GUEST POST BY ROBERT UNDERHILL

“Medicine is gender neutral” is a true enough statement if by that we mean female nurses and techs are comfortable providing virtually all of the intimate care for men and women.  Gender neutral works for the caregivers perhaps, but oftentimes not for the men.

The relative male-female parity amongst physician ranks generally affords both men and women with sufficient options.  The problem for men is lack of options at the nursing and tech level, where most intimate care occurs.  We don’t expect women to have male techs for their mammograms.  Why do we expect men to have testicular ultrasounds by female techs?  Why do urology practices with predominantly male patients only have female nurses & techs for cystoscopies and other very intimate procedures?  Why the double standard?

As with any human trait, there is a continuum when we’re talking about modesty.  On one end of the spectrum are those guys who have no modesty whatsoever.  The healthcare system is fine as is for them.  On the other end are men who forego healthcare rather than have female nurses and techs for intimate care.  The system is failing those men.  Most men are somewhere in-between the two extremes.

Interestingly, when articles are written about men not going to the doctor, modesty is never listed as one of the reasons.  Why is this?  Partly because it is the elephant in the room that the medical world does not want to discuss and partly because men are afraid to speak up.  Why won’t the medical world acknowledge the issue?  Because they’d then be obligated to do something about it.  Why won’t men speak up?  Because all too often when he does he gets “you don’t have anything I haven’t seen”, “don’t be silly”, or “we’re all professionals here”.

Basic bullying and shaming techniques are intended to shut down the conversation rather than acknowledge the concern and then speak to it.  It actually works most of the time but it greatly amplifies the patient’s embarrassment.   Better to instead respond with “I understand your concern and wish I could accommodate your request but we don’t have any male staff.  Know that I take your privacy seriously and that your exposure will be kept to the absolute minimum”.  And then give an example or two of how you do that.

Being empathetic in this manner will satisfy many modesty concerns.  What you don’t know is that he may have been fearful of repeating a particularly bad experience.  That you are comfortable with the man’s exposure is irrelevant.  He is the only naked person in the room and it is his exposure that he is concerned about, not your comfort.

But most guys have no modesty you say; it is a rarity to encounter a modest guy.  Not even close on the first point.  Correct on the second, but only because you didn’t know he was modest.  Most are afraid to admit it because doing so is not “manly”.  Societal norms say men are not supposed to be modest; that it is a sign of weakness.  Males are socialized from childhood that when faced with an embarrassing medical exam or procedure to “man up” making believe it doesn’t bother them.  To acknowledge embarrassment only serves to amplify it.  This is what they have been doing since their first sports physical in Middle School when the female NP hired by the school (with a female assistant by her side) does a genital exam.  Such a powerful message from the school is not forgotten.

Female nurses and techs do not intentionally embarrass their male patients.  They’re just doing their job how they’ve been trained.  The problem is that training all too often starts with the premise that men have no modesty.  Better training is needed.  Here’s a start.  If he jokes about his exposure, he’s trying to hide his embarrassment from you.  If he maintains a tense silence, he’s just plain embarrassed.

Many men have mastered the “it doesn’t bother me” disguise and you won’t detect anything at all.  What can you do to ease the embarrassment, or at least not make it worse?  Ask him if he’d prefer your male co-worker do the intimate procedure.  Knock and ask if it is OK to enter the room.  Close the door or pull the curtain.  Kick anyone out that doesn’t need to be there; don’t turn it into a spectator sport.  Ask for an OK before bringing a student into the room and properly introduce them, including what exactly they are.  Use a sheet to keep the genitals covered before you pull the gown up to examine the abdomen.  Ask before lifting the gown to check the catheter.  Basically give him the same consideration you’d want your Dad, brother, husband, boyfriend, or son given in the same circumstance.

If in doubt about whether a protocol is OK, reverse the gender of everyone in the room and then ask yourself the question.  If the answer is no, then it’s not OK for your male patient either.

ABOUT THE AUTHOR:

 Robert Underhill is a retired executive living in Vermont. More importantly, he is a husband, father, and grandfather.  His goal is to raise awareness to the lack of attention paid to men’s modestly and hopes to achieve gender parity throughout all levels of the healthcare team. We sincerely wish more men will add their voices to this very important yet neglected topic. 

© 2016, Linda Girgis MD. All rights reserved.

Digiprove sealCopyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP

12 thoughts on “Why Men Patients are Forced to Man Up in the Medical Setting

  1. Very well stated. I am a male that doesn’t see a doctor for anything other than routine blood work and exams. I have no issues with my doctor but far too often I have gone in for tests or proceedurs and been undressed with all women. I know I have urological issues but will not go. The last time I went I was left in a room naked from the waist down with two females. It was humiliating and I never went back.

    1. What would help future patients is if you told the urologist why you won’t be back. I silently suffered through the indignities for years but finally found my voice. It was liberating. I am always polite and professional, but I do speak up. If enough of us speak up they won’t be able to continue pretending that there isn’t a problem.

  2. I went for a routine physical. EKG, etc. I hadn’t seen a doctor in 10 years, because of no healthcare. I had submitted a pre-exam letter explaining some of my concerns. I had a small lump around my right testicle. I was told in the waiting room at my visit the NPA does all the exams. Hesitantly I agreed. I was told to undress, and put on a blue gown. She knocked and came in. I went through all the regular things. The first issue I encountered was while on the table with wires hooked up, with gown open, another “Female” tech came in without knocking, who I didn’t know, and got some supplies out of a side unit, looked at me, then left. No words exchanged.
    Then it came time for the intimate part. She excused herself, and then came in a minute later, with another female tech in blue. (This is referred to as an ambush, by the way) I was given a prostate exam in her presence. Then she asked me to turn over and she examined my genitals, and asked about the testicle issue. She attempted to find the lump, in front of the other female tech who held a hand-held light on the area, and after feeling the testicle for several minutes, could not locate it. The manipulation actually left me feeling sore in the area. She could NOT find it. After the exam she recommended an Ultrasound. I drove across town, and went to an imagine center for Ultrasounds. I gave my sheet to the “female receptionist” who entered the date into her computer. So obvious she knew I had a lump and my personal business. Then I was called. You guessed it, another female. I was told again to undress from the waste down, lay on the table, legs closed with a rolled towel under my scrotum and cover. She must have been under 30 years old. She sits next to me. Pulls up the towel FULLY exposing me, then puts Jelly in the area, which was too hot by the way. Then she takes 10 to 15 minutes with the hand held device prodding and taking measurements. Since then, I have undergone 4 ultrasounds, by different woman. NEVER EVER offered a male tech. Highly intimidating. I am reading about how more and more woman are coming into the medical field. The field needs to change fast in being sensitive to men in the exam room. YES _ MANY men have modesty and WANT to be respected and given choice. NOT expected to suck it up. That ideal is failing men as patients. Then people wonder why so many men DIE of prostate issues and such. If you want to save more lives, then give more men the dignity and respect they deserve. Don’t be so sure they feel comfortable with a woman in the exam room. Start giving them a choice of gender for doctor AND chaperone.

    By the way, after the initial visit I had with the NPA and testicle issue, I saw my primary ( male ) doctor about the issue a month later, and he found the lump in 30 seconds. Knew exactly how to find it, and didn’t hurt the area, and leave me sore afterwards. He knew my area from having the same parts himself. He wasn’t as insensitive and aggressive as the NP was.

  3. I was hospitalized 3 weeks ago in Puerto Vallarta, Mexico. On the third evening, as the doctor was leaving the room, she said she would send someone in to help me in the shower. Minutes later a male nurse came in. I was hooked up to an IV and had just had a minor surgery. The curious thing is that he completely disrobed to shower me. We were two naked dudes, which didn’t bother me at all, but I’m sure a female nurse would not have done that. If he had not removed his clothing he would have been soaking wet, so it made sense that he not wear anything. Do male patients get males to assist them in this way, or how would it be different if a male were not available? What is the protocol in a case like this?

    1. I doubt you’d find that anywhere in the US., though it makes sense in the way you describe it. I wonder if hospitals in Mexico routinely provide male staff for male patient intimate procedures.

  4. Hello:

    First let me say, this is NOT in ANY way a rant against women.

    I have nothing but the utmost respect for them. They work just as hard as their male counterparts.

    I’m also NOT a healthcare worker.

    I’m just an American citizen understandably concerned with what is currently one of thee BIGGEST problems that must be solved within the American healthcare system.

    I believe in order to get “real” gender parity in the healthcare industry, the strangle hold currently held by women on the nursing & healthcare tech professions must be broken. Walls must come down and roadblocks removed so qualified men that are look for these types of positions, can get hired.

    Since their inception, the two vocations have grown over the years to become for the most part two “all girls clubs”.

    Part of the reason is for years, men never gave a second thought to ever becoming a nurse or health tech so these women went about building their careers and over time began wielding powerful influence over the healthcare industry. In their profession you played by their rules, their way, or you take the highway.

    Then times started changing.

    Men started asking themselves why can’t I become a nurse or med tech.

    They saw no reason why not so, they quietly went about getting the education and proficiencies needed to become a nurse or technician.

    In the beginning, when and/or if they got accepted by a school that in itself was a victory.

    When they went to classes in the beginning many were given a cold shoulder by their female counterparts which made it all that much harder for them to achieve their ultimate goal of being an RN or registered technician.

    They were told they don’t belong. It’s a woman’s profession. Yada, yada, yada. The profession achieved their objective in the beginning & discouraged many men from continuing their studies & many men dropped out.

    However, there were men despite all the negativity being thrown their way by women, ignored it & went on to get their degrees.

    There perseverance, showed other men they too could get a degree in nursing or med tech if they really wanted to so as a result, more men started going to nursing and med tech school.

    Now, the powers that be in the profession at first brushed off these males trying to get into their world as a fad that would die off.

    Over time however, more men started going to school & it started worrying the leadership. They had to “do something” to discourage these men.

    So what did they do, they moved quickly and closed off any position remotely related to any kind of female intimate exposure to all male nurses & techs.

    Curiously though at the same time they closed off positions to men, they didn’t even give a passing thought to doing the same & close off positions to females relating to any kind of male intimate exposure.

    They could have hired these men to take care of male patients if they requested a male caregiver.

    Instead of taking advantage of the opportunity to welcome these men into their profession with open arms, they looked for ways to further shut them out.

    So for a long time now fully qualified men and male patients have had a very difficult time dealing with the healthcare industry.

    People that don’t just hand over their dignity & respect to the healthcare profession are automatically belittled and shamed into giving it up or they are ignored by the system.

    A lot of the problem might have to do with the nursing & tech leadership wielding their influence where hiring practices are concerned. Many HR departments today are run by women.

    A doctor wants to make his or her male patients feel more comfortable so they decide to hire male nurses to work with male patients if the patient chooses.

    The older female nurses that have been with the practice for years get wind of this. They don’t want their apple cart upset so they wield their influence & convince the doctor that the male patients will be fine with their care. So the doctor without thinking of his patients needs cancels any hiring.

    Urology department head decides they need to increase staff to handle the increase in patients.

    The patients are mostly male.

    Current staff of all women tells the dept. head the men are fine with their care even though the patients were never asked so the department head listens & hires more women.

    These same scenarios plays out in doctor’s offices and hospitals across the country on a daily basis.

    Men are being discouraged left & right from applying for positions they are fully qualified for because they don’t want to break up their “all girls club”. Guys are running into “Females Only Need Apply”.

    So because of the unwillingness to yield, many male patients have decided better to forego needed medical care rather then put themselves through the humiliation the healthcare system will put them through.

    This man could be your dad, brother, husband, or your son. Are you really willing to take a chance with their life?

    To any and all doctors and hospital department heads out there. Why not JUST ASK your patient in say a survey.

    Do you prefer same gender care for any intimate type test or procedure?

    Simple question.

    In the beginning, it might be tough getting some men to respond because you’ve conditioned them so well over the years to put up, shut up, & take whatever you give but, I think you’ll find from those that respond, many want same gender care for intimate type tests and/or procedures.

    Why is it we don’t we see any clinics specifically for men’s healthcare needs opening up? Clinics run and staffed only by men for men.

    You see all women’s clinics going up everywhere.

    I was on the road & I saw a Shirtless Male Nurse on a billboard. The caption read “Who’s caring for your mom?” Next to the words was a young topless man wearing a stethoscope.

    Is this the way the industry views male nurses and their work?

    Had it been a female in just her bra with a stethoscope around her neck on that billboard, there would have been an uproar like nothing ever seen before.

    The system must be open to both sexes and run on an equal basis across the board.

    Stop using the crutch of the costs involved in hiring enough staff. People retire all the time and there are men looking for open positions. They don’t want to be glorified orderlies. They want a nursing/tech career.

    Start thinking about the NEEDS of the patient and what you can do as a healthcare professional to give them the best possible outcome from their visit. Believe me we’re tired of hearing “we’re all professionals & we’ve seen it all before”. Look at all your so-called “professionals” that have been caught for breaking patient rules.

    Best wishes to all,
    Raffie

    1. Raffie, this is why men need to speak up as patients, and also as community members. Too often the medical world hides behind the “nobody has ever brought up that issue before”.

      Something I am in the midst of is posing related questions as just an interested party in the community. I recently inquired of the local hospital about the extent to which 11th & 12th grade LNA students from the local tech school are involved with intimate patient care in their facility, and letting them know that I think it is inappropriate for 16 & 17 year old kids to be allowed such exposure (despite 16 year olds being able to get their LNA license in this State). I could tell that my questions gave them pause to think and that they’ve sharpened their protocols a bit..

      I then went to the tech school itself to inquire about whether they have any outreach to bring boys into the program so as to help address the problems caused by the gender imbalance that currently exists. They are going to change their promotional video as a result.

      I am now waiting on a response to a similar query to the BSN nursing program at the local college.

      Last summer after an ER visit I got a call from the hospital surveying my experience. I noted that I thought it was unprofessional for the doctor to come into the room with a female scribe in tow without ever introducing her or asking me if it was OK that she be there. I said that had there been intimate exposure involved it would have totally inappropriate. I could tell by the reaction that nobody had ever said this to her before, and after agreeing with me that I was right she said she would bring it up at that week’s staff meeting.

      It is only speaking up and being proactive that anything will ever change.

  5. Good Day:

    First let me say, this is NOT in ANY way a rant against women.

    I have nothing but the utmost respect for women. They work just as hard as men & deserve nothing but the best.

    I’m also NOT a healthcare worker.

    I’m just a concerned American who has dealt with the healthcare system as a patient and has seen what currently is one of the many problems that must be solved by the industry working together with the general public.

    I believe in order to get “real” gender parity in the healthcare industry, the strangle hold by women on the nursing & healthcare tech professions must be broken. Walls must come down and roadblocks removed so qualified men that are waiting can get hired.

    Since the inception of the two vocations, they grew over the years to become for the most part two “all girls clubs”.

    For years, men never gave a second thought to ever becoming a nurse or health tech so these women went about building their careers and over time began wielding powerful influence over the healthcare industry. In their profession it became their rules, their way, or you take the highway.

    Then times started changing.

    Men started asking themselves why can’t I become a nurse or med tech.

    They saw no reason why not so they went about getting the education and proficiencies needed to become a nurse or technician.

    When they got accepted by a school that in itself was a victory.

    When they went to classes in the beginning many were given a cold shoulder by their female counterparts which made it all that much harder for them to achieve their ultimate goal of being an RN or registered technician.

    They were told they don’t belong. It’s a woman’s profession. Yada, yada, yada. The profession achieved their objective in the beginning & discouraged many men from continuing their studies & many men dropped out.

    However, there were men despite all the negativity being thrown their way by their female counterparts and teachers, ignored it & went on to get their degrees.

    There perseverance, showed other men they too could get a degree in nursing or med tech if they really wanted to so as a result, more men started going to nursing med tech school.

    Now, the powers that be in the profession at first brushed off these males trying to get into their world as a fad that would die off.

    Over time however, more men started going to school & it started worrying the leadership. They had to “do something” to discourage these men.

    So what did they do, they moved quickly and closed off any position remotely related to any kind of female intimate exposure to all male nurses & techs.

    Curiously though at the same time they closed off positions to men, they didn’t do the same & close off positions to females relating to any kind of male intimate exposure.

    They could have hired these men to take care of male patients if they requested a male caregiver.

    Instead of taking advantage of the opportunity to welcome these men into their profession with open arms, they looked for ways to further shut them out.

    So for a long time now fully qualified men and male patients have had a very difficult time dealing with the healthcare industry.

    People that don’t just hand over their dignity & respect to the healthcare profession are automatically belittled and shamed into giving it up or they are ignored by the system.

    A lot of the problem might have to do with the nursing & tech leadership wielding their influence all over the industry where hiring practices are concerned. Many HR departments today are run by women.

    A doctor wants to make his or her male patients feel more comfortable so they decide to hire male nurses to work with male patients if the patient chooses.

    The older female nurses that have been with the practice for years get wind of this. They don’t want their apple cart upset so they wield their influence & convince the doctor that the male patients will be fine with their care. So the doctor without thinking of his patients needs cancels any hiring.

    Urology department head decides they need to increase staff to handle the increase in patients.

    The patients are mostly male.

    Current staff of all women tells the dept. head the men are fine with their care even though the patients were never asked so the department head listens & hires more women.

    These same scenarios plays out in doctor’s offices and hospitals across the country on a daily basis.

    Men are being discouraged left & right from applying for positions they are fully qualified for because they don’t want to break up their “all girls club”. Guys are running into “Females Only Need Apply”.

    So because of the unwillingness to yield, many male patients have decided better to forego needed medical care rather then put themselves through the humiliation the healthcare system will put them through.

    This man could be your dad, brother, husband, or your son. Are you really willing to take a chance with their life?

    To any and all doctors and hospital department heads out there. Why not JUST ASK your patient in say a survey.

    If you needed an intimate type test or procedure, would you prefer it done by and in the presence of only the same gender as you or would you prefer someone of the opposite gender take care of your needs?

    In the beginning, it might be tough getting some men to respond because you’ve conditioned them so well over the years to put up, shut up, & take whatever we give but, I think you’ll find from those that respond, many want same gender care for intimate type tests and/or procedures.

    Why don’t we see any clinics specifically for men’s healthcare needs opening up? Clinics run and staffed only by men for men.

    You see all women’s clinics going up everywhere.

    I was on the road & I saw a Shirtless Male Nurse on a billboard. The caption read “Who’s caring for your mom?” Next to the words was a young topless man wearing a stethoscope.

    Is this the way the industry views male nurses and their work?

    Had it been a female in just her bra with a stethoscope around her neck on that billboard, there would have been an uproar like nothing ever seen before.

    The system must be open to both sexes and run on an equal basis.

    Stop using the crutch of the costs involved in hiring enough staff. People retire all the time and there are men looking for open positions. They don’t want to be glorified orderlies. They want a nursing/tech career.

    Start thinking about the NEEDS of the patient and what it will take to give them the best possible outcome from their visit.

    Best wishes to all,
    Raffie

  6. Is there a doctor in the house who will agree with the above and try to get the medical profession moving in this direction? A little compassion and concern would go a long way. Please consider the anguish of being in this situation.

    1. Reginald:

      Rarely if ever will you find doctors and/or healthcare administrators willing to engage the public in meaningful conversations on this subject as it is one of the biggest taboos of the industry.

      For them to talk about it would be tantamount to them admitting they’ve been giving guys a raw deal.

      There are some though that will talk about it & they agree men are being short-changed by the system.

      The key for men everywhere is to speak up loud & clear against the system if you don’t like how you are treated.

      Only when enough men have spoken up, will this issue not be brushed under the rug anymore.

      Regards,
      Raffie

      1. I hear what you are saying and it has to change. More people need to speak up. Men should be given more repsect for their privacy.

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