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.
           

19 comments:

Anonymous said...

According to your description, this book seems to be just another confirmation of what we have been aware of all along:

Female, and only female modesty should be paramount.
Male modesty? Forget about it!

Disgusting.i09

Anonymous said...

People write books for one purpose only,profit. I believe
mr.perry at some point realized the book certainly would
not sell if the title were embarrassment for teenage boys
and he repeatedly acknowledges this throughout the
introduction.
How many male nurses have I ever seen on pediatric
nursing floors, ZERO. How many male nurses have I
ever seen on pediatric intensive care units,ZERO. You
certainly won't see a male cna there either. On these
pediatric floors the parents are almost always there,
always. They don't want a male giving their teenage
daughter a bath, let alone catherization.
How many male nurses have I ever seen in a neonatal intensive care unit, ZERO. I don't believe this
book mr. Perry wrote is authentic, serves no purpose
and only adds to the already ever present discrimination.

PT

Joel Sherman MD said...

PT, you're never loathe to state an opinion. But I don't know how you can without having read the book or communicated with the author as we have.
We are 99% sure that the book is authentic.

Doug Capra said...

It's authentic, PT, and you would agree if you read the book. Sure, it may be unusual to have a male nurse on a pediatric ward dealing with female patients. But it clearly demonstrates this "gender neutral" worldview we've talked about. In a system like this, it's expected that male and female nurses just do what they're told and deal with patients of the opposite gender as required. It's all provicer-centered, not patient-centered. And, as you'll see in this book, due to the lack of male nurses, the boys get treated poorly. But so do the girls when they're forced to deal with this male nurse. But, he recognizes that, and gives them advice which can be used by all patients in these situations. So -- read the book, PT, and then give us your opinion.
Also -- I want to point out that we wanted to included much more in our review. In the last part of the book, the author gives advice as to how to make things work for you as a patient. His advice ranges from the simple to the severe. He tells you what the "catch" words to use -- words that get the provider's attention and let them know you're serious about your modesty and same gender care and that it would be in their best interest to accommodate you.
Despite some of its failings, it reveals the inside of the system in way few of any books have done -- and gives some very practical and useful advice.

Anonymous said...

Mr perry may have wrote that book and had it published
but that dosen't mean his experiences are authentic. The
first point I would make to any lay person is this, it is
very difficult for one to document the clinical experiences of a cna, nurse, lpn or a physician. Only licensing agencies can do that and even then they don't always get a clear picture of clinical work. Mr perry may have worked in a pediatric setting, dosen't mean he provided intimate care to female pediatric patients. How can you write a book about young females and embarrassment if you were never involved to that extent of their care.

PT

Doug Capra said...



PT wrote: "How can you write a book about young females and embarrassment if you were never involved to that extent of their care."

I suppose that would like having strong opinions about a book you haven't read.

Anonymous said...

Read the damn book PT and then share your opinion. I generally agree with your opinions but must say your recent use of inflammatory stereotyping such as "Fem-Nazi" is not helpful. Your automatic rejection of this book despite Dr Sherman's endorsement is questionable and puzzling.

Ed

Anonymous said...

If the author of the book took the ethical route and worked with the young boys instead of concentrating his efforts to "respect the modesty" of the young girls, there would be fewer young boys in his hospital being abused by the women.

Anonymous said...

Why should anyone read a book whose author is "amused" by the embarrassement of boys?

Doug Capra said...

"Why should anyone read a book whose author is "amused" by the embarrassement of boys?"

Because his position on this issue is more complicated that that one statement. He's ambivalent, yes -- and that comment annoyed me, too. That's why we published it. But when you read the book, you'll see he's also sympathetic to the boys but because of the hospital hierarchy and his position as the one male on staff -- he can't really do much about. His advice at the end as to how to get what you need and want from the system is excellent. That advice applies to all patients, male, female, young, old. Read that section, PT, and you'll see how he really understands the system and how it works, or doesn't work.

Anonymous said...

Doug, he may advocate for male and female patients, but nontheless this gynocentric attitude for me is all the more repulsive and disappointing because it comes from a male nurse. But then, it could be simply a common trait in everyone who works in this field.
Ray

Anonymous said...

Ed

That this book is damned and fictitious convinces me further not to read it.

Ray

I agree with your comments, however, it should
be noted that mr perry is not a nurse. He works as a
cna, big difference. I will reiterate what I said earlier
regarding staffing in pediatric units. I have never seen
male nurses, cna' s on those units. Any intimate care
on young female patients are delegated to female
nursing staff. It is a double standard and discriminatory
but true.
The same would be true if mr perry claimed he
was a cna in a L&D unit. I look at my decades of
experiences at many hospitals, and I am calling this
highly unlikely. If you have ever been to a pediatric
unit wether intensive or step down, parents of these
young patients are often there 24/7. You might find
that some of these patients are 17,18 years old. His
experiences are highly unlikely, considering the
level of discrimination and double standard that exists.

PT

Joel Sherman MD said...

PT, you're welcome to your opinion, but this conversation is at a dead end. If you should decide to actually read the book, we'll welcome your opinions on it again.

Medical Patient Modesty said...

Michael Perry generously donated several of his books to Medical Patient Modesty several months ago. I really appreciate his honesty about patient modesty violation cases. I personally think that all medical professionals should read this book. I wish there were more books about patient modesty.

It is true that male CNAs are rare on pediatric intensive units and L & D units at many hospitals, but some hospitals are so gender neutral. I was shocked to learn that a hospital in Utah has some male midwives. We all have to keep in mind that some hospitals are more gender neutral than other hospitals.

I do not believe that Mr. Perry wrote this book for profit. Based on my conversation with him, he seems to really care about patients. I believe he wrote this book with the goal that more medical professionals will be sensitive to patient modesty and that more teenagers will be empowered to stand up for their rights to modesty. He sent me an email with positive feedback about the article that I wrote about elderly patients and modesty.

Misty

Very Disturbing Indeed said...

From the review:

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.”


What's funny about the humiliation of teenage boys? ...Would he laugh at a teenage girl who felt similarly about male nursing? ...Who didn't "get over it quickly"? The guy's a sexist and clearly couldn't be less concerned with the modesty concerns (or humiliation) of male patients.

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.’”

How very caring. ...But then looking at his other publications, the man appears to be a typical male feminist. Male feminists care nothing about their own sex, and seek only to ingratiate themselves with women.

From Doug Capra's comment:

In the last part of the book, the author gives advice as to how to make things work for you as a patient. His advice ranges from the simple to the severe. He tells you what the "catch" words to use -- words that get the provider's attention and let them know you're serious about your modesty and same gender care and that it would be in their best interest to accommodate you.

...Then please tell us what this advice is, if it is so useful --- one shouldn't have to line the pockets of a misandrist in order to discover how to obtain respect in our misandristic system. You say you wanted to include this in your review: please, publish an article on what male patients should do to combat the "blatant gender discrimination" (as you rightly call it). Surely that information isn't copyrighted? Surely it should be broadcast freely to as wide an audience as possible?

Doug Capra said...

Thanks for your recent response. Yes, I may do an article about the advice this author gives to patients, male and female. But let me tell you first -- the basic advice is to speak up, which most patients, especially men, don't do. Most of this advice is nothing really new -- we've talked about it on these blogs before.

But "speaking up" also means holding firm about your needs and not backing down. And being willing to work your way up the food chain -- BUT, really trying to solve the problem as low on the food chain as possible -- because once you get up that food chain past a certain point, you involve more people and it becomes a bigger issue. But remember, the lower levels caregivers don't want to go up that food chain either, so if they perceive you're firm and are willing to go there, you may get want you want at that lower level.

It also involving using words and phrases that make clear your intention in the context of caregiver duties and responsibilities as professionals. You need to speak their language. You need to communicate with them on their level -- not with technical medical terms, but with phrases and words that make it clear to them that you know you have the right to respectful, dignified treatment, and that includes your right to define your value system in terms of your modesty. And -- and this is probably most important -- you need to do it with civility -- calmly, respectfully and with confidence -- regardless of how they respond to you.
This is not so much a matter of knowledge, although that's important -- as it is a matter of courage, standing up to the system in a way that won't alienate them but will let them know you know which way the wind is blowing.
And I disagree with you about this author's intentions and perspective. This is an ebook and it doesnt' cost much -- so order it and read it.

Very Disturbing Indeed said...

I won't be ordering the book, regardless of how little it costs --- any man who finds it "amusing" to witness a teenage boy experiencing sexual humiliation at women's hands isn't going to get a penny out of me.

But thanks for replying: I look forward to your article.

...And why do you think it has become necessary for men to have to speak up so firmly simply in order to be treated with respect and dignity by women? When the genders are switched, male staff take female patient modesty much more seriously. Why should female staff be different? And why are there so few who write about this? As far as I can see, it's literally a handful of experts who endeavour to raise the issue (you & Dr. Sherman, Misty Roberts & Suzy Furno-Maricle, plus a couple of others) --- and even that small number is dwindling (I notice sadly that Suzy seems to have stopped writing: her blog is now dead).

Anonymous said...



I won't be ordering the book, regardless of how little it costs --- any man who finds it "amusing" to witness a teenage boy experiencing sexual humiliation at women's hands isn't going to get a penny out of me.

Very well said, thank you!

Ray

Anonymous said...

Misty

I'd say you welcome mr perry and the comments
of his book, but that you are inclusive only to the extent
on how humiliation is bad for women,yet somehow men
deserve it. There is no such thing as a gender neutral
hospital and why would you be shocked at a male nurse
midwife in Utah.
Would you be shocked that there are male Ob-gyn's in Utah. Would you be shocked that there are female
Urologists in Utah. This was never and will never be a
one sided issue.

PT