Informed Patient Consent Is Missing
From Urinary Catheters
A urinary catheter is a hollow
flexible tube inserted into the bladder to drain urine. This catheter drains
urine from your bladder into a bag outside your body. Common reasons for a
urinary catheter include staff convenience, urine leakage (incontinence),
urinary retention, certain surgeries such as prostatectomy, and surgery lasting
more than three hours. Staff Convenience is a very common reason for the use of
indwelling catheters, and one which is recommended against by many universities
and government organization. There is the perception that it is more convenient
for nurses to place a catheter rather than take the patient out of the bed
several times a day to change bed sheets and clothing, to help him/her to use a
bed pan or walk to the bathroom, and to change diapers. Nurses should never use
those reasons to catheterize patients. Foley catheters are not appropriate
as a treatment for incontinence.
Many people feel that urinary
catheterizations are an invasion of their bodily privacy even if they are done
by a nurse or doctor of the same gender especially when they are not really
necessary. Patient modesty is not the only concern with urinary catheters. You
easily get infections or injuries from urinary catheters. Urinary catheters
are the number one cause of hospital-acquired infections. About 80% of
hospital-acquired urinary tract infections are related to urinary catheters.
About 10% to 30% of male urinary catheterizations result in urethral injury.
Check out complications
that can occur from urinary catheters.
While it is true that some hospitals and medical facilities have worked to decrease the number of urinary catheterizations on patients due to concerns about infections, many medical facilities in the United States continue to do many unnecessary urinary catheterizations. Outpatient Surgery clinics typically do less urinary catheterizations than hospitals.
Urinary catheter is standard for many surgeries that do not really require them at some medical facilities. One man who had a simple neck surgery in a Georgia hospital was very upset and embarrassed when he woke up and discovered that he had a urinary catheter. He was not even asked for consent to have the urinary catheter inserted. Urinary catheter is not necessary for a simple neck surgery. When his daughter asked the nurse why he had a Foley catheter, the nurse replied by saying he needed one because he could not walk. A patient’s inability to walk is not a reason for a urinary catheter. Unfortunately, what happened to this man is pretty common at some medical facilities.
While it is true that some hospitals and medical facilities have worked to decrease the number of urinary catheterizations on patients due to concerns about infections, many medical facilities in the United States continue to do many unnecessary urinary catheterizations. Outpatient Surgery clinics typically do less urinary catheterizations than hospitals.
Urinary catheter is standard for many surgeries that do not really require them at some medical facilities. One man who had a simple neck surgery in a Georgia hospital was very upset and embarrassed when he woke up and discovered that he had a urinary catheter. He was not even asked for consent to have the urinary catheter inserted. Urinary catheter is not necessary for a simple neck surgery. When his daughter asked the nurse why he had a Foley catheter, the nurse replied by saying he needed one because he could not walk. A patient’s inability to walk is not a reason for a urinary catheter. Unfortunately, what happened to this man is pretty common at some medical facilities.
Some patients have urinary catheters
inserted when they go under anesthesia and then removed before they wake up so
they are unaware that they had a catheter unless they find out from their
records or had difficulty urinating or felt burning sensation as they urinated
after they woke up from surgery. I feel
that this is very unethical.
Some medical facilities allow nursing students to practice inserting urinary catheters on patients under anesthesia without their consent. This is very unethical. This unethical practice violates a patient’s wishes for modesty and could cause complications such as blood infection, Urinary Tract Infection, urethral injury, etc. Because nursing students have limited experience, they are more likely to injure patients they catheterize. While it is true that nursing students need practice with urinary catheterizations before they graduate from nursing schools, nursing school students should only do urinary catheterizations that are absolutely necessary under supervision of an experienced nurse and with a patient’s consent. Nursing schools should have their students do urinary catheters on mannequins as much as possible. Every nursing school should have a urinary catheter simulator such as a male catheterization simulator.
When is urinary catheter medically necessary?
Some medical facilities allow nursing students to practice inserting urinary catheters on patients under anesthesia without their consent. This is very unethical. This unethical practice violates a patient’s wishes for modesty and could cause complications such as blood infection, Urinary Tract Infection, urethral injury, etc. Because nursing students have limited experience, they are more likely to injure patients they catheterize. While it is true that nursing students need practice with urinary catheterizations before they graduate from nursing schools, nursing school students should only do urinary catheterizations that are absolutely necessary under supervision of an experienced nurse and with a patient’s consent. Nursing schools should have their students do urinary catheters on mannequins as much as possible. Every nursing school should have a urinary catheter simulator such as a male catheterization simulator.
When is urinary catheter medically necessary?
Neurogenic bladder, acute urinary
retention that cannot be resolved, acute bladder outlet obstruction, oliguria
due to hypotensive
shock, end
of life comfort care of a terminal patient, certain surgeries such as
prostatectomy and hysterectomy, prolonged surgical procedure (not a few
hours) with general or spinal anesthesia. Most surgeries are less than 3 hours
long so most surgery patients should not be catheterized at all.
Different types of anesthesia and effects on bladder functions:
Local Anesthesia – This type of anesthesia has no effect on bladder function at all so there is no need for a urinary catheter if you have local anesthesia. You should strive to have surgeries such as hand, wrist, etc. with local anesthesia if possible. Even knee surgeries can be done with local anesthesia now.
Different types of anesthesia and effects on bladder functions:
Local Anesthesia – This type of anesthesia has no effect on bladder function at all so there is no need for a urinary catheter if you have local anesthesia. You should strive to have surgeries such as hand, wrist, etc. with local anesthesia if possible. Even knee surgeries can be done with local anesthesia now.
General Anesthesia – In short surgeries that are not longer than 3 hours,
there is usually no effect on the bladder. The bladder will become distended in
longer cases and the patient could become incontinent over time.
Spinal Anesthesia - Spinal anesthetics block activity along the nerve fibers that travel between the nerve centers of the brain and the bladder. Patients lose the sensation to void about 1 minute after being injected with spinal anesthesia, but will continue to feel dull pressure as the bladder reaches full capacity. In addition, the ability to contract the detrusor muscle is lost 2 to 5 minutes following the injection of local anesthetics and still persists even after bladder sensation is fully recovered. Spinal anesthesia with long-acting local anesthetic therefore contributes more to POUR (Post Operative Urinary Retention) than spinal anesthesia with short-acting local anesthetic, since the inhibitory effect of spinal blockade on bladder function lasts longer. Patients receiving spinal anesthesia with short-acting local anesthetic are often able to void shortly after outpatient surgery and are ready to leave the PACU quickly. (Source: What Do You Know About Post-Op Urinary Retention? - Outpatient Surgery) If you have spinal anesthesia, you should request spinal anesthesia with short-acting local anesthesia to reduce your chances of urinary retention.
Spinal Anesthesia - Spinal anesthetics block activity along the nerve fibers that travel between the nerve centers of the brain and the bladder. Patients lose the sensation to void about 1 minute after being injected with spinal anesthesia, but will continue to feel dull pressure as the bladder reaches full capacity. In addition, the ability to contract the detrusor muscle is lost 2 to 5 minutes following the injection of local anesthetics and still persists even after bladder sensation is fully recovered. Spinal anesthesia with long-acting local anesthetic therefore contributes more to POUR (Post Operative Urinary Retention) than spinal anesthesia with short-acting local anesthetic, since the inhibitory effect of spinal blockade on bladder function lasts longer. Patients receiving spinal anesthesia with short-acting local anesthetic are often able to void shortly after outpatient surgery and are ready to leave the PACU quickly. (Source: What Do You Know About Post-Op Urinary Retention? - Outpatient Surgery) If you have spinal anesthesia, you should request spinal anesthesia with short-acting local anesthesia to reduce your chances of urinary retention.
Any bladder issues after surgery are
most likely due to narcotics used for pain control.
Every patient should use the
bathroom before surgery takes place. Most surgery patients are asked to not
drink anything for at least 6 hours before surgery so their bladders are empty.
Patients who might become incontinent should be given the option of wearing disposable waterproof underwear or boxer shorts. You can buy them before you come to the hospital.
Why is there no informed consent for urinary catheters?
Patients who might become incontinent should be given the option of wearing disposable waterproof underwear or boxer shorts. You can buy them before you come to the hospital.
Why is there no informed consent for urinary catheters?
No informed consent is required for
urinary catheterization. Despite the common use of urinary catheters and the
well-known risks of complications
associated with urinary catheters, patients are not asked to sign a written
consent that discloses the advantages and disadvantages of urinary catheters.
Rarely are patients informed verbally of the risks of
urinary catheters. Another concern is that many patients care deeply about
their modesty and would not want a urinary catheter to be inserted by an
opposite sex medical provider.
John Fisher, a medical malpractice lawyer in New York shares in his article (Why Consent For Urinary Catheters Should Be Mandatory) that in evaluating hospital care throughout New York, he has not seen a single consent form for urinary catheters. Since patients with urinary catheters have a much higher chance of getting a urinary tract infection than those who do not have a catheter, the question must be posed: why is there no informed consent for urinary catheters?
John Fisher, a medical malpractice lawyer in New York shares in his article (Why Consent For Urinary Catheters Should Be Mandatory) that in evaluating hospital care throughout New York, he has not seen a single consent form for urinary catheters. Since patients with urinary catheters have a much higher chance of getting a urinary tract infection than those who do not have a catheter, the question must be posed: why is there no informed consent for urinary catheters?
Do patients really give “implied
consent” to urinary catheterization?
Physicians and nurses will explain the patients give “implied consent” to urinary catheterization based on the theory that urinary catheterization is a common and routine part of hospital treatment. However, informed consent is important for urinary catheters for the following reasons.
Physicians and nurses will explain the patients give “implied consent” to urinary catheterization based on the theory that urinary catheterization is a common and routine part of hospital treatment. However, informed consent is important for urinary catheters for the following reasons.
- Urinary catheter complications
pose such a common and significant risk to patients.
- Urinary catheterization is an invasive procedure and embarrassing for many patients who value their modesty. Every patient should be given the option of having a same gender nurse or doctor for the catheter insertion if it is absolutely necessary. Check out how male urinary catheterization and female urinary catheterization are done.
Once given information about the
risks and benefits of urinary catheterization, the patient can make a fully
informed decision whether they wish to accept the risk and if they want a same
gender nurse or doctor to insert the catheter.
What is the downside of consent for urinary catheterizations? A little more paperwork and time for hospital nurses, but isn’t a fully informed patient worth this minor sacrifice? Patients should be informed that urinary catheter insertion involves the risk of complications, facts about how invasive the procedure is & their option for same gender nurse, and a specific consent relating to the pros and cons of a urinary catheter should be signed by the patient.
What is the downside of consent for urinary catheterizations? A little more paperwork and time for hospital nurses, but isn’t a fully informed patient worth this minor sacrifice? Patients should be informed that urinary catheter insertion involves the risk of complications, facts about how invasive the procedure is & their option for same gender nurse, and a specific consent relating to the pros and cons of a urinary catheter should be signed by the patient.
If the patient is incapable of
making decision about urinary catheter, a family member should be asked for
consent.
How to Refuse a Urinary Catheter?
Because there is no informed consent for urinary catheters and urinary catheter is standard for many surgeries and sick patients who cannot move at some hospitals, patients and their families must speak up and take steps to ensure that a urinary catheter is not inserted. Keep in mind that the inability to walk is not a reason to insert a urinary catheter.
Steps To Ensure That No Urinary Catheter Is Inserted:
1.) Request that no urinary catheter be inserted in writing. Write all over your surgical consent form that you do not consent to urinary catheter and that your underwear may not be removed at all for surgeries that do not involve the genitals. Try to get the consent form the day before surgery if possible.
Because there is no informed consent for urinary catheters and urinary catheter is standard for many surgeries and sick patients who cannot move at some hospitals, patients and their families must speak up and take steps to ensure that a urinary catheter is not inserted. Keep in mind that the inability to walk is not a reason to insert a urinary catheter.
Steps To Ensure That No Urinary Catheter Is Inserted:
1.) Request that no urinary catheter be inserted in writing. Write all over your surgical consent form that you do not consent to urinary catheter and that your underwear may not be removed at all for surgeries that do not involve the genitals. Try to get the consent form the day before surgery if possible.
2.) Talk to the surgeon, nurses, and everyone that will be
involved in your care about how you do not permit a urinary catheter to be
inserted and that your underwear must stay on.
3.) Type up a document saying that you do not consent to a
urinary catheter and make several copies to give to everyone involved in your
care.
Sources:
Catheter patrols: a unique
way to reduce the use of convenience urinary catheters.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517898
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517898
Misty Roberts is the president / founder of Medical
Patient Modesty (http://www.patientmodesty.org),
a 501c3 non-profit organization that works to improve patient modesty.
36 comments:
Many catheterizations have been placed against
patients wishes. One such patient sued and was
awarded $250,000.
PT
PT,
Do you have a link to the article about the patient who was awarded $250,000? If so, can you please share the link.
Hospitals need to work on cutting down on urinary catheterizations.
Misty
Excellent article and site Misty. Thanks for all of your time and research. I'm a fan.
LG
A very thorough and well researched article.
Misty
I will try to find the article as it was about 8
years ago that I read it online. The patient was
a paraplegic who refuse but it was forced upon
him. It should be noted that urinary catheters
improperly placed have caused deaths in patients.
PT
I take extreme caution when I use a urinary catheter. I make sure that I have the most up to date equipment for a urinary catheter. So many people don't know how to properly set on up let alone use it. You need to be educated before using a urinary catheter.
Here is an interesting blog that links to the JAMA article it draws its information from:
http://well.blogs.nytimes.com/2007/12/19/making-hospitals-pay-for-their-mistakes/
I was thinking about the mechanics of urinary catheterization, and did a search. I found these two articles, one dealing with catheterizing a female and the other dealing with catheterizing a male. The tone of both was pretty ribald (even more so in the latter), and I wouldn't want the guy catheterizing me or anyone dear to me, male or female.
I'd guess it's one of the most intimate procedures one can undergo at the hands of a nurse. It's an extreme intrusion for a man or boy to have a female stranger grip their penis. Yet it appears that the nursing profession regard it lightly.
What a shame.
If you go to 1:30 in this video it seems she is admitting they sometimes do them for the staff's convenience:
http://www.youtube.com/watch?v=DQQTKrTSLAE
I wanted to share with you all about a female CNA that made very disturbing comments to a lady, LKT at a hospital recently. LKT shared this on Dr. Bernstein’s blog the other day:
“I had a disturbing personal conversation with a CNA at my local hospital this week, quotes of which I thought I would share here. I was asking her about where she went to school. She revealed that she had gone from working at a local non-medical business to working in ICU after her six-week course at the community college. She had in fact just finished her recertification. She then proceeded to tell me that she really wants to get her CNA II training next because she "really wants to shove a catheter into a man" while making arm gestures as to how she would do it. She then said, "not women though (making a grimace) just men". She then smiled and said, "I'm mean ain't I". I was so struck by these comments that I felt physically ill. Many of the comments/stories from this blog flooded my mind as to how male patients are treated by female medical staff. By the way, this was no twenty something, this was a middle-aged woman. One of my comments to her in response was that I was shocked that they would allow someone with such a low level of education to perform such an invasive procedure that has potential to injure patients. Blank stare. This experience and others after working in the medical field for the last eight years has taught me that no amount of "professional" training/certification guarantees good moral character and trustworthiness. Knowing what I know, if I were male, I would never, ever let a female insert a urinary catheter in me.” LKT
This CNA reminds me so much of the “Juicy Nurse” . It is very clear that this female CNA has no respect for male patients. I believe that male patients are mistreated by female medical staff far more than we can imagine. Most men won’t speak up or file complaints when they are mistreated and that’s why we rarely hear about abuse / mistreatment of male patients by female medical staff in the news. It is also scary to think about how this female CNA may injure some male patients due to her lack of experience and compassion & respect for men. The truth is so many urinary catheters are actually unnecessary. I personally do not think that they should allow CNAs to insert urinary catheters. I found this discussion: Please enlighten me, is the cna allowed to insert urinary catheter in any state? very interesting. Some states apparently do not allow CNAs to do urinary catheters.
LKT is correct that no amount of professional training guarantees good moral character and trustworthiness.
I was very honored to help a man who was concerned about modesty during colonoscopy to take steps to ensure that his wishes for modesty and all male team were honored recently. He spoke to the head nurse (female) and the doctor and they were willing to accommodate his wishes for colonoscopy shorts, no sedation, and an all male team. In fact, he said that the female head nurse said that they wanted to do whatever to make him comfortable. It is very clear she is a compassionate nurse.
Misty
Misty,
Yes that anecdote is very disturbing. It's hard to imagine any medical personnel confiding that to a patient. But she will surely be fired eventually if she makes that a habit.
I am not aware of anyplace where CNA's are allowed to put in Foley's. It is usually done by nurses.
But it is not impossible. After all for decades it was customary that orderlies put in Foley's in men and their training is not any better.
Dr. Sherman,
The female CNA actually made those comments to LKT who is a volunteer at a hospital. I wonder if the CNA would have made those comments in front of her supervisor. I certainly think that this CNA needs to be fired.
I was well aware that orderlies did not have that much training. But I noticed on Dr. Bernstein's blog that at least one man shared that he would rather to have an inexperienced male than a female nurse with 30 years of experience participating in male intimate care on him.
Misty
I wanted to let everyone know that a law student who is a former RN did an article about legal options for patients who do not want urinary catheters. Check out this article: A Patient Has
a Right To Refuse a
Urinary Catheter.
Misty
Thank you for your article & your many other helpful blog write ups. I suffer from ptsd as a result of being forcibly catheterized, held down by a room full of men & women as I screamed "NO" repeatedly. I was very sick- septic, pneumonia, & a near fatal infection in my heart- but at that point I had control of my bladder & was making it clear that I wanted to go to the bathroom. Their reason for forcing this on me- my iv wasn't long enough for me to go to the restroom...? There was no medical need whatsoever for the cath and I made my refusal to consent loud and clear yet I was held down as I kicked, screamed, pleaded. Not that it wouldve been ok otherwise, but to top it off I had been previously sexually assaulted so to wake up in an ICU not knowing where I was completely naked and uncovered from the waist down and then having a room full of people hold me down and spread my legs open was particularly traumatizing and sexually violating. Meanwhile my husband and friend who had brought me to the hospital did nothing to try to stop them from doing this to me despite my refusal- I won't let my husband touch me as a result of this, & I'm sure in time it will ultimately lead to the end of our marriage. The hospital and NYSDOH complaint processes will just make me relive it more than I already do and force me to talk out loud about what I can't verbalize without sobbing &/or becoming violently ill, & I know those complaints almost always lead to absolutely nothing. I don't have the "perfect" case or history so legal recourse isn't feasible, & even if it was it would do nothing to undo the trauma that's been done. To top it all off, as a result of this experience I am going without necessary follow up care because I can't bring myself to go to a doctor & talk about it (I have a hard enough time conveying the basic emotional info related to my ptsd to my psychiatrist). What is left of my life is shattered- flashbacks, nightmares, inability to function, panic attacks, dissociation, etc etc. My family misses me, hell I miss who I used to be, but I feel dead already, hopeless, ashamed, disgusted, worthless. I have "I do not consent _____" written in sharpie on my body should I ever become sick & be brought to the hospital unbeknownst to me again. I really wish my friend had never brought me to the hospital, I was just a day or 2 from being dead, I never would have needed to go through all of this. I've already explained to my kids that if I got sick again I wouldn't be coming back alive, I love them more than anything but my heart mind & body are not strong enough to go through that medical rape again, & if kicking and screaming that no i do not consent isnt enough protection for me then obviously there isnt any way to guarantee that it wouldnt happen again. All of this because it was just basically more convenient for the staff. If only they had been respectful of patient rights & treating people humanely as you seem to advocate through your blog, who knows how many less people would be traumatized, harmed physically & mentally, & how many more people wouldn't hesitate to get the help they medically need but are too afraid of what they'll be subjected to. Education & prevention are key, but where do those of us who've already been wronged, raped, & spat out of the machine that goes "ping!" go?
Here is a simple solution; if catchers are "common and routine," once ever 3 years, as a part of provider license renewal, they shall act as a standardized patient.
There should be no issues since it is so routine, besides how many do they insert every day. Perhaps we should film the learning procedure for patient education.
I am going to place this catheter in you, first I am going to show you a video of my last license renewal, where I was catheterized. This video will show yow what to expect.
I guarantee that this would change the way catheters are used.
The added benefit is that current providers would be furthering medical education, the same way doing pelvic exams on anethesitzed patients, filming patients in the OR, etc. furthers medical education.
-Banterings
It’s heartbreaking about what Anonymous lady who commented on June 24, 2014 endured. I am not sure if this lady keeps up with the comments on the blog. But I personally would recommend that she consider consulting with a lawyer to look into suing the hospital for inserting urinary catheter in her against her wishes. Doctors and nurses should never restrain you to do procedures on you against your wishes. I also think that this lady should report the medical facility to the state medical board. It’s so sad that this lady has suffered PTSD. Catheterizing a patient because her/his IV line is not long enough is certainly not a good reason at all. They could have offered a special toilet and put it right beside her bed.
It’s so sad about how bad experiences in medical settings prevent patients from seeking medical care in the future.
Misty
Thank you Misty, I'm the June 14th commenter. I used to work for a nonprofit patient advocacy organization and am very familiar with what are supposed to be a patient's rights regarding informed consent and refusal, as well as the complaint processes of both the hospital and state department of health and have talked with lawyers about medical procedures performed against a patient's clear refusal to consent before. Not only am I currently too traumatized to talk about it out loud and go through the (usually fruitless) complaint process (what I've typed here is the most I've been able to muster in writing it out), I know from a legal standpoint I don't have a "perfect" case and thus won't be able to find a lawyer who will represent me, especially without me havin to pay a ton of money up front that I don't have- I've got too many medical bills. You know, because essentially being held down and gang raped against my will wasn't bad enough, now I have to pay for the "service." It's their word against mine, and while I haven't been mentally stable enough to handle seeing my medical records yet, I highly doubt it's documented that I was forcibly held down as I screamed NO repeatedly and that there was no justifiable medical reason for it. Theyll say they were acting in my best interests for some bs reason. I'd bet it probably just says "foley catheter placed" plain & simply with no other details, if anything at all. I feel so powerless. This seriously has been harder on me than being previously sexually assaulted. it's more socially acceptable and becoming more common to be able to talk about being raped, but whenever I try to test the waters by bringing up a general statement about feeling sexually assaulted by an unwanted medical procedure against my consent the response I usually get is "doctor knows best, I'm sure they wouldn't have performed a procedure if it wasn't necessary, you should be grateful for being alive." right now I'm not grateful for being alive and having to live with this. if I could get through this and get to a point of being grateful to be alive, why can't I be both grateful for my life*and* traumatized by what was done to me? especially when what traumatized me isn't even part of what kept me alive. anyway, thank you for your post and for the safe place to vent, idk where else to go and even if I could articulate it out loud I don't have anyone to talk to about it who gets it.
Sorry, June 24th, I think I said June 14th in my previous comment. anyway, that's me, unfortunately
June commenter here again. I filed a complaint with the hospital which was responded to by some head-patter who said "I talked with the nurse who cared for you that night...she remembers you & says that after a female friend that was with you helped explain that they needed a sterile sample you agreed and tolerated it well...no males were present...I can't give you the names of the nurse or those who assisted because of privacy laws." My friend & husband (one of the many males present) both recall my version of the story. there was no explaining of the "need" for a sterile sample, & if there was I wouldn't have consented anyway. it was bc they didn't want to let me get up & assist me to the bathroom. I understand I was very sick but I still had the right to refuse any tests or procedures, which I did, but they ignored. How does the nurse supposedly remember a patient among the hundreds she has assisted over the past year+ if everything was supposedly by the books & consensual? why did the responder mention not being able to name assistants- assistants aren't needed to insert a urinary cath unless they are holding down a patient who is kicking & screaming no. but it is just my word against theirs. there is nothing I can do. I am so effing traumatized and there is nothing I can do.
You have every right and the hospital is legally obligated to provide you with a copy of your records to include a list of all those who participated in your care. The "privacy laws" excuse is nothing but a smokescreen and they know it!
Ed
I wanted to encourage everyone to read this very informative article about complications of urinary catheterizations.
Misty
Misty Roberts is a troll, she is projecting her religious beliefs similar to Todd Atkins "legitimate rape" abortion claim.
She probably has little or no health experience and her organization is herself. She does not like homosexuals as quoted
"Gender neutrality is not good. I feel this will encourage more homosexuality. It's sad about how morals are declining in America. There is hope for homosexuals to change with God's help."
Look I have no problem with people expressing religious opinions and beliefs, I welcome and encourage debate, but I do have a problem in an ethical fashion as disgusing yourself in that fashion.
For instance, she says you don't need to take off your shirt for a stethescope? Regardless of whether she is right or wrong (She might be saying so because of modesty or religious beliefs), is she an MD?
Image in Joel wasn't really an MD but part of some religious think tank be it Muslim,jewish,christian, whatever and offering psuedo information.
That is unethical and should be pointed out. For instance if a muslim is opposed to pork, he or she could exaggerate health concerns or instance of circumcision which is debatable.
Misty has never hid her religious convictions which she's entitled to. That doesn't mean any of us have to agree with her views on homosexuality which I personally take issue with. I have told her that I would not directly support her website because she makes it clear she would not support lesbian gynecologists or practices that use them.
However I can attest that she does not write on medical subjects without researching them adequately. This is no different than nearly all lay writers on medical issues and all her articles here are worth reading.
She researches articles that seem to for the most part support her point of view, and like the stethoscope article and articles like virgins don't need pap smears, it seems to be a right-wing bias.
I am no hard left-winger, but you have a non-health professional cherry picking articles, and not even disclaiming who she is and who she isn't. Where is her bio on her website, and her certs? Her "organization" seems to be one of a religious one promoting modesty not unlike a Muslim Patient's organization.
If Joel Sherman was just ordinary Joe, would he be as credible. Also so according to Misty, what's a gay or lesbian gyno to do or with transgenders?
Your criticism is unwarranted. We all have points of views and biases. We present different points of views on this blog and all are welcome.
My interest in patient modesty has nothing to do with religion but religion is clearly a primary motivator of many patients' concerns about personal privacy and deserves a hearing.
And as I said and stress again, Misty Roberts's posts on this blog are well researched and worth reading.
Last year I had a very bad experience in a hospital. I was very sick. I am a kind of person that never ran to a doctor for every little thing. After weeks of not feeling good I called by son to take me to the hospital. He had to help me to the car. I was yellow in color dizzy and could not see vey well. Well when I got there they got me into a room. Took 5 tubes of blood. Started me on IV'S. At this point I had cold shakes and chills. Had a 103 fever. At this point the doctor came in and told me I had sepsis by white blood count was over 25.000. He told me that I had about another week I would have went into kidney failure. This is where my problem started. He asked me for a urine sample. I told him that I just went pee before I came to the hospital and I did not need to go. Also I told him that I do not pee on demand. My doctors know this. He walk out of the room and said we will see. Within 10 minutes I had a male RN and a female TN come into the room. He told my son to leave. At this point I asked what was going on. He never answered me. They he told the other RN to take my pants off. Before I could ask again he forced a catheter in me. My pants were not ever off. After that I gave up. He pulled that one out and forced another one in pushing it in and out yelling do I have a prostate problem. They never got it in and just walked out. When my son came back into the room he ask what happen. I told him and he ask why didn't they tell me or him what was going on. I was taking to a room and a hour later I peed on my own. To make a long story short I went and saw a urologist and after some test He found a stricture in the urethra just before the prostate. That nurse could have done more damage then he did. I have some male problem now that I am working on. That will never happen again I had paper draw up that they are not allowed to do anything on me without my permission. I know it is over but I will never forget it...Ken P
Urinary catheters are unnecessary 95% of the time. Any patient can refuse any treatment they dont want so just refuse them. I have never and will never have a catheter. If the medical facility goes against your wishes sue them for battery and invasion of privacy and also get the staff concerned struck off by taking to the medical counsel
I'm really pissed off.
My wife is going in for knee surgery in about 4 weeks. We went to see her anaesthetist last week just to go over some basics. What I and my wife thought would be a simple knee surgery, now turns out she will be completely sedated and given a catheter.
The anaesthetist infomrs my wife, just so so matter of fact, as if he was saying, Oh, I'll be wearing white on the day ...
Just comes straight out and says ... Oh, I'll be inserting a catheter into you! Oh, and I'll have a couple of students with me too!!!
I never really thought it through till now. You think you are taking your wife in to hospital for a general knee operation, then you put the pieces together ....
She will be pretty much fully exposed in front of 4-5 men!!!
A male anaesthetist is very open about the fact that he will be putting a catheter into her and will have a couple of students with him. For all I know, she will be knocked out, so she could be lying there with no pants on for the whole operation.
Then, of course, she will have an ECG monitor on her, which means they have to stick the little pads and sensors on, around and under her breasts. So, I know they have to take her top off to do this, as I've seen it done before, when I took her to the hospital once before when she was complaining of chest pains. Luckily, this time, it was a female nurse.
There is NO modesty. She made her take her clothes off and put a gown on. the nurse then got her to lay flat on the table where she preceded to pull my wife's top completely down, so that her breasts were exposed. Shen then stuck the sensors on her breasts. the nurse didn't bother to pull the gown back up and so my wife tried to, but was told to just lie still.
There was then a knock at the door, and the nurse said come in doctor ... I jumped up and pulled my wifes gown up. The doctor came in, but the doctor was a woman. Even so.
I'm not going to be in the room during the operation, which is all males. God only knows what level of modesty happens in those rooms. My guess is it is ZERO!!!
What can we do about it?
Nothing!!!!
Anonymous on October 5, 2015,
Your wife’s case is very concerning. There is actually no need for your wife to have an urinary catheter for a knee surgery. It sounds like the anesthesiologist has a bad attitude. You should avoid him at all costs.
It is possible to keep your modesty intact for knee surgery. In fact, I encourage you to watch this video, http://bit.ly/blockjocksadductorcanal of a woman being prepped for ACL reconstruction surgery on her knee. You will notice that her cotton underwear stays on and you cannot see her genitals at all. They only pulled up her gown when they needed to access her thigh to a degree the near end. You will notice that this is having an abductor canal block done to her thigh. This is an alternative to femoral nerve block. This lady definitely does not have an urinary catheter at all.
It is always better to opt for nerve blocks or regional anesthesia for surgery whenever possible to lower chances that the patient's modesty will be violated.
I encourage you and your wife to cancel surgery immediately and look somewhere else. You both should look into another hospital and a team of doctors that are willing to let your wife wear underwear and possibly surgery shorts that are short enough for them to access the thigh. Also, make sure she is not catheterized. You also should ask if they can do abductor canal block on her thigh and request that your wife stay awake for surgery so she can be in control.
I am the founder of Medical Patient Modesty, a non-profit organization that works to educate patients about their rights to modesty in medical settings. Please contact me via the contact form through email if you need any further help. Please do not fall to the notion that there is nothing you can do. Your wife and you have the power to decide what can be done to her. Your wife's private parts should not be exposed for knee surgery. She can easily wear a special kind of bra such as http://www.digniproducts.com/Products.html.
Misty
I went through a somewhat similar experience of forced catheterization to what the June 24th/ July 29th commenter describes. So sorry to them for having such a terrible experience. Really can relate.
It was a couple days after my 5th birthday when this happened to me. Was being sexually abused at home and got taken into the hospital eventually after months of serious pain and discomfort from that... guess they suspected a UTI. well couldn't pee for them because I'd gone recently and instead of just giving me some water or something and waiting a little bit I got held down by tons of nurses as they put the catheter in. Similarly, can't do anything about it. It just says that the catheter was placed in my chart and I was a minor anyway so they can do whatever they want.
Now I'm just extra messed up, I guess.
Hello:
I liken urethral catheterization to getting a colonoscopy.
Both are barbaric procedures!
Being as invasive and personal as this procedure is it should (if the patient is conscience and can legally make decisions for him or herself), ALWAYS not only require verbal but require written consent every time it's performed only after the patient is fully informed of both the upside and downside of going thru with the procedure.
We need to get this into HIPPA regulations or the government needs to make it law.
I personally will never consent or submit to urethral catheterization under any circumstances at any time. I fully understand why there is a need for the procedure however, I've read about all the down side that can come of it and have talked to patients and friends that have had it done to them and I have decided it's not for me.
If I bring an advance directive with me to the hospital that states "NO urethral catheterization at any time without prior written consent from patient" and I write on the surgical informed consent form "NO urethral catheterization under any circumstances at any time during any surgical event" and the staff puts one in against my direct wishes before going into theater, in theater after I'm under sedation, or in the PACU, the action taken would lead to an expensive lawsuit.
I'm against urethral catheterization in the hospital even if I needed one for the simple reason it's extremely invasive & I don't know ANYTHING about the person that's going to put it in.
I have all the respect in the world for doctors and nurses. They work tirelessly and don't get the pay or recognition they deserve but, having the title MD, RN, or CNA after your name means nothing when it comes to such a personal event.
How do we really know how experienced this person is that is going to do this procedure?
We don't know. They'll tell ya not to worry I've done this hundreds of times.
Yeah right.
I for one, am not about to take their word on something so invasive and personal. I don't know you and you don't know me so this procedure isn't happening.
Just a thought but maybe if there was a database patients can access somewhere that has stats on how many successes and how many failures hospital staff have had doing this procedure it might ease patients minds a bit.
A database setup by a healthcare organization whereby patients who are to endure this procedure are given the name of the person who will do it then they could access the database and check out the credentials of the person performing the task. Just something that says how many times they've done it successfully & how many failures. Then they could say give me someone else or decline the procedure.
One can go online to numerous places to check on physicians but I've never seen an online site with public access that rates nurses for procedures they perform.
For this kind of invasive procedure, maybe that's what is needed to help put patients more at ease with this process.
Until I have irrefutable proof you've done it successfully many times over, I won’t even consider going forward, I will always decline a urethral catheterization simply because if they make a mistake (and mistakes happen in hospitals ALL the time), I'm the one that in the end will pay dearly.
As an alternative to urethral catheterization I've started to research the possibility of maybe a suprapubic catheterization if catheterization needed in an emergency.
Otherwise, I have watched all the self-catheterization videos over & over and believe if push came to shove after surgery & I was home and needed relief, I would be willing to self-cath if I had to. I would just need to know where to get the supplies needed. I know it's ify but if it's done wrong at home, it's on me.
Thanks for listening.
Regards,
Raffie
Hello:
My thoughts on urinary catheterization are as follows.
I don't know anything about this person that says they've come to cath me.
I have no way of knowing how many times if any they've done this procedure before or how many times they've done it successfully or failed at it.
I'm sure as heck not going to fall for the story just lay back and relax now, don't worry, I've done this hundreds of times.
This procedure is extremely personal.
The procedure itself is extremely invasive.
I know nothing about you and have no way of verifying your qualifications or what you said.
If a mistake is made, I'm the one that has to live with it.
After I consider everything, I've decided no thank you. This catheterization will not be done.
I asked a urologist once how hard would it be for an adult to self-cath themselves.
He came back. People do it all the time. There are movies all over the net that show the procedure. In the beginning you have to really relax with it & take your time until you develop a rhythm.
That being the case, I'd rather take the chance and do it myself if it had to be done.
The other thing they might look at is.
Mostly nurses and CNA's do this so maybe if there was a database available that showed their stats on performing certain procedures they could show them to the patient before they get started so the patient could make an informed decision on whether they choose to go forward or not.
Those are my thoughts.
regards,
NTT
Hello:
This disturbing article comes from the Agency for Healthcare Research and Quality (AHRQ).
After reading this you might think twice before allowing a nurse to cath you.
AHRQ Study Finds Lack of Training Among Nurses on Proper Urinary Catheter Use and Specimen Collection
Key skills may be lacking among many nurses who treat patients with urinary catheters, according to a recent AHRQ-funded study.
The researchers found that recommended procedures to test for catheter-associated urinary tract infection (CAUTI), a common hospital-associated infection, are not followed in many cases.
Collecting specimens for urine culture is a key part of testing for CAUTI, requiring proper procedures for arriving at accurate results and keeping patients safe.
Of 394 nurses studied, 76 percent reported receiving education on CAUTI risk reduction within the last 12 months.
Almost half of the nurses did not believe that their peers comply with urine sample collection standards.
This research indicates the importance of addressing both nursing competencies for obtaining urine cultures and nurses’ knowledge as to when the culture is indicated.
The researchers concluded that nurses are not commonly evaluated on the skills of placing and maintaining urinary catheters.
Read the abstract for “How and When Nurses Collect Urine Cultures on Catheterized Patients: A Survey of 5 Hospitals,” which appeared in the February 2016 issue of the American Journal of Infection Control.
Nobody's making sure these people know what they are doing.
How safe does that make you the patient feel?
Regards,
NTT
I went for a spinal surgery and woke up with a catheter, i agreed to the surgery but was NEVER informed i would be molested by unknown people shoving a tube up my dick! I was never informed of any risks or side effects because i wasnt told i was gonna have one put in! How embarrassing waking up realizing i'd been fondled and abused AFTER i was put out for a SPINAL SURGERY and not a catheter! If i was informed of all the bad risk i would NEVER have agreed to it, i felt, and stiil feel, violated......my rights, and personally! If i EVER had consented i would want to be awake so i knew i was treated with respect and not like a test dummy for some nursing student doing his or her first catheter! Im appaulled this is allowed, giving a procedure without telling the patient who was in sound mind and body BEFORE being put to sleep, i feel they did it without telling me to trick me into surgery
Anonymous, my opinion is when people go for surgery, both the hospital & doctors are of the opinion that “What the patient doesn’t know, won’t hurt the patient and won’t get the hospital and/or doctor sued.”
Not many patients want to know the nitty gritty as to what has to be done beforehand to get the patient ready for surgery then how the surgery is performed. Say you went in for kidney surgery. They brought you into the OR on a gurney and you laid on the OR table on your back. If you went in on your back, how’d you get that scar on your back when you came out? Because after they knocked you out, one of the things they did was they turned you over on your stomach. Wonder how many people participated & saw everything?
Recently the American College of Surgeons (ACS) underscored the need for surgeons to proactively and fully explain how other providers might also be involved in a procedure. Informed consent discussions provide physicians with an opportunity to talk with patients about why they may not be present for the entire surgery, as well as which other team members might participate. They’re looking to get a well-executed informed consent form that can both guide the conversation you have with your surgeon and support the conversation with all the proper documentation.
Basically they’re trying to cover their a** better. Patients are getting tired of going in one way & coming out another. The patient is pushing back & the surgeon doesn’t like it.
I personally don’t think enough time and effort are put into the informed consent phase of an operation.
They wait until you are in pre-op then come at you, “here’s what’s wrong and we are going to perform this operation to fix it. Sign here please.” So you sign it not knowing you just declared open season on yourself.
When someone decides with their doctor that surgery is needed, the surgeon should have a sit down session with the patient in their office. No time limits. The session should be used to make the patient feel comfortable with what’s going to happen. Find out from the patient how much detail they want on the surgery. Explain in detail to patient’s satisfaction the informed consent forms.
Personally if I’m scheduling surgery, I’m going to push whosever’s buttons I have to, to get those consent forms BEFORE I go to any hospital. I don’t want to have to scan them & sign. I want to take my time & read them under no pressure from anyone.
You have the right to cross out and not consent to any part of those consent forms. Like taking of pictures or videos, outside sales people, trainees, you can also write your own comments on them like “I do not consent to having urinary catheterization done at any time before during or after surgery.” “All pre-op procedures are to be completed while patient is awake.” The down side to making modifications is the surgeon may feel you are tying his/her hands & won’t then do the surgery.
If you are going to make modifications on any forms, you make sure the person that came with you gets a copy of the modified forms signed off on by the surgeon and their witness BEFORE you go into any operating room. This way you have a copy of the legal record in case the one with your modifications on it should somehow disappear while you’re in surgery.
The level of mistrust with the medical community is growing daily & they only have themselves to blame for it.
Regards,
Raffie
Still furious a month later. Went for a TKA with spinal and light, which I thought was "conscious" sedation. Looked up and found myself naked from the waist down, utterly spread eagled, so I asked "What are you DOING?"
Now I am a doctor's wife in a rural hospital, the surgeon is a friend and unfortunately my husband had invited the anesthesia person, another social "friend" without asking me. He had forgotten the fact that this person had treated me with disrespect and I had subsequently refused to have anything to do with him.
So I was knocked out by the anesthesia guy at that point using Versed. I never gave permission for an amnesiac either. I had no preop with this nurse.
This is gang rape by persons in a position of trust. My brain took a flash photo of what I saw and it won't let go of it. Utter shock! I went through three preops and NO ONE even mentioned the possibility of a Foley. Having had a much longer bone surgery before, fully conscious with a spinal, and no catheter I just assumed that after this short surgery I might need a straight cath later. Much more private in my room. Not in front of my male friends!
PTSD, no local resources.
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