Tuesday, April 28, 2015

Patient Dignity: But it is Sexual... Redux


In one of my first posts, Patient Dignity 02: But it is Sexual..., I show how touching the genitals (whether it be for pleasure, therapeutic reasons, as a demonstration of power, for procreation, etc., IS a sexual act. 

“If two men, a man and his countryman, are struggling together, and the wife of one comes near to deliver her husband from the hand of the one who is striking him, and puts out her hand and seizes his genitals, then you shall cut off her hand; you shall not show pity.” (Deuteronomy 25:11-12)

Despite what doctors tell patients, the manipulation of one's genitals feels sexual. Now I have research to back my assertion. 


By the very nature of the physical exam it is a sexual experience for both the doctor and patient.[1]

Patients (especially children) perceive genital exposure and the physical examination of the genitals may be experienced subjectively as nosocomial sexual abuse.[2] [3] Many patients suffer lasting physical and psychological effects similar to those who have been the victims of sexual abuse as a result of repeated genital examinations in childhood.[4] [5]

“Repeated examination of the genitalia, including medical photography, may be experienced as deeply shaming. [...] Medical interventions and negative sexual experiences may have fostered symptoms of posttraumatic stress disorder and referral to a qualified mental health professional may be indicated.”[6]

For patients, genital exams (GEs) or genital procedures, to be viewed or touched by another individual was difficult to dissociate from the sexualized situations in which this behavior ‘normally’ occurred.[7] GEs are characterized as a potentially sexualized (as opposed to a strictly clinical) experience.[8] [9] In particular, the genital exam represented a vulnerable and highly sexualized situation.[10]



Gender choice can also affect the degree that a procedure involving the genitals is sexualized.[11] Patients’ preferences for physicians' gender is well documented. [12]

While providers (doctors, nurses, etc.) have training to neutralize these situations, patients do NOT. Clearly, the exposure of one’s genitalia – or the ‘nude body’– is never rendered neutral or stripped of cultural value.[13]

These strategies include objectifying patients, looking professional, threatening the patients, using chaperone, telling jokes about jokes and empathizing with the patients.[14]

Data illustrate how male-female social/sexual relations, even within clinical encounters with female service providers (e.g. genital exams), remain ‘dangerously feminized,’[15] thus retaining a “sexualization” about it.

Many organizations put out guidelines, that have NO SCIENTIFIC BASIS, that claim that, “Routine examination of the external genitalia as part of a well-child physical normalizes the examination for the child and helps to inform the physician about the large variations in normal genitals.”[16] Evidenced-based research has shown that genital exams are NEVER routine.[17] [18] [19]

The “normalization” process that happens when performing genital exams routinely (as per the guidelines[20]) is the same process that normalizes sexual contact in victims of abuse.[21] [22] [23] [24] Normalization is the process by which an idea or behavior goes from clearly problematic to an accepted part of societal culture.[25]


Normalizing is a tactic used to desensitize an individual to abusive, coercive or inappropriate behaviors. In essence, normalizing is the manipulation of another human being to get them to agree to, or accept something that is in conflict with the law, social norms or their own basic code of behavior.

Aggressors often work to make their victims feel less sensitive to, or more accepting of offensive behavior by minimizing, down playing or mocking any negative reaction to inappropriate acts.  In turn, victims often normalize bad behavior (the other person's and their own) by buying into the aggressor's logic and lowering their own standards. They learn to accept as normal what they once believed to be unacceptable, wrong, or dangerous.  Normalizing is achieved when the victim no longer questions a behavior as inappropriate and starts to accept the perpetrator’s assertions that a questionable behavior is, in fact, normal and “healthy.” [26]

The reason that doctors do not know that genital exams are abusive is because the power imbalance of the doctor–patient relationship prevents the patient from voicing concerns and research indicates that the closer the victim is to the abuser, the less likely he or she will disclose the abuse.[27] The patient is pressured to identify with the [abusing] doctor in a positive way by family, the doctor, and other healthcare providers, which is psychologically identified as “Stockholm Syndrome”.[28]

The long-term emotional consequences for the patient of being sexually “touched” by a doctor have been likened to rape or incest.[29] Doctors unconsciously manipulate the situation so that the discussion never comes up; “exploitation can nevertheless be argued if the fiduciary has acquired information about the client's vulnerabilities that otherwise would remain concealed”.[30]

Doctors never explicitly tell a patient that they can refuse a genital exam although ALL guidelines state a “Patient has the right to refuse any or all parts of the exam at any time”.[31] [32] [33] [34] [35] [36]

Providers themselves are prone to sexualizing the patient and the encounter.[37] The following is an extract from the publication “Learning about sexual boundaries between healthcare professionals and patients: a report on education and training” (2008), published by The Council For Health Care Regulatory Excellence (CHRE) of the United Kingdom.[38] It clearly acknowledges that medical students, doctors, and healthcare professionals are not different from any other human beings when it comes to sexual attraction.

Medical students must be taught that there is nothing unusual or abnormal about having sexualized feelings towards certain patients, but that failing to identify these feelings and acting on them is likely to result in serious consequences for their patients and themselves. Students and healthcare professionals should be made aware that while it is not unusual to find patients or their carers sexually attractive, it is the healthcare professional’s duty never to act on these feelings and to ensure appropriate action is taken to avoid a breach of sexual boundaries. If a healthcare professional is sexually attracted to a patient and is concerned that it may affect their professional relationship with them, they should ask for help and advice from a colleague or appropriate body in order to decide on the most professional course of action to take. Developing awareness about the Dynamic of Patient-Doctor relationship is the duty not only of healthcare professionals, but also of patients: It is in fact essential to timely recognize, and prevent sexual exploitation from the doctor. The key point is that the CHRE establishes that dealing with this situation is always the healthcare professional’s responsibility. For this reason, any denial of the fact that both patients and doctors are, due to their own human nature, potentially susceptible to experience sexual attraction, arousal and even feelings during intimate examinations, is not on only very unscientific, and very intellectually dishonest, but it is a severe offense of the supreme value of their human dignity: Neither the patients stop being human and become a simple combination of tissues, nerves and bones when they enter a medical room, nor the medical doctors get magically transformed into robots and lose their human nature when they wear their white coat. Unfortunately many doctors fail to keep up with the standards and the rules of their profession. Those who are in denial and who are not able to recognized and deal with their sexual feelings or their patients' sexual feelings.

Doctors defend these exams as being necessary or routine. What they fail to realize that many of these guidelines have been written by sexual predators. What providers consider a "necessary, normal exam" can be an act of RAPE.

The nurses conducted their exams over the protests of the children, with some crying for their mothers. Still others, intimidated and filled with fear, even attempted to resist physically. Their parents did not know that the exams were scheduled and had not given their consent. So there was no way they could have known the terror their children were enduring during their school day.
The nurses stretched the children out on a floor mat, on top of a school desk, and forcibly removed their clothes. Although the nurses were not even wearing hygienic gloves, they pressed and probed the children's genitals and took blood samples. The exams were conducted en masse--the children endured these humiliations in front of one other, amidst the panic, crying and fear.
When confronted about the situation, the Head Start director responsible for the exams said that he didn't think there was anything strange or unusual about the physicals. The tragic thing is that the director may be partially right--horror trips like this may become less and less unusual. A similar situation has already occurred to middle school girls at a public school in Pennsylvania. (Source: The Rutherford Institute) 



Image courtesy of William H Ayres Watch Blog

Convicted pedophile psychiatrist Dr. William Ayres, was president of the American Academy of Child and Adolescent Psychiatry and co-author of "Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused" which is now an accepted guideline. [39] Many of the egregious acts he used to groom the victims, give him access to their bodies, and allowed him to molest he had written into those guidelines. This has turned abuse into medical procedures. 



The genital examinations of patients of William Ayres appeared to have "very specific” reasons and follow the general consensus of researchers who not only approve of but encourage such methods, a psychotherapist with a medical degree told jurors yesterday.
 
...Dr. Gilbert Kliman, who belongs to the American Academy of Child and Adolescent Psychiatry [Ayres once was president], differed from prosecution witness, Dr. Lynn Ponton, who told jurors there was little if any reason for the genital exams described by 10 former patients who testified.
 
…Kliman disagreed. He called one patient’s file a "delightful psychotherapeutic interaction” and praised Ayres’ methods. …the wider realm of psychiatry which allows — and sometimes proactively supports — the idea of physical and genital exams performed in conjunction with treatment.
Some researchers believe physical exams provide more comprehensive care and "increase rapport” between doctor and patient, Kliman said.
 Kliman conceded he’d likely seek parental consent before performing a physical and genital exam on a minor patient but that it isn’t an industry standard. [40] 
Ayres also said there is nothing inappropriate about a psychiatrist giving physical exams. He said every full pediatric exam should include an inspection of the genitals.  [41] Yet when common sense prevails, it is denounced because it goes against guidelines: 
"My training was very strict on that," said Hugh Wilson Ridlehuber, a retired child psychiatrist who said he was present for Ayres' presentation and once worked out of the same group practice as Ayres. "Even if it's done innocently, there is a very high risk of a patient sexualizing it and affecting your relationship with the patient." [42]


Clearly we can see why PTSD can result from genital exams when preformed professionally and according to recommended guidelines.[43] Doctors and other healthcare providers have committed malpractice for failure to recognize that PTSD, other physical, and psychological side effects can result from the sexual nature of genital exams.











[5] Leserman J. Sexual abuse history: prevalence, health effects, mediators, and psychological treatment. Psychosom Med 2005;67:906-15.
[11] Holland, J., Ramazanoglu, C., Sharpe, S. and Thomson, S. (1998) The Male in the Head: Young People, Heterosexuality and Power. London: The Tufnell Press.
[13] Barcan, R. (2004) Nudity: a Cultural Anatomy. Oxford: Berg Publishers.
[15] Flood, M. (2008) Men, sex, and homosociality: how bonds between men shape their sexual relations with women, Men and Masculinities, 10, 3, 339–59.
[17] Rey-Stocker I : Principes généraux d’examen gyné- cologique; in Salomon-Bernard Y, Thibaud E, Rappaport R (eds): Traité médico-chirurgical de gynécologie de l’enfant et de l’adolescente. Paris, Doin, 1992.
[18] Beyth Y, Hardoff D, Rom E, Ziv A: A simulated patient-based program for training gynecologists in communication with adolescent girls presenting with gynecological problems. J Pediatr Adolesc Gynecol 2009;22:79–84.
[19] Barcan, R. (2004) Nudity: a Cultural Anatomy. Oxford: Berg Publishers.
[30] Feldman-Summers S. Sexual contact in fiduciary relationships. In Gabbard GO. Sexual Exploitation in Professional Relationships. Washington (DC): American Psychiatric Press, 1989: 193–209

Posted by at 1 comment:

Monday, March 9, 2015

Why bad things happen to good people


I wanted to share something with you that has been bothering me. I looked to my faith, and think I found the answer. This is something I have never heard said before, but logically answers the question. 

It really came to light just over a year ago when my pastor gave his homily about a book he read. The theme was "Why bad things happen to good people." I have heard sermons on this before, and they all fail to address the "WHY?"



I have heard answers to "it makes us stronger" to "no one is good" (Luke 18:19 "Jesus answered him, “Why do you call me good? No one is good but God alone"). They either went off on a tangent, focused on a single aspect (like no one is good), or they gave God a pass ("we don't question God"). Probably the closest thing to a good answer was something I read some time ago about Paul Harvey visiting a young man in the hospital dying of cancer.

Paul Harvey wondered, “What can I say to encourage this young man?” He said, “When I came away from that hospital, I was encouraged because this young man who was dying looked at me and said, Paul, I don’t believe that the Divine Architect of the universe [God] ever builds a staircase that leads to nowhere.”



There was also the theory that God does not micro manage our lives, he sees the big picture. Then I remember being taught that God is "all-knowing," so he must know the bad things that and who they happen to. God is "all-loving," so why does He allow these things to happen and why doesn't He stop them?  He is "all-powerful" so he can stop them. (I know, I sound like Nietzsche.)

From my younger and more cynical days, I adopted the philosophy that "God needs to take responsibility for what happens to us." Even worse it seems, people who most follow His laws, suffer the most.

We may cause it to happen to ourselves, but He knows about it and can stop it. I furthered that philosophy by the logic if God created everything including us, He is also the cause of bad things happening to us. At one point I felt guilty about this belief, but that guilt morphed into faith. If I truly believe that God is all-powerful, all-knowing, and all-loving, then He knows about the bad things and doesn't stop them because He loves us.



It was not until I combined this view with another view I had from my cynical days: "People can't be happy unless they are miserable and everyone else around them are miserable too." This was my dealing with my own struggles and trying to answer the reverse of my pastor's homily; "Why do good things happen to bad people?"

See: Lyrics for Soul Asylum's "Misery."
Hear Soul Asylum's "Misery"....

I had to accept that God was all-powerful, all-knowing, and all-loving. That being true, then He created a world where bad things happen to us, He knows what, when, how, and to who they happen to, He could stop them (but doesn't), and He allows them to happen because He loves us unconditionally. Those are my parameters for my theory, they are accepted as fact even though they seem contradictory. 

In the nature of man I found the answer. We need things to be bad. Look what happened when God put Adam and Eve in the Garden of Eden; not a care in the world, everything was fine. How did that work out for us?



You hear stories of celebrities, politicians, powerful people who have it all, then they screw up royally. People who have "billions and billions" [Carl Sagan] of dollars and say that they are not happy. They were happier when they were struggling and had nothing. We acknowledge this with phrases like "Money can't buy happiness, but you can pick your own misery."




Perhaps Jesus was alluding to the nature of man when He said, "Again I say to you, it is easier for a camel to pass through the eye of a needle than for one who is rich to enter the kingdom of God" (Matthew 19:24). I questioned many years ago why can't one be rich and good? Why are the two mutually exclusive? My theory answers this. 



We also hear about the strength and sacrifice that man makes in the face of the worst overwhelming circumstances. A single man will stare down a legion of evil know there is no chance of surviving, simply on the principal of doing what is right. Look at the statue of Fr. Maximilian Kolbe. (I know he is a saint, but learning about him as part of my Polish heritage, he is always "Father" the same way Pope John Paul II will always be Karol Wojtyła.) Fr. Kolbe stared down the Third Reich, alone. 

This theory explains how the existence of great evils come about. Take the Third Reich, in my previous example. Hitler's rise to power was through a labor party (union) that was fighting against the deplorable conditions of the average German citizen. He was fighting against this "misery." That gave him the strength and ability to rise up so fast and so strong. Once things started going good.....  Like Paul Harvey said, you know the rest of the story. 

There is part of another mystery that this answers: Why God became man to save us? It does not answer the "why," but it shed light on the choice of "vessel" (the human body) that God chose. We don't know why God had to endure suffering to save us, but we will assume that this had to happen. So if God came down as God, he could not suffer. He is God, nails, spears, whips, etc. can't hurt him. If he chose another form, the vessel would break before the task was completed (i.e. die from the scourging or give in to the temptation in Gethsemane: "He advanced a little and fell prostrate in prayer, saying, My Father, if it is possible, let this cup pass from me; yet, not as I will, but as you will" Matthew 26:39). In human form, God could have the "human experience" and endure all the pain and suffering that Christ endured. 

This is also a mechanism that saves man from himself. Think of a regulator on a steam engine, also called a "centrifugal governor." (Pic attached, Wikipedia link: http://en.wikipedia.org/wiki/Centrifugal_governor ) It is those spinning balls on every "Willy Wonka" machine. They regulate how fast the engine spins. When things start going good for man and we stop living the way God wants us to, we screw everything up. Now we have to fight to survive and become the person that God wants. 



Let me illustrate: Think of "good" as "light." God, His love, and His goodness is described as "light." God's goodness is so great that we have to turn our eyes away or we will die. "Then Moses said, Please let me see your glory! The LORD answered: I will make all my goodness pass before you, and I will proclaim my name, LORD, before you; I who show favor to whom I will, I who grant mercy to whom I will. But you cannot see my face, for no one can see me and live." (Exodus 33 18-20)

Man is made in the image of God (Genesis 1:27), then some of that light is in us. Obviously it is not as strong as God's, but there is some light there. (Again, ALL good is light, no just God's goodness.) When things are going good for us (noon time, sun shining bright), you can't see man's light or our light looks darker.



But when things are at their darkest, our light shines the brightest. When things are going really bad, we are capable of amazing things. The darker it gets, the more that you can see our light is the light of God.

This is just a theory of mine. I have never heard it put forward before and it lends itself to the answer of other questions (like why Christ became man).

So let me finish with this....



Thank you for reading AND stay STRONG!



Posted by at 1 comment:
Labels: ,

Wednesday, January 21, 2015

Informed Consent is Missing from Male Adolescent and Young Adult Cancer Screening

Consent, particularly informed consent, is the cornerstone of patients’ rights. Consent is based on the inviolability of one’s person. It means that doctors do not have the right to touch or treat a patient without that patient’s approval because the patient is the one who must live with the consequences and deal with any discomfort caused by treatment. A doctor can be held liable for committing a Battery if the doctor touches the patient without first obtaining the patient’s consent. (Source: Farlex Legal Dictionary "Patients’ Bill of Rights" [Redirected from Federal Patients’ Bill of Rights])

Informed consent is missing from many areas of healthcare. With new guidelines released, there has been a focus on informed consent missing for women's annual pelvic exams. Informed consent is missing from from male pelvic cancer screening as well. 

Informed Consent

One of the best resources on informed consent is Temple Health's (Temple University) "A Practical Guide to Informed Consent." It states:
Informed consent is an ethical concept—that all patients should understand and agree to the potential consequences of their care—that has become codified in the law and in daily practice at every medical institution. One of the earliest legal precedents in this area was established in 1914 when a physician removed a tumor from the abdomen of a patient who had consented to only a diagnostic procedure (Schloendorff vs. Society of New York Hospital). The judge in this case ruled that the physician was liable for battery because he violated an “individual’s fundamental right to decide what is being done with his or her body.” [Edwards 1998, Wescott 2005] 

Women's Pelvic Cancer Screening

Doctor Joel Sherman, a cardiologist and an advocate for patient dignity, had written a a November 2009 article, "Informed consent is missing from Pap smears and cervical cancer screening." In the article, he points out that women are rarely given complete information and the choice for cervical cancer screening. Here are some other articles on the topic:

In fact, many women are coerced in to cervical cancer screening. Physicians still require women to submit to cancer screenings and pelvic exams before prescribing or refilling of oral contraceptives, despite guidelines indicating they are unnecessary, research suggesting they can pose a barrier to contraceptive access, and NO laws requiring the invasive and humiliating exams.

One study found that 44% of clinicians who prescribe oral contraceptives admit to requiring the exam. (Source: Over-the-Counter Working Group) In reality, the percentages requiring exams are much higher. In another study, "Nearly all respondents indicated that they would perform the examination in the 55-year-old despite the absence of her ovaries, uterus, and cervix, and over half believed it to be very important for this woman." (Source: American College of Obstetrics and Gynecology "Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists")

Male Pelvic Cancer Screening; Lack of Evidence

One group that is not afforded full disclosure to make an informed decision (informed consent) is male adolescents and young adults. These exams are done more as ritual than evidence based medicine. The American Academy of Pediatrics' guideline, "Male Adolescent Sexual and Reproductive Health Care" states:
Despite the lack of evidence-based guidelines supporting routine testicular screening and teaching of testicular self-examination for detection of testicular cancer, a genital examination, including examination of the testicles, represents an important part of a male adolescent's complete physical examination during annual preventive health visits and, specifically, as part of a visit related to a genital complaint. The content of the pediatric/adolescent physical examination required to report preventive health care codes (Current Procedural Terminology [CPT] codes 99382–99384; 99392–99394) depends on age and developmental level and would be expected to include a male genital examination...

Despite the lack of recommendations that support testicular cancer screening, the USPSTF... The American Cancer Society has stated that it "does not have a recommendation on regular testicular self-examinations for all men"... An external anal inspection, a digital rectal examination, and screening for hernia as part of the male adolescent physical examination should be performed on the basis of specific concerns or complaints such as a bulging mass or pain (hernia examination), hemorrhoid or rectal bleeding (digital rectal examination), or risk factors that would warrant an external anal inspection for HPV lesions in a young man who engages in receptive anal intercourse.
Along with the the lack of recommendations that support testicular cancer screening, the USPSTF makes no recommendation for either hernia or pubertal development and other disorders. The Journal of Family Practice states "Insufficient evidence exists to recommend for or against screening genital exams for boys playing sports."

Other Reasons for Screening

The content of the pediatric/adolescent physical examination required to report preventive health care [billing] codes (Current Procedural Terminology [CPT] codes 99382–99384; 99392–99394) depends on age and developmental level and would be expected to include a male genital examination. 

Routinely examining the genitals from childhood through adolescence can help the male patient understand the routine nature of this examination component. 
Providers point to another value to doing a genital exam which is the clinician learning what the range of "normal" vs "abnormal" exam findings are and the range and variation present in human genitalia (citation needed). Is that disclosed as part of informed consent?

Respecting Patient Dignity and Autonomy

Sexual health also requires a positive and respectful approach... People should be able to have pleasurable and safe sexual experiences free of coercion, discrimination, or violence. Men, along with women, have the right to be informed and have access to safe, effective, affordable, and acceptable methods of family planning of their choice and the right of access to appropriate health care services...

Trust and relationship-building are also critical elements of the male adolescent's visit that help him to feel comfortable regardless of a physician's gender and/or background.

Examination in gowns will help prevent missing important physical examination findings, such as gynecomastia or truncal acne. A 
Health care providers might be confronted with male adolescents who refuse a genital examination because of concerns about homophobia, lack of experience with such examinations, fear of getting an erection, or even because of previous abuse. 
Understanding the specific concern can help the health care provider educate the patient about the importance of this examination, determine the priority of such an examination for a particular patient, and negotiate how and when to complete the required components of the examination. Routinely examining the genitals from childhood through adolescence can help the male patient understand the routine nature of this examination component. The use of a chaperone might also be relevant and should be considered during all genital examinations for patient and/or provider comfort regardless of whether the provider and patient are the same gender.
Note: The term "informed consent" does NOT appear anywhere in the above publication.

 Here are the problems that I have with genital exams for males:
  • True informed consent is not present. 
    • Evidence does not support exams
    • Exams are rarely OFFERED, that is patient is told that they may decline.
  • Gender of provider is ignored.
  • Use of a chaperone is usually not a joint decision.
  • Gender of the chaperone is ignored. 
Most patients have gender choice in their providers, adolescent and males especially for genital exams. The following studies that confirm patient gender preferences:  
Doctor Sherman goes in to more detail about gender and embarrassment  in "Adolescent Boys and Genital Exams Reducing Embarrassment". This is an excellent piece, I suggest reading it. 


Dismissing the Patient


Too often the solution by providers is to dismiss the patient.
 When the patient's beliefs—religious, cultural, or otherwise—run counter to medical recommendations, the physician is obliged to try to understand clearly the beliefs and the viewpoints of the patient. If the physician cannot carry out the patient's wishes after seriously attempting to resolve differences, the physician should discuss with the patient his or her option to seek care from another physician. (Source: American College of Physicians "ACP Ethics Manual 6th Edition")
Patients are allowed to choose the level of care that they wish to receive. Threatening dismissal is only coercion and the physician NOT trying to earn the trust of the patient.

Psychological and Emotional Trauma

A study in Journal of Reproductive and Infant Psychology Volume 11, Issue 4, 1993, "Post-traumatic stress disorder in women who have undergone obstetric and/or gynecological procedures: A consecutive series of 30 cases of PTSD." highlights the psychological and emotional trauma from intimate exams.

 Forwomenseyesonly ("Gynecological Procedures Can Cause PTSD") highlights the study: 500 women took part in a study about the psychological effects of vaginal exams, pap tests, and other gynecological/obstetric procedures. Of the 500 women who took part in the study, over 100 women reported their experiences as ‘very distressing’ or ‘terrifying’. Of the 100 women who reported distressing experiences, 30 were diagnosed with PTSD. The study highlights the similarities between the after effects of rape and women’s experiences with gynecological procedures.
There is a lack of research related to PTSD following gynecological procedures. The study quoted above was published in 1993, and there does not appear to be any follow-up research specific to gynecological procedure- related PTSD published since that time. There has been some recognition in the literature given to the trauma of pap tests experienced by women with a history of having been sexually assaulted, but the trauma caused by pap tests themselves is generally ignored.
Some of the phrases used by the women who took part in the study to describe their experiences include:
"dehumanizing and painful";
"degrading and distressing";
"my opinions were dismissed as irrelevant";
"hurting and feeling violated";
"very brutal internal was excruciating";
"it felt undeniably like rape".

30 out of 500 is 6%!. Just as OB/gyn procedures can cause PTSD, there are so many other procedures (such as male genital exams) that can do the same. What about the borderline diagnosis? Those who may not have full onset PTSD, but have been traumatized none the less?

Conclusion:

The genitalia are part of the body too. They can become diseased, or give clues to disease in other part of the body. A physician who does not offer to examine the entire body during a routine physical exam is doing a great disservice to the patient. If the patient refuses that is their right, but they need to know that there is a risk of missing something serious as above.

These exams should be "offered" after discussing the associated risk factors unique to each patient while clearly be given the opportunity to decline. If they elect the exam, they should be conducted privately without a chaperon, unless the patient requested one, and then only if the chaperon was the gender the patient was comfortable with.

From the stand point of "Informed Consent," the first conversation needs to be IF the patient is going to allow the exam. After that, then HOW it will be preformed needs to be discussed. 


Thank you for reading.










Posted by at No comments:
Labels: ,
Subscribe to: Comments (Atom)