Friday, September 3, 2010

Not Just Bodies


By Doug Capra © 2010

A few years ago, I came across an interesting article while surfing the web. It’s title immediately attracted my attention -- “NOT JUST BODIES: Strategies for Desexualizing the Physical Examination of Patients” It can be found in by Patty A. Giuffre and Christine L. Williams. Both authors are sociologists, not medical professionals. I noticed the study wasn’t published in a medical journal, but in Gender and Society put out by Sociologists for Women in Society.

Since doctors and nurses routinely deal with naked bodies, the study asks how these professionals avoid or deny their personal sexual feelings. How do they deal with patients who show sexual feelings toward them? Polices and professional ethics standards guide them in many ways. In medical and nursing school they are taught to desexualize the human body, to hide their feelings, avoid emotional involvement and to use scientific, technical language, But these are often strategies taught in the “academic” curriculum. Students then go on to learn and develop many other strategies in the “hidden” curriculum as they enter the profession. Most of us have experience this “hidden” curriculum. You’re given training, then you get on the job training, then you start working, perhaps with a mentor. “This is what you learned in school,” they tell you. “But this is how we really do it.” Or, the message isn’t even verbal. It’s taught silently. You just watch and learn.

In medicine, the “hidden” curriculum can be extremely powerful since it gathers its strength from medical history, tradition and culture.

In discussing “patient” modesty, we are sometimes missing the other half of the equation -- that is, doctor and nurse modesty. As human beings, these medical professionals bring with them into the examination room just as much emotional baggage as do patients. Doctors and nurses have certain feelings and values associated with bodies and nudity. They don’t leave these issues at home.

But -- the big difference between these medical professionals and most patients is the years of experience they have had dealing with naked bodies. Nudity becomes routine to them. They may still have the feelings and attitudes they began their professional experience with, but the report “Not Just Bodies” found that “With few exceptions, the men and women in this study reported that they were uncomfortable performing examinations in the early part of their training but that they became more comfortable as they progressed through their careers.” The report goes on: “Several physicians and nurses noted that they ‘see 20 patients a day and everybody looks the same’ and that they ‘have been doing this for so long’ that they never get uncomfortable.”

Why? Because they have developed strategies to deal with this. At the very least, these strategies make them feel comfortable.” That’s the key, and it makes sense. To do a any job competently, one has to feel comfortably competent.

The more empathetic, experienced and talented doctors and nurses have developed a variety of strategies that work different patients with a focus on making the patient more comfortable, too. But some medical professionals, depending up the personal baggage they bring with them, and their communication skills, are more focused on their own comfort, or perhaps on just getting the task done.

This study deals with physician and nurse comfort. But the theory seems to be that if they feel comfortable and go about the exam demonstrating that comfort, then the patient will be comfortable. And that theory as much merit to it. No one wants medical professionals working on them who seem uncomfortable and uncertain of what they are doing.

But this is a tricky and sensitive subject. And, as far as I can determine, it’s rare to find any studies that look at this from the patient perspective. How do patients see this? What strategies work for what patients? What role does the gender of the doctor or nurse play when matched with male or female patients? How do patients react to strategies used by same gender care or opposite gender care?

This study focuses on gender and the caregiver as it tries to answer questions like “How does the gender of the doctor or nurse, and the gender of their patients, figure into their choices of which strategies to use? The authors aren’t so much interested in how successful or effective these strategies are, but rather the logic behind the strategies used and how they may differ for male and female patients.

These strategies, the authors contend, are mostly “unreflective habits bolstered by an organizational context that frames their workplace interactions.” We can call this the hospital or clinic “culture,” the underground values and mores that are mostly hidden, not discussed, rarely challenged, considered “just the way we do things around here.” The authors write: “…it is likely that most health care professionals follow hospital rules and conventions without considering their disparate impact on men and women. Many may not even be aware that they use different strategies for men and women.”

The researchers conducted lengthy interviews with doctors and nurse, asking questions like: “How do you make yourself and your patients comfortable when you are physically examining them when they are unclothed? (Note here that the interviewers don't appear to ask how the doctor or nurse really knows if the patient is comfortable. Do they ask?) Do you think you treat your male and female patients differently? Are you concerned about allegations of sexual impropriety? If so, how do you protect yourself from false allegations?

I believe this study is extremely important. I’m not claiming it is definitive. The authors didn’t interview thousands of medical professionals -- but they did conduct in depth discussions with the ones they did contact. This study does represent, I believe, important indicators regarding patient and caregiver modesty and how this subject intersects between and among them. I would like to see a team of sociologists and doctors continue studies in this area, perhaps using this study to help them get started.

In a series of articles, I will cover these various strategies from the patient perspective, how to recognized and analyze, and more importantly, how to communicate your feelings to caregivers based upon how comfortable you feel.

These strategies discussed in this study are:

-- Using a Chaperone
-- Objectifying the Patient
-- Empathizing with the Patient and Protecting Privacy
-- Joking about Sex (I would broaden this to read -- Using humor, perhaps body humor.)
-- Threatening the Patient (I would rather put this as -- Using power to control and/or intimidate patients to do what they’re told.)
-- Looking Professional

These are the strategies we’ll explore in upcoming articles --
but more specifically, how patients can recognize these at work and learn to express their personal comfort level. If a strategy makes you feel uncomfortable, more embarrassed, or humiliated -- don’t hesitate to speak up and let the doctor or nurse know. They may or may not even be aware of how what they are doing affects you as the patient. And if you find a caregiver who is particularly good at making you feel respected, valued, dignified and comfortable in any intimate situation -- be sure to compliment them. They don't often get feedback in this area and, like all of us, I'm sure they would appreciate knowing they did an excellent job.


Suzy Furno-Maricle said...

It is interesting to show the other side of the equation, however I find some of the things admitted by caregivers conflicting.
" that is, doctor and nurse modesty. As human beings, these medical professionals bring with them into the examination room just as much emotional baggage as do patients. Doctors and nurses have certain feelings and values associated with bodies and nudity. They don’t leave these issues at home."
Then they say "they ‘see 20 patients a day and everybody looks the same’ and that they ‘have been doing this for so long’ that they never get uncomfortable.”
Of course they do not get uncomfortable. We are talking about the difference between viewing nudity and being nude. Most people whether they are medically trained or not have less anxiety viewing others naked than being naked themselves. This is not any sort of special caregiver trait that should make people feel less modest.Instead, it points to the obviousness of the problem and the lack of respect caregivers give it.
Maintaining ones own level of modesty while dening others the validity of theirs (if true)is a bit sociopathic. And it does not seem possible to teach 4 million people selective and compartmentalized sociopathy.
These tricks of the trade are simply coersive tactics to fulfill the needs of the caregiver.
They are projections of what they want people to believe.
If one believed that caregivers maintain their own modesty, but do not realize that they may be offending others sense of modesty is conflictive. It is not plausible to believe that caregivers dress before leaving home, pull curtains when showering, and close doors when using the restroom, and then 'forget' that others feel the same.
If caregiver were more honest and less manipulative, we could get to the core issue of modesty and perhaps fix the broken system by oferring ethical solutions.

Doug Capra said...

I don't disagree with much of what you say, swf. The nature of the work of doctors and nurses is that they deal with naked bodies -- they examine them, look at them, touch them. My goal in this series of articles is to try to show patients what may be going on with them. Patients need to observe these things. Patients need to learn, to some extent, to be participant-observers. Note these strategies and decide how you feel about how you're being treated. Point out the problems you may have with your treatment.The strategy Dr. Sherman just wrote about, using chaperones, is a good example of how doctors may protect themselves. Patients need to note when "assistants" are really "chaperones" and decide whether that's okay with them. If not, point it out. If "chaperones" are used, and the patient isn't given a choice or even asked, it's obvious that the chaperone is for the doctor.

María said...

SWF is to be commended for her comment. What really compelled me to write is when they say "everybody looks the same". WOW! really???
Tell me... If everybody "looks the same", why are there people so beautiful or good-looking that they make a living exclusively because of it? From the beautiful young lover of an old king to movie stars nowadays, nobody except for these distorted individuals believe that. Not only it makes me angry, it makes me doubt their sanity. An attractive individual is an attractive individual, no matter the context, and an ugly one is an ugly one. No amount of draping will change that. I don't care if I am insulted, bullied, or whatever. I am convinced that an attractive girl or woman should never be alone with a male caregiver, nurse or doctor I don't care. BTW, by escorted I men someone she trusts, not some chaperone who is often a desk clerk, doesn't care about the patient and is there only to save the doctor's medical butt.
As for males, they also should be more assertive and think about the topic. I am convinced tht male healthcare workers may be intensely jealous of patients that are unussually "big", too. And there are jokes for those that are "micro"!... MER, don't believe me? Go to all nrses and search for "embarrassing". Look at the thread where they describe the most embarrassing moment in their nursing carrer. You'll see two comments about size, one too big (Afro American, of course), and one too small. Of course, now it's "closed for review"!

Anonymous said...

Maria -- It's not that I don't believe you. Your take is that this behavior is the norm. I contend that it happens, but it isn't the norm. The fact that it even happens bothers me, especially that the medical culture doesn't encourage (support?) other caregivers to report this behavior. People who report can endanger their careers. I would also suggest that in our current society we have what I'll call the "Cult of the Body." Just look at magazine covers. The concept of beauty has a tight, glossy look -- abs are in, fat is out. So, this idea of "just bodies" doesn't match what our media culture touts. As a culture we're very into the difference between media-promoted beauty, and what we really look like. Providers are as much affected by these cultural mores as the rest of us -- and, yes, it does get reflected in their work and how they respond to "Just Bodies."

Anonymous said...

Very well explained, l agree and how I feel about privacy violations against me...medical caregivers don't even want thear it.i've filed complaonts and my calls were not returned,the quality of care nurse even said,''I've read over the reports and talked to staff members involved ,and find nothing in question,sorry about your displeasure.'' Doctors and nurses do not understand that some men are humiliated when female nurses and doctors see their private areas. I know they see it all the time. Maybe some male patients do not care if nurses are going to see and touch their genitals. But I have canceled several procedures to avoid female caregivers. Lpoking fpr a hospital with all male surgical teams has been discouragong and without success. The fact that very little is being done to prevent male patients from being ''patronized or intimidated even humiliated'' while privacy concerns are ,not an issue caregivers think about ...only hospital administratipns can change this problem. That will help me and men like me seek more medical care and keep appointments we should keep,instead of worrying,and getting so stressed that our choice of a solution is to cancel the appointment or to not even seek medical care . Yes I have had panic attacks prior to surgery,and knowing female nurses and scrubs and anesthesialogists will see every part of me and not care how embarrassed and humiliated I feel before surgery ,and how that makes me deny any pain just so I can leave as quickly as I can. Now I won't even drive past a hospital,I am so discouraged I wouldn't accept advise from my doctor and an appointment schedueler to make and keep appointments.This all has to stop soon.It would help if caregivers would show concern and offer options and solutions.

Will King said...

I tend to agree with much of what is said.

Having worked in the medical field, and seen numerous naked people - I sometimes had thoughts come into my mind - such as how attractive / unattractive a person's body looked, but never expressed those thoughts. As time went on, I was more de-sensitized, and the thoughts/ visuals did not stick in my memory.

That all makes sense - part of being normal and human.

For me,the difference between Dr. / Nurse modesty versus the Patient is that the Dr./Nurse chose to ne in this field and they are not the ones getting naked. If they are uncomfortable, then they chose the wrong profession or need to chose a field with no / little nudity - such as Ear, Nose, Throat or Podiatry.podaitry.

I went to a Primary Care Dr., and she seemed very uncomfortable with the nudity and I could tell she was trying to delay it as much as possible. Once the underwear was lowered, had to be the fastest testicle and digital exam I've ever had. It clearly made me uncomfortable and reluctant to discuss any sexual or genital concerns I may have.

On the other hand, I went to a Dermatologist and it was so natural and comfortable. She did not ask - "can you remove your underwear" or "do you mind if I look". When it came time for that part of the exam, she simply pulled them down and did the exam, - no big deal. I really liked that she didn't try to make a joke or awkward conversation, like "well, I guess it's time to look at the guy things".

For the medical field, I think they need to stop trying to have a "one solution fits all" attitude.

I like how masseuse handles it and leaves it the to customer. Why can't the Nurse offer, "for today's exam we will be examining your full body, and you'll need to remove all your clothes. You can go ahead and get completely undressed, or if you, prefer, you can keep on your underwear until that part of the exam."

Treated as normal - no big deal. Deal with those that are more modest, but above all let the patient make the decision as it their body and their health.

Doug Capra said...

Thank you for your comments, Will. Some medical professionals are or become comfortable with patient nudity. Unfortunately, some become so comfortable that they forget whose nude and how that person feels. Others don't. Some medical professionals are so uncomfortable with nudity that they choose defense mechanisms to protect themselves -- strategies that protect their sensibilities but not the patients. Others use strategies that are empathetic and empowering for the patient. What makes it complicated is that what works for one patient may not work for another. Generally, one strategy isn't always better than another -- it depends upon situation and patient context.
What does all this mean? As you say, communication. And empathy.