A Disgusting Article

I am writing regarding the article, How Patient Modesty Affects Medical Care. This article is an affront to human dignity (patient dignity being a subset of this). 

I will make my argument why this is an affront to patient (human) dignity. 

Many patients avoid healthcare due to dignity (modesty) issues.

Today patients view themselves as customers and expect that their needs will be met. Yet, the paternalism that still infects medicine fights back against the concept that patients are customers and meeting the patients' needs.

Patient dignity is the correct term to use (as opposed to patient modesty). "Modesty" is no longer the correct term to use (in the same way that non-adherence" replaces non-compliant).

First let us establish some definitions.

mod·es·ty / ˈmädəstē /

noun Behaviour, manner, or appearance intended to avoid impropriety or indecency.

Source: Oxford Dictionaries

dig·ni·ty / ˈdiɡnədē /

noun The state or quality of being worthy of honour or respect.

Source: Oxford Dictionaries

The mercurial concept of human dignity features in ethical, legal, and political discourse as a foundational commitment to human value or human status. The source of that value, or the nature of that status, are contested. The normative implications of the concept are also contested, and there are two partially, or even wholly, different deontic conceptions of human dignity implying virtue-based obligations on the one hand, and justice-based rights and principles on the other.

Source: The Internet Encyclopedia of Philosophy (IEP) (ISSN 2161-0002) (peer reviewed)

My argument  is that referring to the human condition of not wanted to have one's (the patient) body exposed (being naked) as modesty can be construed as the patient is asking for something that they are not entitled to. The phrase that most demonstrates this is "You are being too modest."

Dignity on the other hand takes into account the intrinsic value of a human being that makes the person deserving of being treated in an absolute, respectful, and dignified manner that is not open to interpretation or negotiation. To treat one in this manner is often not the easiest option and can be inconvenient.

The basis for human dignity (by non-atheists) is that we are endowed with it by our Creator (God). For Judeo-Christians (such as myself) the concept is furthered in that we believe that we were "created in the image of God."

This was rejected because the thread has been titled "Patient Modesty" and a change would some how create a disconnect. This is nothing more than marketing fluff. I will expand on this.

As an online resource for "reliable, understandable, and up-to-date health information," you use correct terminology, especially in regards to medical terminology as well as human anatomy. Not only does this keep the procedure medical in nature (as opposed to being sexual), but it also denotes the professionalism of the physician (provider) by showing that they are (properly) educated in the correct terminology.

By using the term modesty instead of dignity, it is making one look less professional and less educated.

The term "modesty" blames the victim. The patient can be accused of being too modest.

Modesty is taught to girls at some of the youngest stages of their lives. Modesty as projected by the person (patient) is t different levels. (Read about how New Jersey 'Mormon Prom' Draws Hundreds Of Teens For Celebration Of Modesty.) Modesty is about one choosing to be modest.

Teens were required to sign a pact agreeing to dress and behave modestly, to dance “appropriately” and to abstain from using alcohol or drugs...

The nearly 300 students abandoned several conventional prom practices — including arriving in limousines and wearing expensive outfits. (Organizers encourage attendees to be modest in their spending as well.) Most were dropped off by their parents, and some of the girls swapped or borrowed dresses to keep down the cost...

The problem in healthcare is that providers are taught to respect patient modesty and NOT patient (human) dignity. Let me expand...

An anesthetized patient (technically) has no modesty. [Everybody line up to practice rectal exams on the anesthetized patient.] An anesthetized patient DOES HAVE dignity. The lack of consciousness negates the presence of modesty being practiced, requested, or displayed.

I bet you know where I am going next...

A cadaver has no modesty. A cadaver DOES HAVE dignity. Increasingly, medical schools are having ceremonies honoring the sacrifice that people made leaving their body to science. This is to humanize the cadavers where traditionally (and still today) the cadavers were de-humanized. This is what happens when medical providers are taught to respect modesty and NOT taught to respect dignity:

...Last month, Stony Brook University Medical Center in Long Island announced it was developing a revised ethics policy after a student posted a photo on Facebook of a classmate posing with a thumbs up next to a cadaver. The State University of New York Upstate Medical University in Syracuse also is updating its ethics curriculum after a former resident posted a snapshot of an exposed brain on Facebook...

Let us also NOT forget the Denver 5...

By using the term modesty instead of dignity, nullifies and disregards the basic intrinsic value that human beings have and deserve being sentient beings and as endowed by our Creator. This is akin to calling a black man "boy."

...One, it's the ultimate sign of disrespect, and is often more offensive than calling them the N-word. For years black men were summarily dismissed and treated with disregard. It was as if their stature was diminished when someone white called them a boy...

Do you remember the images from the sanitation strike that the Rev. Dr. Martin Luther King Jr. was leading in Memphis in 1968? The most striking visual was that of the male protestors wearing signs saying, "I Am A Man!"

This mirrors the profession of medicine. Just as the hidden curriculum, the use of the patient gown, and teaching the term "modesty," helps retain and the paternalistic power that physicians are desperately trying to hold on to. It makes the doctor-patient relationship resemble the parent-child relationship.

For at least 2,500 years, the doctor-patient relationship has resembled the parent-child relationship. The norms of medical ethics, codified in historic documents or perpetuated as informal traditions, encouraged doctors to shield patients from bad news and from general medical knowledge. While Western medical tradition has always included some patient protections, such as informed consent (and its antecedents), doctors have possessed broad powers to withhold treatments that patients desired and, at times, to mislead patients for what they perceived to be the patients’ own good...

Even the term "doctor-patient relationship" attempts to consolidate and preserve physician power br putting the doctor first. I prefer the term "patient-physician relationship" because it puts the patient first, and recognizes the difference between a doctor (PhD) and a physician (medical doctor).

In the evolution of the doctor-patient relationship, such outdated terms are replaced with the correct term. The new terms show a respect for patient (human) dignity. One such example is noncompliance vs. nonadherence. Noncompliance as a term is a slur against patients. Nonadherence has become the preferred term to use.

The British have what I believe to be a much more acceptable term: “concordance.” This term recognizes that health care providers serve as consultants to their patients (or “clients,” as our psychology colleagues call them). Concordance implies a more equal relationship, in which the health care provider offers input, the patient offers input, and together they discuss, negotiate, and reach agreement on the most appropriate management plan for the patient.

Noncompliance painted a picture of a paternalistic provider mandating the rules of play, while the patient cowered below as a disobedient subordinate. It also implied that the patient did something wrong by breaking the rules and that the actions of the patient ought to be modified to fit the rules, rather than the other way around. On the other hand, non-adherence signified that the patient was a contributing partner in the development of the treatment plan and, further, that he may be justified for not abiding by the terms of his plan.

Many facilities have ordered the term noncompliance with nonadherence. There is a current movement to do away with the term nonadherence (along with noncompliance), because they can interfere with treatment.

Non-adherence used to be called noncompliance, which sounded too paternalistic. Now some experts are shifting to an even less judgmental language of "medication abandonment."

Now let me show how this practical application of the term "dignity" benefits providers.

There is no question that providers' modesty is respected in the healthcare setting (they wear white coats OVER their clothes, where patients remain half-naked wearing only a gown). Now if the profession of medicine was set up to respect patient dignity (human dignity), it would notice and correct the affronts to provider dignity (physician burnout, mental illness, EHR, etc.).

Trisha Torrey tells patients to "get over it" despite their reasons. This is very unprofessional and borders on malpractice for providers for not taking history of past abuse into account. 

This article also is contradictory to trauma informed care, especially trauma from healthcare providers.