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Tuesday, October 25, 2011
Nicole Lee is the creative director of Stirrups and Stories. She has worked in the area of sexual and reproductive health for over five years: taking sexual histories, training others to do the same, working in HIV prevention, and providing quality control for clinic and agency management.
The word “modesty” is loaded with too much emotional and cultural connotative meaning to be a neutral concept. Who is saying the word, and how, and to whom, and for what purpose? Is “immodesty,” with all of its attendant frightful connotations, the shadow defining the edges of modesty?
In the context of health care provision, modesty is a double-edged ideal: on one hand, respecting patient-initiated modesty enhances our ability to serve patients. Some of the ways we do this include: acknowledging and responding to the cues our patient gives us about her level of comfort; by asking for permission and consent before touching her; by echoing the language she uses; by avoiding unnecessary, invasive procedures; by acknowledging the legitimacy of her family structure. We do this by listening – and hearing – what she is saying to us. By explaining in language she understands why we are asking intrusive questions, and working with her to procure the necessary information. By respecting a denial of consent and fully honoring the process of informed consent. By seeking training on cultural competency specific to the populations we see.
Such a type of respect requires our acknowledgement of the wholeness of the patient in front of us, including the soul and the heart that embraces that modesty. No longer is she a composite of parts and organs and symptoms, a medical puzzle waiting for construction (or deconstruction): her embodied self is not our disembodied medical task. When we as health care workers are respecting a woman’s own sense of modesty, we are helping to make more visible the value system in which she functions. Significantly, that value system is fundamental to the context in which our palliatives, prevention, and education must succeed, and is a potentially key part in identifying pathogens or risk.
On the other hand, if a health care worker or policymaker enforces modesty, the relationship between patient and provider is inhibited. Such a dynamic can silence a patient, leaving health care workers without knowledge that may prove vital to providing care for a given woman.
The enforcement of modesty is rarely overt, but instead typically a thoughtless perpetuation of a set of cultural norms that liken immodesty to being unladylike. It provides a prescription of acceptable behaviors and appearances for women to assume, and defines the dimensions of space women are allowed to occupy.
Is it immodest and unladylike for a woman to disclose the number of sexual partners she has had? To choose not to shave any particular body part? To use abrupt or rough language to describe her experiences? To talk openly and unashamedly about her partner(s), who may be of the same sex? To speak of her abortion with sadness and no shame, or with no sadness at all?
Is it unladylike for a woman to challenge our authority as medical care providers?
Women are faced with a variety of messages that often boil down to one – the feminine ideal is to be a lady, so avoid an immodest exposure of self.
Are our offices spaces where women can expose the necessary parts of themselves without fear of sanction?
If they are not safe because we (or our staff) judge our female patients for not abiding by the standards that we, possibly unconsciously, have for women, it is nearly impossible to conceal. Our biases are conveyed in a plethora of ways both subtle and overt, including how we ask questions (and which questions we choose not to ask), our body language, our double standards for men and women.
Conversely, by ignoring a woman’s own unique modesty and sensibilities, we are imposing on her an authoritarian message of subservience and disrespect. Without thinking, we risk telling her that “her body is ours” and that she has given up certain rights merely by seeking health care. This encourages a retreat from visibility for many women and a reduced ability to successfully communicate with her health care provider.
What and how we communicate, and how we receive information given, can contribute to a woman’s reluctance to seek prevention or cure for any number of health concerns.
By respecting her values and that which she chooses to conceal or protect, we are inviting her to reveal more of herself to us. In that exposure is the human for whom we are charged with caring, and in this new relationship is the true potential for health and healing.
By refraining from imposing our own values of modesty on our patients, we open up the possibility to clearly see our patient in her own context. In that exercise of self-awareness and self-restraint, we lay the groundwork for a respectful and deeply therapeutic relationship with her.
The narrow channel between what we subscribe to and what we prescribe for others is a tricky space to navigate, but that is exactly what we must do.
Posted by Joel Sherman MD at 6:04 PM