Tuesday, February 26, 2013

Hospital Gowns and Other Embarrassments
A book review

Hospital Gowns and Other Embarrassments
author Michael W. Perry
A Book Review by Doug Capra and Joel Sherman, M.D.

Finally.  Finally a book from a medical insider that directly discusses patient modesty concerns.   If you imagine a large target in the distance, this book hits the target at different circles with an occasional arrow in the center. It also misses the target completely in some areas, and we’ll point out why – but we do recommend it be read by anyone interested in this topic.   It’s a brave book. But it’s also an extremely disturbing book.  As background, this book relates the experience of a male nurse’s aide on a pediatric floor, a rare combination, and his attempt to make his teenage female patients as comfortable with him as possible by respecting their modesty.  Many of the patients are cancer patients and are facing potentially terminal illnesses.

The focus of the book on teen girls only may put off some who follow this topic.  Written by former nurse’s aide Michael W. Perry who worked in a major pediatric hospital, the title is directed solely to girls.   Now, I can hear howls already from some readers: “Why a “teen girl’s guide? Why not for boys, too?” And that is the first criticism we have with this book. The author gives us an answer in a very disturbing section titled “Beleaguered Guys.” Talking about the male teens, Perry writes: “If a guy had any sense of modesty when he arrived, he had to get over it quickly. Most of their care was done by nurses, all of whom were women and many only a little older than they.”

He says that, looking back, he finds that “amusing.” At any time, he writes, “a female nurse or aide might dart up their bed insisting that they do something they’d rather not do.”  I wondered why Perry didn’t write a book for teen boys as well as teen girls.  He answers that question: “If I wrote one, it’d be entitled Hospital Nurses and Other Embarrassments and would consist of two short sentences. ‘Give up. It’s hopeless.’” At least the author adds the following sentence: “Poor guys! I only hope that, by helping teen girls like you, this book also eases their plight.”  But the book is nearly 98% about girls and his empathy for boys is half hearted at best. 

So – assuming this book is accurate and we truly are getting an inside view of the gender care culture within some or many hospitals, Perry is essentially confirming some of the worst stories and anecdotes we’ve been reading on this blog and others like Dr. Maurice Bernstein’s thread on modesty. We see blatant gender discrimination.  Boys just have no rights when it comes to protecting their modesty. They are second-class citizens.  Perry writes: “The girl’s situation could not have been more different. Their privacy was almost complete. Their rooms were the domain of a nearly all-female staff. That meant that they could be much more casual about their undress.  Their situation was nothing like that for the guys.”  How did it affect they teen boys? The one’s he cared for “seemed so sullen and withdrawn that all my efforts to get to know them came to naught.” One wonders if this might be a sign of depression – just what seriously ill teens, some in the process of dying, need at this time in their short lives.

In fairness to the author, he’s giving us a rare inside view of the female-dominated, “gender-neutral” culture within hospital. So, in spite of these disturbing passages, they are at least honest. This is a brave book. And, being one of the only male aides on these wards, he shares with us his most challenging experiences, working with teen age girls.  With revision, the book could be for adults as well.  In fact, we see this book as actually being more valuable for adults than it is for teens. That’s why we’re recommending you read it.  More importantly, it should be required reading for doctors, nurses, CNA’s, medical assistants, and patient techs – indeed, all those who have contact with patients in potential embarrassing situations.   And this book should be required reading for parents of teen boys so they can help advocate for their child.  If what this author observes is accurate, young teen boys need a patient advocate.

So – before we present our critiques, we want to first say that this is a brave book.  A courageous book.  A book that finally acknowledges the issue of modesty quite openly.  Perry is brave enough to admit that hospitals need to “rethink their obsession with single, overly efficient, unisex procedures.  Hospitals need to make practical adjustments for men caring for teen girls and perhaps women caring for teen boys.” Of course, the italics is ours. The author still tends to perpetuate the myth that boys just don’t deserve the same protection from modesty that girls deserve.

But Perry also writes: “Kindness about embarrassment should be such a core value in hospitals, that everyone thinks about it and no one gets berated for acting on. There are more important things than bed sheets and efficiency, particularly for someone facing the serious possibility of dying…We should be gentler with teens facing terrible illnesses and not add to their already heavy burdens.”

            More importantly, Perry admits in print what many of us have been claiming for years but what few within the health care system are willing to admit. The author writes: “I fear that, in all too many cases, problems arose because all talk about modesty, embarrassment, and even feelings of violation were taboo.  Nursing staff, including me, seemed afraid to bring them up and expose their supposed lack of professionalism and insufficient desensitization. On their part, administrators seemed to fear that any lessening of the ‘staff that are neither male nor female’ rule would complicate their work and lower efficiency. I doubt that’s true.”

 Read that paragraph again. That’s why we call this a brave book.  Perry admits a culture that’s all too prevalent in American medicine today – the “gender-neutral” world view.   It’s a view that tends to ignore the importance of the gender of the to patients, especially for intimate exams and procedures.  In that paragraph, Perry also acknowledges the tendency to place efficiency above modesty --  the attitude that says let’s get this job done and over with as quickly as possible so we can move on to the next job.  The patient may be embarrassed, even humiliated, but he/she will get over it.  A third element Perry raises in that paragraph is what he considers the discomfort of the provider in these kinds of situations – this tendency, he writes, of the caregiver to  fear “their supposed lack of professionalism and insufficient desensitization.” Frankly, it’s like pulling teeth to get most medical professionals to talk in public about these issues.

            But let’s get our second criticism out in the open so it won’t surprise you.  Perry comes down hard on young male doctors and young residents. Unfortunately, he seems to perpetuate the stereotype of gawking, sex-starved men seeking out opportunities to seek naked, vulnerable young girls.  In fairness, he does acknowledge that these men represent a minority, but we think his analysis is unfair.  He uses a blatant double standard.  Nurses routinely expose their patients, both boys and girls to embarrassment, but they only do so because in his opinion they are so completely jaded to nudity that they are unconcerned and unaffected by it.  Men on the other hand do so because they are ‘creepy’ or ‘perverted.’  Perry never admits that male providers can unconsciously expose kids as well with no other intent.  He also comments on gawking young teen boys on the ward.  Interestingly, Perry comments about how most female nurses openly protect the young teen girl patients from these gawking boys .   They definitely did not protect them from older men to our surprise.  We’re not suggesting this behavior doesn’t happen. But we are suggesting that it’s not only some men who seek out this opportunity. We’ve had many posts by males about young female nurses and aides who take opportunities to gawk as well.

So in summary this a rare book that actually discusses patient modesty in a hospital setting with the emphasis on gender conflicts and interactions, a subject which is nearly taboo in our gender neutral present day health care system.   We are not aware of another book that focuses on this subject.  Anyone interested in this subject should read this book.  We’re not sure though that the author’s intended audience, all adolescent girls, should read this book unless they are hospitalized and having difficulties coping.  It could scare them for no purpose, and if they are like the cancer stricken kids described, they start out with much more serious concerns.  The book would be helpful though for parents of kids, especially girls, who are facing chronic illness and hospitalization.

This book is available from multiple online sellers.