view and creates policies that consolidate and protect the organization's power while subjugating the "them."

This is where healthcare has come up with beliefs, customs, norms, mores, etc. that are abusive to patients, scientifically unfounded, and defy common sense. One such example is [sic.] the AAP's statements of "normalizing" and showing the "routine" nature of the genital exam despite the fact that research (which I referenced previously) concludes that a genital exam is "never routine" (for the patient at least).

Perhaps the biggest fallacy that healthcare promotes is that just because one becomes a provider (and has a magic white coat), then they have the RIGHT to see ANY patient's (person's) body (naked), AND the patient (person) should have NO objections and comply. This is seen in the statement, "I am a professional."

***WARNING*** This may seem "pornographic," but it is actually [more] ABSURD. It is an extreme example to show the absurdity of the statement "I am a professional."

Let us extrapolate this to another profession. I am a porn star. I have been trained in all the safe sex practices of the CDC, California Department of Health, and Cal/OSH. I have had sex wit so many people so many times, that I do not experience sexual pleasure, it is just a JOB. "I am a professional."

So no healthcare provider should object to me touching their genitals...

Let's take this down a notch. I am a camera man in the porn film/video industry... "I am a professional." So no healthcare provider or any member of society should object to me looking at their genitals.

Let's extrapolate some more. Theoretically most (almost all) members of society can be educated, trained, and become a healthcare provider (not just physicians and nurses). Do you think that most people (if not everybody) would accept the notion that potentially any member of society if given a magical white coat can see their (naked) body and touch their genitals AND they should be comfortable with this?

Disclaimer: I know that there are other factors that come in to play with the above examples such as "being therapeutic" versus sexual pleasure. But I argue that these are the same, there is a benefit to both parties. Again, it is more to illustrate the absurdity of the "I am a professional" statement.

Just look at how people date/choose a mate. First there is a preference or perhaps NO preference (bisexual) in gender. There are other factors as well. Think of the "creepy" person would NEVER date due to that (perceived) "ick" factor. What about the patient's perception of some providers being "creepy?" What about the cultural sensitivity papers put out by provider groups about female Muslim and Hmong patients? Just as religion dictates gender norms in healthcare, so it dictates in marriage (sexual relations), thus validating my examples.

The policy should be, "I am a professional, may I have your permission to participate in YOUR healthcare?" "If not, we will find someone that you are comfortable with." But as "The Third Wave" illustrates, organizations are self-serving and protect their status and existence with power, control, and convenience (PCC).

Read what the VA (Veterans' Administration) says about "moral injury" as a cause of suicide:

However, even in optimal operational contexts, some combat and operational experiences can inevitably transgress deeply held beliefs that undergird a service member’s humanity. Transgressions can arise from individual acts of commission or omission, the behavior of others, or by bearing witness to intense human suffering or the grotesque aftermath of battle. An act of serious transgression that leads to serious inner conflict because the experience is at odds with core ethical and moral beliefs is called moral injury.

More specifically, moral injury has been defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009).

Read the words of Iraq war veteran Daniel Somers, who committed suicide following an arduous battle with post traumatic stress disorder (PTSD) that was caused by his role in committing “crimes against humanity,” according to the soldier’s suicide note.

Then again, healthcare is in denial about what they do to patients being traumatic, so "moral injury" could never be the cause of physician suicide...

It is not uncommon for (dysfunctional) professions, systems, families, etc., to deny the internal abuses (reference; The Third Wave), this is very common in the dynamics of dysfunctional families. This is very often seen in families where sexual abuse and/or alcoholism is/are problems.

Experience “reality shifting” in which what is said contradicts what is actually happening (e.g., a parent may deny something happened that the child actually observed, for example, when a parent describes a disastrous holiday dinner as a “good time”). Source: Brown University

This may be due to (psychological) projection as a defense mechanism. In order to hide one’s own sociopathic characteristics (the lack of empathy that prevents some providers to validate patients’ modesty issues), they project mental illness upon patients. Why should anyone have a problem letting all the doctors, nurses, and students examine their genitals, you are getting hundreds of second opinions...

Another cause is burnout. Burnout in healthcare has long been considered "a state of chronic stress” that can lead to illnesses both physical and psychological, most notably depression, substance abuse, and suicide. (source: Psychology Today, The Tell Tale Signs of Burnout ... Do You Have Them?) There is a question does burnout describe a set of symptoms describing an illness OR is it one of the symptoms describing an illness:

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no such diagnosis as “burnout”, unlike depression, which is a widely accepted and well-studied illness. That is not the case with burnout. Some experts think that there might be other symptoms behind being "burned out" – depression or an anxiety disorder, for instance. Physical illnesses may also cause burnout-like symptoms. Diagnosing "burnout" too quickly could then mean that the actual problems are not identified and treated properly.(source: Depression: What is burnout syndrome?) There is growing support that burnout is an illness with comorbidities. (reference: Oxford Journal, Burnout as a clinical entity--its importance in health care workers.

Burnout has also been causes of patient neglect frequently relate to organizational factors (e.g. high workloads that constrain the behaviors of healthcare staff, burnout) (source: Patient neglect in healthcare institutions: a systematic review and conceptual model). It has lead to "an unfeeling and impersonal response toward recipients of one’s service, care treatment or instruction,” "treat patients as objects" (source: Society of Critical Care Medicine: Physician Burnout - A Threat to Quality and Integrity).

This is significant because providers who did not learn disregard for patient dignity and modesty as part of the formal or hidden curriculum of their training are at risk to become offenders due to burnout.

How to Create a Sociopath: Part 5

How to Create a Sociopath: Part 5

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3

How to Create a Sociopath: Part 4

How to Create a Sociopath: Part 5

In regards to gender, patient dignity, etc., the focus of healthcare has always been primarily about healthcare. Patients are secondary. Just like the medieval guilds, healthcare sought narrow regulation of the industry in order to restrain competition against encroachment from outside competition. (Source: A Tale of Two Theories: Monopolies and Craft Guilds in Medieval England and Modern Imagination)

The first AMA Code of Ethics, is all about the patient’s duties to the doctor, not what the doctor owes the patient. To see more how healthcare view the patient in its inception, read Victorian medical ethics and the subordinate patient.

Society granted physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that physicians would be competent, altruistic, moral, and would address the health care needs of individual patients and society. This "arrangement" remains the essence of the social contract. 

...The professions arose in the guilds and universities of medieval Europe and England. They had little impact on society until science made health care worth purchasing and the industrial revolution provided sufficient resources so that society could afford it. Some means of organizing health care was required and society turned to the preexisting concept of the profession. This occurred in the middle of the 19th century, when licensing laws were passed granting the medical profession a monopoly over the use of its complex and expanding knowledge base, thus establishing the basis of the modern social contract. (Source: AMA Journal of Ethics)

Let me demonstrate another example of "guilds" looking out for their own self interest at the cost of human dignity:

PREA is the acronym for the Prison Rape Elimination Act. After decades of societal indifference to prison rape, Congress, in a rare show of support for inmates’ rights, unanimously passed the Prison Rape Elimination Act in 2003.

The law describes prison rape as epidemic. It refers to“the day-to-day horror of victimized inmates, and of the need for Congress to protect the constitutional rights of prisoners in states where officials displayed deliberate indifference.

It took almost a decade for the Justice Department to issue the final standards on how to prevent, detect and respond to sexual abuse in custody. And it took a couple of years more before governors were required to report to Washington, which revealed that only New Jersey and New Hampshire were ready to certify full compliance.

What took so long? Resistance was coming from (and still is) from many correctional agencies. The 52 standards for prisons and jails apply to everything from hiring and staffing levels to investigation and evidence collection to medical treatment and rape crisis counseling.

With the second annual reporting deadline, advocates for inmates and half of the members of the National Prison Rape Elimination Commission (a bipartisan group charged with drafting the standards) say the pace of change has disheartened them despite pockets of progress.

“I am encouraged by what several states have done, discouraged by most and dismayed by states like Texas,” said Judge Reggie B. Walton of United States District Court for the District of Columbia, who was appointed chairman of the now-disbanded commission by President George W. Bush.

Some commissioners fault the Justice Department for failing to promote the standards vigorously. Others blame the correctional industry and unions for resisting practices long known to curb “state-sanctioned abuse,” as one put it. All lament that Congress has sought to weaken the modest penalties for noncompliance, and that five governors joined Governor Perry last year in snubbing the standards. The other renegade states, as advocates called them, were Arizona, Florida, Idaho, Indiana and Utah.

But states face only a small penalty, the loss of 5 percent of prison-related federal grants, if they opt out of the process entirely. There are a lot of carrots in PREA, and not enough sticks.

Texas’ opting out was considered especially significant, however, because it has the largest prison population in the country and by far the most reports of sexual assault and abuse. Texas had three and a half times as many allegations as California in 2011, when California still had more inmates than Texas (according to the federal data).

Texas state officials found some standards particularly intrusive. Governor Rick Perry protested that limitations on cross-gender strip searches, pat downs and bathroom supervision would force Texas to discriminate against its female officers.

Read more at The National PREA Resource Center

One of the lessons of The Third Wave experiment (conducted by schoolteacher Ron Jones's which he created a proto-fascist movement amongst his high school pupils in Palo Alto, California, in 1967) was that organizations are self serving of their own best interests.

By the latter part of the 20th century, however, many social scientists concluded that the profession had abused its privileged status and public trust, and that its regulatory procedures were seriously flawed. (Source: AMA Journal of Ethics)

If healthcare really cared about the dignity of patients, then Tuskegee would not have happened, pelvic exams on anesthetized women would not have occurred and we would STILL been having that conversation in 2012.

The AMA Journal of Ethics alludes to there being something other than gender in Patient Requests for a Male or Female Physician. It refers to a study published in Pediatric Emergency Care in 2005 entitled "'Doctor' or 'Doctora': Do Patients Care?" One of the study survey questions was:

"If you had a choice, would you prefer to have a male doctor, a female doctor, or the doctor with the most experience?"

This throws in to the mix another trait; qualification. Those who defend the gender neutrality of healthcare (on this and other blogs) usually say something to the effect, " I don't care if the doctor is male or female, I just want the most qualified."

So I ask, if by the nature of having initials after your name (MD, DO, RN, PA, NP, etc.) negate patient choice, why should qualification (or what we perceive as qualification, like intelligence, education, experience, etc.)? Remember the old joke, "Q: What do you call the person who graduates last in his class from med school? A: Doctor."

Why should all patients, even those in in the healthcare field, NOT just accept the first doctor or surgeon available?

Studies of the effects of physician gender on patient care have been limited by selected samples, examining a narrow spectrum of care, or not controlling for important confounders. 

...Physician gender potentially affects the physician-patient relationship and its outcomes in a variety of ways. Physician gender differences in personality and attitudes, especially with regard to gender roles, might influence interactions with both male and female patients. Patients also may have differential expectations of their physician based on gender. For example, they might expect the female physician to be more supportive and empathic and, thus, to disclose more information. Another way in which physician gender might be important is in the status relationship between patient and doctor. As gender is a substantial component of social status, same-gender physician-patient dyads may be closer in social status (greater status congruence) than opposite-gender dyads.

Source: Physician Gender, Patient Gender, and Primary Care

And where does perception come in to all this? Sociologists and social psychologists have long known that there is a widespread perception shared by many people that physically attractive people are more intelligent and competent, as well as hold many other desirable characteristics.

A large number of experiments over the years have shown that, when asked to rate the intelligence or competence of unknown others, people tend to rate attractive others as more intelligent and competent than unattractive others. (Source: Psychology Today)

So competence is associated with attractiveness. Then the inverse is that people who are less attractive (or creepy) are perceived not as qualified (and not the best doctor).

To further the concept that there is more than gender, why do we not see physicians with visible piercings and tattoos? Answer; dress affects people's perception of physicians. See "Preferences of parents for pediatric emergency physicians' attire" and "Effect of doctor's attire on the trust and confidence of patients.."

But should it? Should patients not just have trust in a physician because they have initials after their name? Is that not what patients are told about gender.

Creepiness is very real. Our “creepy” reaction is both unpleasant and confusing, and according to one study (Leander, et al, 2012), it may even be accompanied by physical symptoms such as feeling cold or chilly. The little bit of research that was at all relevant focused on how we respond to things such as weird nonverbal behaviors, and being socially excluded. These studies did not use the word creepiness, but their results implied that our “creepiness detector” may in fact be a defense against some sort of threat.

So, what is creepiness?

A recent study (currently under review for publication) by Knox College social psychologist Francis McAndrew and his student Sara Koehnke takes a stab at unpacking exactly what creepiness is.

Creepiness universal human response related to the “agency-detection” mechanisms proposed by evolutionary psychologists. These mechanisms evolved to protect us from harm at the hands of predators and enemies. If you are walking down a dark city street and hear the sound of something moving in a dark alley, you will respond with a heightened level of arousal and sharply focused attention and behave as if there is a willful “agent” present who is about to do you harm. If it turns out to be just a gust of wind or a stray cat, you lost little by over-reacting, but if you failed to activate the alarm response and a true threat was present, the cost of your miscalculation could be high.

We evolved to err on the side of detecting threats in such ambiguous situations. Creepiness is anxiety aroused by the ambiguity of whether there is something to fear, and/or by the ambiguity of the precise nature of the threat—sexual, physical violence, or contamination, for example—that might be present.

Gender plays a role:

Note the rating of traits of creepiness, in this chart of the study results (Likelihood of a creepy person to possess certain characteristics), include gender (opposite 4.01, same 2.41).

95% of survey participants thought creeps were more likely to be male than female — a perception that was equally held by both male and female survey respondents. Women were also more likely to perceive a sexual threat from people they deemed creepy.

See a visualization of creepiness in "The Lonely Island's" song "The Creep."

As to every study done on gender preference of a physician (or other healthcare provider), they are ALL flawed! The flaw simply asks for the preference of a male or female physician. There are so many other variables that affect the decision beyond just gender. Here are examples:

In the study, "The role and impact of gender and age on children's preferences for pediatricians," the sample was taken when coming for an outpatient visit to a university-sponsored, urban pediatric practice. This is a population that is are regular patients at selected practices. These patients are already conditioned (or have developed coping mechanisms to deal with that as a traumatic event).

Data from students participating in the Commonwealth Fund 1997 Survey of the Health of Adolescent Girls, only asks the question of preference of the physician (provider) gender, but NOT necessarily for an intimate (genital) exam.

The study, "PHYSICIAN Gender Preference in Adolescent Males within an Inner-City Youth Population," does ask preference of the physician gender, for a genital exam. The problem is that there is an assumption that a GE is absolutely required, the patient has granted informed consent (including knowing that it can be refused without retaliation).

Note: The only absolute indication for a genital exam is a specific genital complaint. Even then, many diagnostics do not require direct genital examination. Many genital conditions can be diagnosed through urinalysis, blood tests, self-collected specimens (swabs), self-exams, imaging, etc. They are not necessary for "mandated" wellness exams (just as wellness exams are no longer necessary). 

One example is a guidline for testicular cancer from "Teaching the TesticularExam:AModel Curriculum From“A”to “Zack”" which states:

"Patient preference would then determine whether these men would be screened by physician examination and/or TSE."

This is like the situation where somebody is wronged erroneously. The wronged person asked the one who committed the infraction, "Head or stomach?" (The inference is that to "make things right," the wronged party is going to give the perpetrator a "punch." They are being polite in letting them choose the "correction.")

One can study this situation and conclude that a certain percentage of people prefer to be punched in the head and a certain percentage prefer the stomach. Let us hypothetically say 80% prefer the stomach. I can then use this to justify me punching people in the stomach. This is what healthcare has done with gender and intimate exams.

In AAP publications dealing with genital exams, their guidelines all state:

"Routinely examining the genitals from childhood through adolescence can help the male patient understand the routine nature of this examination component." (Example: Male Adolescent Sexual and Reproductive Health Care

Note in the study "Shoe Size Changes - Layman's Marker of Onset of Puberty," 23% of the children refused the SMR exam.

To properly study this question the first question should be: "When going to the doctor, for a genital exam I:
C.) would refuse a genital exam
B.) prefer a male doctor
C.) prefer a female doctor
D.) have no preference if the doctor is male or female
E.) would make my choice on some other factor

An ongoing issue in healthcare is the failure of physicians to acknowledge that these situations are humiliating, can have severe negative side effects, let patients know that they can refuse them without retaliation (whether recommended by guidelines or not), and follow guidelines that call for omitting them.

Discussion about sensitive topics and sexual organs can be uncomfortable for both physicians and patients. If not appropriately addressed, this discomfort can result in inadequate patient education about self-examination of sexual organs, with failure to detect early warning signs of cancer. Discomfort may also result in patients feeling physically and psychologically exposed and humiliated, increasing the possibility of withholding important information or even avoiding the physician completely,1 which could potentially delay cancer screening and/or early diagnosis. Source: Teaching the TesticularExam:AModel Curriculum From“A”to “Zack”

Finally, this humiliation can be the source of many frivolous lawsuits. Consider this conclusion from one of the best articles that recognizes Shame and humiliation in the medical encounter:

I believe that most patients who are angry at their physician or at the medical profession are responding to perceived experiences of shame and humiliation. The specific complaints are not that the doctor makes mistakes, misses the diagnosis, causes too much pain, or charges too much. The complaints are that "the doctor does not listen to me," "the doctor tells me I am too fat," "the doctor seems too busy for me," "the doctor treats me like a piece of meat," "the doctor is sexist," "the doctor insults my intelligence," "the doctor thinks my problem is all in my head." Underlying these complaints, I contend, are the emotions of shame and humiliation.

Social scientists argued that medicine had abused its monopoly to further its own interests, had self-regulated poorly, and that its organizations were more interested in serving their members than society.
Source: AMA Journal of Ethics, "Professionalism and Medicine's Social Contract with Society"

...By the latter part of the 20th century, however, many social scientists concluded that the profession had abused its privileged status and public trust, and that its regulatory procedures were seriously flawed. Standards were considered to be weak, variable, and inconsistently applied, and physicians were further accused of using collegiality as a means of shielding poorly performing peers. Medicine was further criticized for its lack of openness and transparency in regulatory procedures and for the absence of public involvement in them. In short, the system appeared to lack accountability, and it was suggested that an informed public should participate in medicine's regulation. Many of these criticisms proved to be accurate and had an impact on both public policy and on the level of trust that the profession enjoyed.

...Since the medical profession's rights to self-regulation are delegated by society via federal and state legislation, society can, if it becomes dissatisfied with the performance of the profession, alter the terms of the social contract and reclaim some of these powers. Following major lapses in self-regulation and a consequent decrease in trust, society has already diminished the scope of medicine's powers (eg, the Office of the Inspector General's new guidelines for physicians' relations with industry)
Source: AMA Journal of Ethics, "The Medical Profession and Self-Regulation: A Current Challenge"

Patient Paternalism

The new paradigm for healthcare is going to solve this problem. Watch this video of the 2015 Keynote at the IHI National Forum"The Moral Era” given by Donald Berwick, MD. (Note item #8, at 39 minutes and 25 seconds.)

Dr. Berwick states (at 40:30):

“…patient centered care, they are encoding a new balance of power. The authentic transfer of control over people’s lives to the people themselves…"

At 41:15 Dr. Berwick cites an example of the new way of thinking in modern healthcare:

“…Southcentral Foundation, you know in Nuka, they don’t say patient, they say customer-owner. Now you may want to think about that for a minute and see how that changes what you think…”

This is placing the power where it belongs in healthcare, with the patient. Now, if the patient demands the physician’s attention, it is up to the healthcare (hospital) system to figure out how to satisfy all the other other demands put on the physician.

Here is another dose of reality; physicians are not going to be the ones that fix the problem. It would take me writing a book to explain why, but let me offer this bit of insight as to why:

“We can't solve problems by using the same kind of thinking we used when we created them.” 

— Albert Einstein

This is how this new paradigm will fix the broken system.

As patients, we are taking back healthcare.

Patient Dignity

I have heard people describe the issues that I fight for as “patient modesty.” That is NOT the correct term. That implies that the patient is asking for too much, they are too modest,

The issue is really “patient dignity,” and healthcare is NOT giving enough!

This is a flag that I did to symbolize what I do. Notice the mongooses 

fighting the snakes of the Caduceus. This is my refusal to allow 

myself and others to be mistreated by healthcare.

France to ban vaginal exams without consent

"France to ban vaginal exams without consent"

Source: The Local
Published: 29 Oct 2015

France has moved to ban vaginal and rectal exams on unconscious patients after a study found that many were being performed without patient consent. 

It might sound like common sense, but France is set to put an end to the practice of doctors and their students carrying out rectal and vaginal examinations on patients who haven't expressly given their permission. 

The reason? It was revealed that some doctors have been using patients under general anesthetic as teaching tools for their students.  

While doctors claimed it was simply medical teaching, others were outraged that male and female patients hadn't given their permission. 

Among the most vocal were a group of fifty doctors, feminists, and social workers, who wrote an open letter to the French government in February demanding a change to the system. 

The group noted that medical directors had been quoted as saying they didn't ask for permission because patients "might say no", or even that it was "preferable" that the patients "don't remember that people unknown to them have 'had a look'".

Women's rights group Osez Le Féminisme said the examinations met the legal definition of rape in that they were “An act of sexual penetration committed on another, either by violence, restraint, threat or surprise”.  

One former student doctor told L'Express that she remembered carrying out gynocology exams on unconscious patients at a Paris clinic.  

"Before the operation, we were told we could make a vaginal examination when the patient was asleep. We all took turns without asking any questions," she said. 

In response to the revelations, Health Minister Marisol Touraine asked for an official report to be carried out by teaching hospital medical deans, who came back with troubling figures.  

They said no patient consent had been obtained for for one in three pelvic examinations by first-year students, or one in five such procedures carried out by more experienced students.  

Touraine said the report was "very worrying" and "condemned with the utmost firmness these illegal practices". 

"The state will be extremely firm against these unacceptable practices which undermine the integrity of the human body and the human rights of patients," she said in a statement. 

The minister added that new measures would be taken to ensure no one in France would be examined by third parties if they hadn't given prior permission. 

Commentary:

Really?

It took this long to realize that this is a good idea?

One can only ask, “what is wrong with doctors?” If they refuse to practice on each other then why on patients without permission?


Thank you for reading.

Trump Needs to Call Carson Out...

@realDonaldTrump

#Trump2016 

#MakeAmericaGreatAgain    

#Trump

Dr. Ben Carson has thrown his hat in the ring as one of the 2016 Republican Presidential candidates. He had made his share of gaffs. 

He’s compared Obamacare to slavery. He was for gun control – especially assault weapons – before he was against it. He compared homosexuality to bestiality and child abuse. He said fashion models looked like Auschwitz prisoners. (Source: Blue Nation Review)

I do not believe that he can be a candidate unless he answers for the shameful practices of medical schools, AND promises an end to them. I speak of pelvic exams and other intimate exams of patients, while under anesthesia, by medical students, WITHOUT explicit consent. 

Here are links to PubMed articles (National Institutes of Health) on the subject

• Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. 
• Unauthorized practice: teaching pelvic examination on women under anesthesia. 
• The ethics of intimate examinations-teaching tomorrow's doctors. 
• Written consent for intimate examinations undertaken by medical students in the operating theatre--time for national guidelines? 
• Ethics versus education: pelvic exams on anesthetized women. 

The issue was brought to light in 2003. The practice was rampant especially in the 1970’s and 1980’s (Carson graduated medical school in 1977). I am sure that Dr. Ben Carson had learned to to pelvic exams in this manner. A 2003 survey of Philadelphia medical students found that 90 percent reported being asked to perform pelvic exams on women who had not explicitly consented to the procedure. (Source: PubMed, "Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient.” )

This act of rape under the guise of medical care is still happening today. See the 2012 PubMed article, Practicing pelvic examinations by medical students on women under anesthesia: why not ask first? 

As a medical student, Dr. Shawn Barnes had an experience that he says left him feeling ashamed and conflicted. During his rotation through the obstetrics and gynecology ward of a teaching hospital in Hawaii, Barnes performed pelvic exams on women under anesthesia without the women's explicit consent to the procedure… 

"For three weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women," Barnes wrote in an editorial published in the October issue of the journal Obstetrics and Gynecology… 

But Barnes says the exams are done without explicit consent more often than these doctors indicate. A 2003 survey of Philadelphia medical students found that 90 percent reported being asked to perform pelvic exams on women who had not explicitly consented to the procedure. (Source: Live Science)

It is not only women at risk for this, but men are at risk too. (Source: ABC News, "Students Perform Pelvic Exams Without Consent”) In fact, male modesty and consent is often overlooked more than female modesty and consent. (Reference: Patient gender preferences for medical care)

Donald Trump needs to call Dr. Ben Carson out on the issue of how he learned to do pelvic exams and other intimate exams. Has he ever owned up to what he did? Has he ever apologized for what he has done. This does not only happen to women, but to men as well (although it is not as publicized). 

Donald Trump has been hard on all candidates, asking the tough questions. Now he needs to get tough on Carson. 

The problem stems from physicians and medical students believing that patients are obligated to be teaching subjects, hence reducing patients to warm cadavers. This had become such an issue, that ethical research was done to show physicians and students that patients do NOT have an obligation to participate in medical training. (See: PubMed, "Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical students”) 

Even in 2015, physicians and medical students believe that patients are obligated to be teaching subjects and insufficient respect for patients’ autonomy. (Source: PubMed, “Medical Students’ and Physicians’ Attitudes toward Patients’ Consent to Participate in Clinical Training”) 

Please note that I do not have any direct proof that Dr. Ben Carson was trained in this manner,BUT if you look at the 2003 PubMed article cited above, 90% of medical students admitted to being asked to perform pelvic exams on women who had not explicitly consented. When you take in to account a certain number of students may have been ashamed of doing this and lied, the number is higher. 

Further, being a medical student and a person of color in the 1970’s and 1980’s, there was a perception that the medical student was not the most qualified candidate (reference: Black Man in a White Coat: A Doctor's Reflections on Race and Medicine, Taking My Place in Medicine: A Guide for Minority Medical Students, and The Atlantic), hence not the best doctor. 

Couple that perception with the racism of the time (racism is still a problem today), AND being male, Dr. Carson would probably have had very few opportunities to perform pelvic exams as a medical student. (reference: Black Man in a White Coat: A Doctor's Reflections on Race and Medicine, and Taking My Place in Medicine: A Guide for Minority Medical Students) 

None of this is meant to degrade Dr. Carson, in fact it does just the opposite. There’s no doubt that Ben Carson is a brilliant neurosurgeon, although now retired from his illustrious career as a neurosurgeon, Dr. Carson holds 67 honorary doctorates, is a member of Alpha Omega Alpha (AOA) Honor Medical Society and sits on the board of directors of several leading organizations.  

What just as disturbing, is Dr. Ben Carson’s anti-gay views and comments are paramount to a racism of sexual or gender identity. Dr. Carson compared gays who support marriage equality to pedophiles and practitioners of bestiality during a March 27 interview on Fox News' Hannity. (Reference: Media Matters) 

Patients should feel safe at a physician’s office, and physicians expect patients to be honest and tell them the most intimate details of their lives. According to new research, your doctor may biased against LGBT patients. New findings from research conducted by the University of Washington show that health care providers may in fact harbor biases against patients of opposing sexual orientations.

According to the abstract of the study published online Thursday by the American Journal of Public Health, “implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers.” This maltreatment amounts to torture. 

A federal court in Minnesota issued a preliminary ruling in a case concluding that discrimination against an individual because of his gender identity is prohibited under the Affordable Care Act… 

The lawsuit, known as Rumble v. Fairview Health Services, was filed in June 2014 by the Minnesota-based advocacy group Gender Justice. In addition to making claims on the basis of the Affordable Care Act, the lawsuit also alleges the hospital violated the Minnesota Human Rights Act. The court also allows the litigation to move forward on the basis of alleged discrimination under this statute. (Source: Washington Blade)

There can be no free pass for Dr. Ben Carson. Donald Trump talks about getting tough. It is time that he needs to get tough on Ben Carson. He needs to ask him about learning PEs and his views on LGBT individuals.

Thank you for reading.