Not Just Bodies

DEAR DOCTOR AND NURSE: WE’RE 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.