by David Penner
There is a strange nudist colony in the woods of American health care. Some say that there are a number of these colonies in the heart of New York City. This colony has a name. It is called the Dermatology Resident Nudist Colony.
The curious thing about this nudist colony, is that while the patient isn’t wearing any clothes, there are other people in the colony who are. Often the door swings open while the patient is undressed and another person enters the room. Indeed, it is not uncommon for the door to open more than once, with different people in white coats coming and going. This is what is commonly referred to in the colony as privacy.
The American Academy of Dermatology’s code of ethics states, “The dermatology profession exists for the primary purpose of caring for the patient. The physician-patient relationship is the central focus of all ethical concerns. Dermatologists should be dedicated to providing medically competent service with compassion and respect for human dignity.” It goes on to state that, “The dermatologist should maintain a reputation for truth and honesty,” and that, “The dermatologist should conduct himself or herself morally and ethically, so as to merit the confidence of patients entrusted to the dermatologist’s care, rendering to each a full measure of service and devotion.”
Indeed, it is difficult to conceive of an institution more respectful of truth, honesty, and human dignity than the Dermatology Resident Nudist Colony, a place where nurses and residents are invited to watch patients get examined sans clothes. When speaking with one of these residents, I inquired as to whether she would mind if a male resident were to watch while she were examined by a physician. To my surprise she looked at me in horror. In another perplexing exchange, I asked a resident if, since I was getting undressed, she wouldn’t mind also taking off her clothes. It is a nudist colony after all! To my bewilderment, this suggestion was not well received. And so there are some very strange rules to this most unusual of nudist colonies, and it is difficult to fully grasp all of them.
Trying to understand how such a colony comes into being is no less confounding. Some argue that they are founded principally out of a sense of altruism and piety, while others maintain that the answer lies in the genetics of the founders. Whatever the case may be, it is clear that the Dermatology Resident Nudist Colony places compassion, morality, and the emotional well-being of its patients above all else.
This moral code involves jettisoning petty and anachronistic curiosities such as privacy, informed consent, confidentiality, medical ethics and the doctor-patient relationship. It also involves using patients as teaching tools and medical models without their consent. One of the most prestigious and renowned of these colonies tells us that, “We teach technical training in all aspects of surgical and medical dermatology, as well as the values of compassion and humanism that are most important for a physician.” This involves inculcating impressionable and ambitious residents with an understanding that patients on Medicaid and other unglamorous plans are actually dromedaries, as opposed to human beings that have an inalienable right to privacy. Some argue that in addition to resembling an unusual veterinary clinic, the celebration of patient nudity is actually one of the principal goals of the colony.
And so there are many curious aspects to this most peculiar of nudist colonies. Patients with the best insurance plans are able to avoid them, should they feel the need to meet with a dermatologist in private, although why anyone would wish to do such a thing is a source of controversy. Another curious thing about these colonies, is that the people wearing clothes are evidently also fond of using their superior insurance plans to seek care elsewhere, thereby avoiding (albeit ironically), their own empathetic and superlative care.
An extraordinary amount of education is required to work in a Dermatology Resident Nudist Colony. In fact they regularly recruit from the best and the brightest of our medical schools. These chosen few are then educated in the ways of the colony. Sometimes a patient is sick, wearing a gown, has an insurance plan that is rejected by the majority of dermatologists in their city, and has their request to meet with a dermatologist in private denied. This is what is known in the colony as consent.
From to time, a colonist will argue that teaching residents to regard the naked creature as an inferior life form is advantageous when it comes to profit-making, although many dismiss this as hogwash. It also appears to be a rite of passage for the dermatology resident to learn how to place their career over what is best for those who are naked.
Indeed, it is difficult to conceive of a better place for residents to be steeped in a culture of medical ethics, and inculcated in the profound importance of the doctor-patient relationship. Alas, sometimes patients complain, and say they feel as though they were a laboratory animal. Little do these poor fools know: for what they have received is actually compassionate and patient-centered care.
Some feel that exploiting low-income patients in this manner is unethical, while others maintain that this is mitigated by the fact that the resident serves as protection from lawsuits and accusations of impropriety. Yet who can fail to see the benefits of the Dermatology Resident Nudist Colony: a place where some are clothed, while others go naked – and primum non nocere reigns – but only for a privileged few?
David has taught English as a Second Language at The City University of New York and at Fordham. His articles on politics and health care have appeared in CounterPunch, Dissident Voice, and KevinMD; while his poetry has been published with Dissident Voice. Also a photographer, he is the author of three books: Faces of Manhattan Island, Faces of The New Economy, and Manhattan Pairs.
I was recently diagnosed with a rare condition called “Superior semicircular canal dehiscence of left ear”……only discovered in 1995. I basically can hear my heartbeat, my eyes move, and my feet hitting the ground. It is because I have a hole in the top of my inner ear….Its really irritating and I need surgery…the procedure is serious…… so… what is stopping me? Not the operation….. it is because I learned I will get a catheter placed in my penis. I un-refutably don’t want that. I envision 2 young females telling me my doctor has ordered it….and them telling me “It is my lucky day”….. and me groaning in pain as they do it. NO. Hospitals do not give a DAMN about male modesty…it pisses me off GREATLY and I am angered even thinking about it….. – there is no greater lower demeaning thing, than to have this procedure done. So I really feel for guys who have to be naked with woman present……. and I think woman in particular…. in Dermatology, should grow up, and give ANY man the UPMOST respect and dignity, and sensitivity, and Make damn sure they limit ALL naked-ness and keep any man behind drapes where NO one will see, except for the Right person to treat him. Any un-necessary eyes, should GO AWAY – if he doesn’t want it….RESPECT WHAT HE WANTS….. Reading this makes me mad as hell.
I certainly don’t want to get into a debate on this. This may be a city mouse/country mouse situation. I am from a rural environment and no medical practice I visit has any superfluous personnel. Bare bones staffing here means you only get who is absolutely needed in any medical exam. From the sounds of it, it seems like you must be from a more metropolitan situation.
I have always entered my dermatology exams and urological exams fully expecting to be seen naked by the necessary medical people. I feel completely satisfied that they see me as a patient rather than a sexual object. I am always offered gowns or drapes for those moments when I may be exposed to the hallway. I get the impression the writer has experiences unlike mine, which is understandably upsetting. I think the sarcasm in this article is so thick that I can’t tell exactly if the people in “white coats” are medical staff or not. If the author is opposed to nudity during medical exams, he could have said it clearer.
Tom, I’m not the author but what he is referring to is the casualness with which people who are not necessary to the exam come into the room. I’m OK with necessary medical staff too, though I prefer same gender for intimate exams or exposure, but I object to extra people in the room without my express permission. Medical or nursing students, scribe trainees, and even residents are not necessary for the exam and permission should be requested before they ever enter the room. That’s just good manners.
Using my example in my other post, a dermatologist does not need an LPN standing there watching a naked patient be examined. That adds nothing to the exam. If there is a mole or something to be removed and he needs assistance then an LPN can be brought in. As for the scribe, they don’t have to watch the patient stand there naked in order to take notes. They can face the other way or be behind a partition while the doctor dictates to them or even be in a different room taking that dictation.
The problem is that the medical staff act as if none of this matters when it is a male patient.
As an aside I came to be more vocal on being treated as if my dignity matters because of female staff seeing me in terms other than as simply a patient. Getting a nursing or other license does not automatically make one a professional. Sometimes it is more than just clinical to some of them. Been there.
Well said. Even those of us with good insurance are treated as if there is something wrong with us if we want a bit of privacy with the dermatologist.
A year ago when making an appt. for my 1st ever dermatology exam at what is a very large practice at a teaching hospital, I asked for a male doctor and was assigned to a male resident without any fuss. I then asked if he did exams by himself and was told that a scribe and LPN would be present. I said OK but please make sure both are males. The (female) scheduler tells me they only have female scribes and nurses. I tell her I’m not comfortable being on display in that manner and she becomes openly hostile. Rather than argue with her I figured I’ll deal with it the day of the appt.
On the day of the appt. I am quickly led to a room by a female MA who just tells me a nurse will be by to talk with me. An LPN arrives and I tell her I had asked for only male staff when making the appt. She looks at me as if I am some strange zoo animal and says only the doctor will come in then. He comes in and shaking his hand at my genital area asks me if I have a problem with women. I tell him I just want the same same-gender privacy considerations that female patients receive. You’d of thought it was the oddest thing he ever heard by the expression on his face. He then proceeds to not give me the full exam I was scheduled for despite me reminding him of it.
I follow-up with a letter to the Section Chief. A month later with no response at all I then go to Patient Relations with my complaint. A new policy results that allows male patients upon request to have exams with just the doctor present if male scribes and LPN’s are not available. I am told the staff being 100% female is not by design. Of course that new policy is not to be found on their website nor is it posted anywhere in the office. It thus effectively only applies to men willing to speak up.
They switch my follow-up appt to be with the Section Chief rather than the Resident, probably because I am now labeled a problem patient for wanting to be treated with a modicum of dignity. The day of the appt. I remind the nurse updating my history the exam is to be males-only present. She says of course, leaves me with a gown and instructions to undress. A few minutes later literally as I am standing there naked and reaching for the gown to put on, a female scribe knocks on the doors asking if I am ready. I shout NO rather loudly and she proceeds to walk in on me anyway despite the fact that she wasn’t supposed to be there in the first place. She quickly backs out as I shout loud enough for the entire office to hear “I said NO”. The doctor arrives and doesn’t apologize for what just happened.
This attitude towards male patient privacy is not unique to dermatology. It is rampant throughout healthcare. A key piece of this is that when it comes to male patients, staff being polite has somehow been deemed synonymous with respecting the patient’s dignity. It is not the same.
I have had similar experiences and now insist beforehand on same gender in any intimate situations and have refused and left when not accommodated…“Sorry, I made my position clear.” This includes notice of any additional people that may be present. My personal belief is that this phenomenon follows the narrative that “men are terrible” and therefore deserve no decency in such matters.