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.

           

Elderly Patients and Modesty by Misty Roberts

In Nursing Homes and Hospitals

The elderly patient presents a unique problem when dealing with the modesty issues they may face.  An elderly patient’s modesty is often compromised because they are unable to speak up on their own behalf, making them vulnerable.  Dementia at any level in an aged patient also poses problems because medical professionals assume that their modesty does not matter if they are not 100% cognizant of what is going on.  

Nursing homes and hospitals have become gender neutral. It is common for male nurses / aides to bathe, perform intimate procedures (changing diapers, urinary catheterizations, shaving their genitals for procedures, etc), and assist with in the bathroom, female patients they have been assigned to. Many families have been shocked and outraged to discover that their family members were bathed by opposite sex nurses or aides without their consent. Nursing homes and hospitals need to work to accommodate elderly patients’ wishes for privacy. 

I personally think it is risky for nursing homes to assign male nurses or assistants to female patients for intimate care tasks (bathing, changing diapers, dressing, cleaning women’s private parts after bowel movements, etc) due to the potential for sexual abuse. Cases of sexual abuse by male nurses and assistants at nursing homes are in the news frequently. The false assumption exists that the elderly do not care about their modesty. This could not be farther from the truth. Many female nursing home residents will not even allow their sons, grandsons, or male relatives help them with intimate care tasks. Why should they have to give up their boundaries about men not helping them with intimate care in nursing home and hospital settings?  I personally believe that male nurses and assistants can certainly work with female patients, but they should have no contact with female patients’ private parts.  This will not only honor their wishes but also help to ensure that sexual abuse does not happen. “Elderly nursing home residents are easy prey for sexual predators, because they are often weak and defenseless. They may also fall victim to sexual abuse because they had a stroke or other medical condition that caused them to lose their speech or motor skills. When a nursing home resident is unable to protect themselves or speak, the likelihood of becoming a victim of sexual abuse increases” according to Sexual Abuse in Nursing Homes – Edgar Synder & Associates.

Nursing homes and hospitals may use this excuse: a male nurse has to assist in bathing some women for the purpose of lifting them and ensuring that they are not dropped. This is not true.  Due to the potential of sexual abuse, this is very risky. It is my opinion that a female nurse or assistant should always bathe a woman. A male nurse or assistant could help to lift a clothed woman in the bathtub if necessary and leave while a female nurse or assistant bathes her. Then the female nurse could call for the male assistant to come back to get her out of the bathtub after the woman has been dressed.  Sponge baths can be given to very frail patients in their beds, requiring no lifting or male assistance whatsoever.

A number of relatives of elderly female nursing home residents have expressed how upset they were to find male nurses / assistants handling their loved ones’ intimate care issues.  Here are a few examples:

1.)    A very painful incident for me involved my mother, who in the advanced stages of Alzheimer’s, was hospitalized with a broken hip. I visited her room one day and found a male nurse cleaning her up after a bowel movement.  She was highly agitated and terrified.  My Dad, who was present, had not protested, so I didn't say anything.  I cannot believe that I was such a coward.  Mother passed away five years ago, and I have not gotten over the regret of not speaking up for her.    Given the opportunity again, I would have insisted on female nurses and aides ONLY!
– Man from South Carolina 

2.)    I have a grandmother in a nursing home that requires assistance in the restroom, help bathing and changing. She is also not completely there in her mind. She can easily be taken advantage of and cared for by a male. The position my grandmother's in is already degrading enough, but to have a male nurse taking care of her and seeing her exposed is wrong in many ways. My family does not want to have a male nurse taking care of her because of the degrading and immoral nature of the situation.”
– A young lady from Durham, NC 

Modesty issues are not reserved for only elderly female patients, elderly male patients also struggle with them.  Years ago, male nurses were very rare. It’s wonderful that we are seeing more male nurses / aides for elderly male patients who are not comfortable with female nurses / assistants. Some nursing homes hardly have any male nurses or aides to help with male patients who are modest. A nurse / aide actually swore at an elderly man who asked her to leave the room for a few minutes so he could use the bathroom. She thought he was crazy for asking her to leave the room.

A pastor shared this with Medical Patient Modesty: A very pleasant, likeable, and religious congregant found himself in the hospital for a prolonged period, prior to his death. His recurring conversation with me, over the course of my many pastoral visits was his resistances to female nurses inserting Foley catheters, giving him complete body baths, and dressing him. Disclosing that he could accept the immense physical pain foisted on him and that he was prepared for death, this sheep of my flock related that the most difficult problem of his entire life was this issue of frontal nudity before strange women! It was foreign to his life experience. "It's not right!" was his plea. His tearful eyes looked to me for counsel. The only consolation this veteran clergy provided him was that if I were in his shoes my feelings would be identical to his own! The female nurses told this suffering, dying patient, "You don't have anything we've never seen before!" "Don't worry about it, we do this all the time!" and "You'll get over it!"

If you have to place a loved one in a nursing home, take time to meet with the nursing home administrator, supervisors and other staff members to discuss how you want the loved one’s modesty to be protected. Ask questions about how they can ensure the protection of your loved one’s modesty.  Make sure that all of your directives are put in writing and be succinct with what you want.  For example, state that no male nurses or aides are allowed to bathe your elderly mother.

Adolescent Boys and Genital Exams Reducing Embarrassment

              by Joel Sherman MD

Here is an unusual post that actually discusses the most embarrassing part of the male physical exam.  Every practitioner who does male genital exams is certainly aware of this problem yet it is rarely discussed.  I quote from this anonymous nurse practitioner's (NP) blog:

It is a hard fact of practice that there will be a time in a clinician's life when he or she will be confronted with an erect penis.  … In newFNP's experience, these awkward moments tend to occur with teenage boys who will pitch a tent upon sensing a sideways glance at the penis. … In general, newFNP really feels sorry for her male patients who have an itchy trigger penis. She knows that they know that they have an erection at an inappropriate time. She knows that they are uncomfortable and assumes that they might like to sink into a crack in the floor. 

I showed this blog to a NP I know who does sports physicals.  She confirmed all the main points:  Yes, this occasionally happens and the boys are generally incredibly embarrassed.  This has been posted about a few times by other practitioners as well although the articles have since been deleted.  I asked the NP whether she was trained to deal with this situation.  The answer was no, the subject was never mentioned in her NP training.  My medical training was decades ago, and that was certainly true then; the subject was never mentioned.  I tried to find out if it is any different now.  A medical educator and physical exam instructor of 2^nd year medical students, Dr. Maurice Bernstein  says that his students are told to reassure men that it is a normal physiologic reaction.  It’s hard to know what else to say, but the response can beg the question.  It is a normal reaction for the practitioner.  -But not for the patient.  Adolescents are not used to having their genitals seen and touched, especially in a non sexual situation, and may respond sexually.  Despite reassurances to the contrary, as seen in the above quote from the blog, the encounter can be a source of amusement to others.    

Standard textbooks on adolescents and physical exams have almost nothing to say about this.  Mosby’s Guide to Physical Examination (4^th edition) was the only text I came across that actually mentioned that young patients especially may be fearful of having erections.  But it doesn’t make any recommendations as to how to avoid the problem or what to do when it occurs.  Two textbooks (Swartz, Textbook of Physical Diagnosis  (6^th ed.) and Bickley, Guide to Physical Examination, (10^th ed.) had brief articles on how to reassure girls for their first pelvic exams.  Incredibly though when it came to the male genital exam, these 2 books only discussed how to reassure the medical student doing them.  The patient’s embarrassment was not mentioned.  Yes the exams are embarrassing for new physicians as well, but concern for the patient should remain primary. Two texts I viewed on adolescents said nothing about the subject.

So it is well recognized by practitioners that genital exams are embarrassing for boys as well as for girls. It is also documented that the gender of the provider is one factor.   (Adolescent Girls and Boys Preferences for Provider Gender & Confidentiality in Their Health Care, Journal of Adolescent Medicine 1999;25:131-142. &  Patient Preferences for Physician Gender in the Male Genital/Rectal Exam, Family Practice Research Journal, Vol 10 No 2, 1990.)   There is evidence for both boys and girls that the exams are more embarrassing when done by opposite gender providers (for further references see link).    The American Academy of Pediatrics (AAP) has published extensive guidelines for both male and female genital exams.  For girls it states: Clinicians should always be sensitive to the possibility of past or current sexual abuse, which can affect the patient's comfort with the examination and her preference regarding the gender of the examiner.  For boys it states:  Trust and relationship-building are also critical elements of the male adolescent's visit that help him to feel comfortable regardless of a physician's gender and/or background.  In other words for girls one should respect their gender preferences for the exam.  For boys it makes no difference if the exam is done properly.  And they don’t appear to recognize that sexual abuse of boys is very common as well, about half the incidence of girls.  The conclusion from the AAP appears to be that girls should be given a gender preference and boys should not.  Given the clear embarrassment that both boys and girls can suffer, there is no justification for the different treatment.  

Likely this difference is a reflection of the varying importance Western society has put on modesty for women vs. men.   And it probably also reflects the genuine difference in the complexity of the exams, a woman’s gynecologic exam taking up to 15-20 minutes with specialized equipment and the patient in an unfamiliar embarrassing position vs. a few minutes for the average male exam with no unusual equipment or positions needed.   But clearly the embarrassment that boys feel during these exams can be comparable to what girls go thru, especially if an erection develops.  Indeed many men as well as adolescents can’t help but feel that someone handling their genitals is a sexual experience, usually more intense with an opposite gender provider.

Adolescents in particular deserve utmost sensitivity for genital exams, especially for their first thorough one.  While this is recognized for girls, it is rarely mentioned for boys even though every practitioner must be aware of boys’ embarrassment.  Parents will often accede to their daughters wishes for gender preference and will prepare their daughters for what to expect; boys are rarely accorded the same consideration which is now much more of a problem than it was years ago when female pediatricians were a small minority.  It is easy to find texts and manuals as to how to handle pelvic exams in the least stressful and embarrassing way possible.  For boys a similar discussion is rare.   Most practitioners must know how to reduce embarrassment by keeping the boys covered as much as possible and keeping tactile stimulation to a minimum through brief exams and the use of gloves.  It is time that medical teaching and parents caught up with the fact both boys and girls need equal consideration including offering them a preference for the gender for the provider.

Privacy Rights in PrisonNew Regulations Increase Rights to Prevent Prison Rape

By Joel Sherman MD

A California Prison

A recent directive of the Dept. of Justice (DOJ) to prevent rape in prisons has gotten very little general publicity, but it represents a major change in prison standards, one which increases privacy rights.  These rights in prison are not directly related to privacy in general or medical privacy, but still and all there are ramifications that echo throughout society.  The courts have long held that prisoners have restricted privacy rights and that security in the prisons is paramount.  But over the last 40+ years, equal employment rights have often also been held to trump prisoners’ privacy rights.  Thus women guards are common in men’s prisons and men have always been present in women’s prisons.   Over the years there have been innumerable lawsuits over this with conflicting results.   Rules vary from state to state and prison to prison with separate rules governing federal prisons.   As a general rule, women prisoners are afforded more privacy from male guards than vice versa.   For both cross gender strip searches are generally only permitted in emergencies, though the interpretation of what’s an emergency can be very liberal.   But cross gender viewing in showers, bathrooms and cells is very common with once again women afforded more protection.  However the release on May 16, 2012 of new federal rules from the DOJ to prevent rape in prisons may change all of this.  These regulations immediately take effect in federal prisons, but can only be enforced in state and local lockups through loss of federal grants.  So these changes will take many years to percolate down through the nation.

The federal government has documented that there is an epidemic of rape in prisons.  One in ten prisoners have been raped, usually the weak, disabled, gay, lesbian or transgendered.   Half of prison rapes are prisoner on prisoner, but nearly half involve guards and prisoners.  Surprisingly more of the guard on prisoner rapes involve women guards and male prisoners.   For juveniles an astounding 95% of sexual encounters were with female guards;  40% of encounters were considered forced by the juveniles.  For adults nearly 75% of guard on prisoner sexual encounters were rated consensual by the prisoners, though legally they are all classified as assaults.  Consensual or not, all guard prisoner encounters are destructive to jail discipline.  The lengthy new federal regulations are primarily concerned with what administrative changes can be made to prevent rape with special protections needed for juveniles and the LGBT population.  Most pertinent to this blog are the recommendations they made that directly affect the privacy rights afforded prisoners:   

“Cross-Gender Searches and Viewing. In a change from the proposed standards, the final standards include a phased-in ban on cross-gender pat-down searches of female inmates in adult prisons, jails, and community confinement facilities absent exigent circumstances—which is currently the policy in most State prison systems. However, female inmates’ access to programming and out-of-cell opportunities must not be restricted to comply with this provision.

For juvenile facilities, however, the final standards, like the proposed standards, prohibit cross-gender pat-down searches of both female and male residents. And for all facilities, the standards prohibit cross-gender strip searches and visual body cavity searches except in exigent circumstances or when performed by medical practitioners, in which case the searches must be documented.

The standards also require facilities to implement policies and procedures that enable inmates to shower, perform bodily functions, and change clothing without nonmedical staff of the opposite gender viewing their breasts, buttocks, or genitalia, except in exigent circumstances or when such viewing is incidental to routine cell checks. (Emphasis added)  In addition, facilities must require staff of the opposite gender to announce their presence when entering an inmate housing unit.”

Note that the only double standard now permitted, in a change from their preliminary guidelines put up for commentary, are that  cross gender pat downs searches (that is searches done through the prisoners clothing) are permitted for adult men but not for women.  I believe this change was done for practicality only, not because it wouldn’t afford men more protection.  There are so many women guards, in some jails, such as in the men’s city prison of New York where they are over half, that they’d have to fire women guards and hire more men.  All cross gender strip searches are forbidden except in emergencies.  What this tells us is that the Commission believed that cross gender intimate contact of all types greatly increased the risk of sexual assaults, whether consensual or not.

What is the relevance of all this to society in general, and healthcare in particular?  A new standard has been set that reverses over 30 years of preponderant court decisions in the US.  Up to now the courts have generally given preference to equal employment rights over privacy rights.  This applies to institutions other than prison such as healthcare.  There are exceptions (BFOQ, bona fide occupational qualifications) to the rules but they are applied sporadically without any uniformity creating lots of work for attorneys.  The new regulations adopted by the DOJ recognizes for the first time that unfettered equal employment rights can put people at risk of abuse.  To my mind, this is an important new precedent.

Unfortunately the federal government is a multi headed hydra.  I note that in recent news the Office of Civil Rights, part of the US Dept of Health and Human Services has asked to file a brief in support of women guards in Ohio in a case they claimed was employment discrimination.   The Ohio prison defended their employment policies saying they could not use women guards in areas of men’s prisons where they needed to witness strip searches and showering.  That would seem to accord fully with DOJ regulations.  I don’t know how this will all play out; an accommodation could potentially be made to increase female employment in non sensitive areas.  I think our prisons would be safer for all though if no opposite gender guards were permitted in sensitive areas which are the majority of most prisons.  The US is the only country in the world which insists that male guards be in women’s prisons because of equal employment rights; it violates United Nation law.

To summarize, privacy rights are more than just a nice legal theory but are also important for safety.  The right to same gender intimate care and monitoring, both in prisons and throughout society should not be held hostage to equal employment rights.

Medical Students Learn About HIPAA Guest post by Estelle Schumann

Medical Students Learn about Patients’ Right to Confidentiality

Patient health information and privacy has been protected since 2003 under the Health Insurance Portability and Accountability Act, or HIPAA although it is something that both current and aspiring health care professionals  have always been aware of. Congress enacted HIPAA in 1996 as part of a broad health care reform effort. Initially, the emphasis was on promoting personal health insurance portability, but the emphasis changed to standardizing the process of sharing insurance claims with medical insurers.

Congress recognized a great potential for abuse of electronic health data, so they placed strict controls on its movement and care. Doctors and hospitals must comply with HIPAA regulations, and so must academic medical centers. Like all other staff of hospitals and medical centers, medical students must complete HIPAA training. Every health care facility must provide documentation of this training for everyone who has access to patients or patient data.

Protected Health Information (PHI) which is stored, transmitted, accessed, or received electronically is called ePHI. Under HIPAA, PHI means any information “that identifies an individual and relates to at least one of the following:

• The individuals past, present or future physical or mental health.
• The provision of health care to the individual.
• The past, present or future payment for health care.

Information is said to identify an individual if it includes the individuals name or any other information that could be used to determine the individuals identity.

To know the specifics of how to protect patient data, entering medical students must complete HIPAA training, which is generally administered online. HIPAA is site specific, and entering students, for example, at the University of Washington must complete training both for UW HIPAA and the Veteran’s Administration Hospital’s HIPAA prior to Orientation. The course for UW Medicine is web-based and takes approximately two hours. Students will receive a user ID, password, and web address for the training in an email, the summer before they enter medical school. Upon completion, they will receive a compliance certificate, one copy of which they must email to the school in PDF format, and one copy they may be asked to provide at clinical sites or to participate in research that includes patient data.

Some general HIPAA guidelines, according to the Medical College of Wisconsin Affiliated Hospitals, Inc., are:

• Access patient information only if you need that information to do your work.
• Share or discuss patient information only if it is necessary to do your work.
• Never share your identification number or password with anyone.
• Follow the hospital’s or healthcare provider’s policies on confidentiality and privacy.
• Log off your computer session when you are not by your workstation.
• Ensure confidentiality when you handle protected healthcare information.

In addition, MCWAH trainees are required to sign a confidentiality form.

Yale University is required to notify individuals within 60 days if the security of their PHI has been compromised. They must also notify the Department of Health and Human Services, and, if more than 500 individuals are involved, they must notify the media. Civil monetary penalties and criminal penalties have been established by HIPAA for knowing use or disclosure of identifiable PHI. An individuals own access to his or her health information is somewhat restricted under HIPAA, but generally the law protects the individuals right to privacy.

Doctors, medical students, and healthcare personnel, are trained and certified to follow HIPAA guidelines. It is an important piece of legislation that is vital to protecting patient privacy.

Estelle Schumann blogs at  http://www.healthscience.net/

The Mass Media & Men's Health by Joel Sherman MD

This article was chosen for reposting on KevinMD.

CBS Cares - About my prostate !

The mass media has a long history of covering medical dramas and rarely doing so with any realism.  We’ve gone from Marcus Welby MD to a host of shows dedicated to portraying medical personnel in the most salacious ways possible.  But at least with all these dramas it is understood that they are fictional.  There are now though a host of shows which pretend to show real life medical stories which are even more perverse. 

Some of the most egregious examples come from Untold Stories of the ER, a Discovery Health Channel production which is sporadically rebroadcast on The Learning Channel.  A prime example from this show is episode 4 from season 5, ‘Grandma’s Back.’  This episode can be downloaded from Amazon .    One of the incidents portrayed is that of a young man entering with priapism, an erection which won’t subside spontaneously.  This is a relatively rare occurrence as a side effect of Viagra.  But can also be associated with serious underlying clotting disorders and malignancies.  After an episode of priapism men are frequently left impotent.   In short, the condition is a serious one and anything but a joke.  It’s about as intrinsically funny as female infertility. 

The vignette portrays a young man coming in the ER with a prominent bulge in his pants accompanied by his mistress.  His wife later shows up and the two women fight as neither was apparently aware of the other.  The patient is portrayed as being in great pain and whining for relief while trying to fend off the two women who turn against him.   The whole episode is one of comic relief in contrast to the other 2 episodes in this hour show.  The other two tales in this episode concern critically ill women, one young and attractive, the other elderly but well preserved, both of whom ultimately do well.   Needless to say, both are treated sensitively as if a miracle had taken place without a hint of mockery.

The doctor in the priapism story is identified and I was able to call him.  He said the season was filmed in Vancouver, in a defunct medical clinic, which the network rented out for the month.   Of course all the patients and likely most of the staff are actors, but the identified physicians are real.  The priapism tale is one the physician suggested based on a real experience from his residency.  In commenting on the filming, the doctor said that ‘sex sells.’

A further episode portrays a man who came in with testicular pain.  A testicular ultrasound is ordered, but a mix-up occurs and an orthopedic patient is sent instead.  The patient who underwent the mistaken testicular ultrasound by a woman technician of course is later shown to have thoroughly enjoyed the exam.   Two other episodes make a point of showing men being embarrassed to be treated by female physicians or nurses.  Needless to say, I’ve seen no episodes ( though I haven’t seen them all) where women are portrayed in such a mocking disrespectful way.

The attitude taken on this show towards male health problems is reflected throughout society.  It is routine on TV and in movies for the portrayal of men being hit in the groin to be used as a comic event despite the fact that serious injuries occur.  The media treatment  of the John Wayne Bobbitt case is an extreme example.  There are many sites devoted to jokes about the incident.  It’s inconceivable that mutilation of a woman could be treated similarly by the media.

Men’s reluctance to obtain routine health care is also routinely treated as a joke.  Even physicians have done this.  An example quoted before on these blogs' is Dr Sharon Orrange’s article  on the 10 reasons men don’t go to the doctor including “you are afraid we will put our finger in your butt” and “you are afraid we will examine your balls.”   This same physician has never treated woman’s issues with levity. 
 

Even when the motives are unquestioned, the media frequently uses humor and sex to try and encourage men to receive medical care.   CBS has run a series of public service announcements to entice men to receive prostate exams.  Some are directed to women rather than men, a common strategy.  Some of these ads use a young alluring woman to give the message with a smile (pictured above).   Can you imagine an ad to promote Pap smears using a young handsome man?  I don’t think you’ll ever see one.   Why not use an ad from a former athlete who may have had prostate cancer himself?  There are lots of them.  Johns Hopkins was featured in an ABC TV series in 2008 purportedly to show real life situations in medicine.   One episode featured a female urologist coaxing a minimally reluctant  older man to submit to an exam.  He is shown from the back lowering his pants for her.  There was no point to this episode except to introduce some sex and male embarrassment into the show.  There are many thousands of women physicians in this country who do thousands of exams on men every day.  Why feature men for embarrassment?  Women get just as embarrassed,  but that’s never a matter for humor.  That’s treated as a serious concern.  On an opposite but analogous theme, a play called, ‘Midlife Crisis, the Musical’ has one scene showing men sitting reluctantly in a doctor’s office waiting for their appointment.  But they are then told that the provider has been changed to a young pretty female physician, and the men now jump up with eagerness to get their exam.  So men are either reluctant to have an exam or eager, depending on what seems more humorous in the setting.

In short, the media has always portrayed medical situations in sitcoms and dramas in a way to sexualize and dramatize the entire episode.  It is highly variable whether any pains are taken to get medical facts correct; often they are totally inaccurate.    But at least it’s apparent that these dramas are fiction.  The so called reality shows are worse in that viewers are more likely to believe that they are actually witnessing valid portrayals of modern medicine.  Male patients are usually not shown as being capable of making intelligent choices about their health care.  They either need their wives to push them into it or the medical encounter needs a pretty provider to attract them.  Frequently they are embarrassed to seek help.  Now these characterizations do fit some segment of the male population, but why are they the only segment shown?  No humor is portrayed when women  need to be pushed into obtaining needed medical care.   The majority of men who need chronic health care, predominately middle aged and older men, would be better served by intelligent and factual reminders of what is needed.  Some professional organizations like the American Cancer Society do provide this, and there are serious health segments, especially on cable news, but in general the popular mass media fails miserably.  I see no organized protest about this.  Groups such as the AMA could improve the situation if they tried.