John's Cancer Blog

Patient Dignity

Last week I received a sigmoidoscopy as one of three checks in my quarterly checkins.   There was one part of that check that made me upset and very uncomfortable with the check I received.    Thus, I wanted to check in with this group to see if the approach used on me is common with other health care providers.

Before the doctor began the sigmoidoscopy, he wanted to check my lymph glands in my groin.   The doctor was being thorough which I appreciated.   

In the room there was a female nurse, a female resident and a male doctor.    Before I had a chance to express my desire for modesty and privacy, my gown had been lifted and the sheet that covered me was pulled down partially exposing my front genitalia.   I was VERY UPSET that the doctor took that approach while failing to explain the check and what wud be required to perform this check.  I like this doctor - he had seen me before with no prior issues.   However, this time he missed the mark as far as I am concerned.   The doctor didn't seem to give consideration for my privacy and dignity in front of female medical staff.   I am sure I am not the only one who has experienced this uncomfortable situation in a doctor's office.

On my next visit I plan to be VERY DIRECT and explain that my diginity and privacy are important to me.  As such I expect the medical staff to let me know what will be involved during a check or test, especially if it will require my dignity to be comprised.    I also want to have a say as to who is present in the room for the checks.

Please let me know if you think that the aforementioned approach is reasonable.   I know doctors are busy and sometimes use the most expeditious approach to get their jobs done without delays.

It's awkward to have this conversation with your doctor.   However, it also seems like maintaining a patient's dignity and privacy should be high on the list of priorities.

Easterly sent you a prayer.
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I have also been exposed to this, It seems our cancer is one for teaching. I changed docs and this latest one was also very public with 2 people besides the doc. They were much more discrete than the first doc and even left me alone with wipes to clean up. My firs doc didn't set the stage at all and left me with nothing to clean myself afterwards.
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I'm so sorry! That kind of treatment is so unnecessary! What the training should include is for the trainee to experience what it's like to be a patient.
Oh and also, the conversation with the group of people there, as if you're not even one of the people, in the room.
Lucky, Maggie like this comment
Same here. I changed doctors for that reason, so happy with the new doc. I'm done with that brutally painful way of doing the exam. As well as the exposure situation, humiliation of it being in front of people I worked with. I was told by a friend, that worked in the surgery group, she asked for a job change because of the dialogue that went on about my case in the staff meeting prior to my surgery; she told me a year after treatment was over. That was the final straw.
There was 2 other extremely humiliating situation, that were deeply embarrassing, and involved people I worked with.
But, now, even for just the pain relief, and comfort of being able to share with my doctor what is going on, is all the difference.
Yes, they do use it for training, but, in the evil doctors case, that would be "abuse" training.The trauma from this brutality, and embarrassment, aside from just generally the horrible treatment for this cancer, has still followed me. PTSD
So, I better stop now, or I will go on and on about it.
Do speak to him, before the appointment (email, if you can, or ask to schedule a phone visit)
Thank you for letting me express this
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Hi John—If you are being seen in a teaching hospital situation (as I am at UCLA), it is pretty common practice to ask if you are comfortable with additional observers (residents, medical students). But they should always ask ahead of time, and respect your decision. At UCLA they also ask if you would like a “chaperone” of the same sex when sensitive areas of the body are exposed. We all need to advocate for ourselves, so even though the initial conversation with your doctor may be awkward, it is necessary, and gets easier as you move through your treatment and follow-up. Sending positive thoughts your way.
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Thanks....I am at a teaching hospital. I have had three different doctors involved in my treatment: radiation, oncologist, and surgeon (just in case it's needed). The surgeon is the person who does the follow-up visual checks with the sigmoidoscopy. I have made it clear to my radiation doctor as to how I feel about privacy and dignity. I should have done the same with the surgeon.
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Well, you’re on the right road. As I said, it gets easier. After my treatment and all the follow-ups, I’m kind of immune to the embarrassment now in general. You deserve to be asked though, and when you’ve stated your position that should be the end of it (no pun intended...😉).
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Thanks for the pun - laughter is good medicine!
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I go to Mayo a teaching hospital. So there’s always residents and students in the room. It is very embarrassing. But I am always asked if it’s okay that they are there even though you feel like you can’t say no. The last time I went to my radiation doctor he was feeling around with his finger to make sure he doesn’t feel growth and it always hurts SO BAD!!! The doctor says now let the student have a feel. I jumped up so fast saying NO WAY! The doctor looked at me in shock that I wasn’t going to let the student stick his finger in my butt!! He asked a couple more times after that. I thought that was BS that he was making me feel guilty over it. Unfortunately our cancer isn’t in a better spot like on our arm. I think doctors just get so focused on teaching that they loose sight that this is very personal for us. Sorry you felt that way at your appointment. It’s hard enough to deal with the worry about them finding a lump and the reliving the embarrassing torture we went thru to get rid of the cancer. Sending support your way. 💙
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I am so proud of you! I think if this ever happens to me in a dismissing way again; I will say "YES, IF I CAN DO THE SAME TO YOU FIRST!"
Apparently, unbeknownst to them, there is GENTLE.
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I wanted to tell my doctor sure if the student can do it to you first! It made me so mad he was giving me a guilt trip. My doctor is not gentle and always says to me it can’t hurt that bad. It hurts to sit in the car on the way home after!
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Actually it can cause tiny lesions; my evil doctor it would hurt for weeks after. (and other, too humiliating things he did, to speak of)
My new doctor, (although, if I didn't have to do it, I wouldn't) knows the evil doctor; (she knows what I'm talking about) so that's a little pay back, he has to make out a referral to her.
Gosh, I keep thinking this rage is gone; it's still there. This subject, isn't even the ghastly treatment for cancer... I gotta go for more counseling, it's just so hard to talk about to a non peer, and since it also involved my workplace~ugh.
I can see in you, that at the very least, need for his sympathy, and support, would be so helpful, rather than to harass you about it "can't hurt that bad" attitude; would be so helpful.
I do hope you address this with him. Maybe even share this blog page... or find a new doc.
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My attitude toward any medical staff is to be respectful but to also make it perfectly clear that I am the patient (customer). Doctors and other medical staff are no different than any other professions - there are good ones and then there are bad ones. I have a female radiation doctor - she is young but very professional and knowledgeable. She is always respectful and gentle when performing exams. I really can't say enough good things about her to date.
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To Easterly: Best answer EVER!
Easterly likes this comment
I'm so sorry that happened to you! Shame on that doctor. He absolutely should have made sure it was ok with you to have female medical personnel present. My UCSF doc brings in a female assistant whenever he exams a woman since he's male. I had never had a doc do that before, but it was something I appreciated, and more so because he told me ahead of time. I definitely believe in advocating for yourself and I am sure your doctor will appreciate your views on the matter. It will help him be a better doctor in the future.
D
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I just find it a bit hard to believe in 2020 that doctors are not more sensitive to patients dignity & privacy. I believe that some doctor's & medical staff falsely assume that because you are in a medical facility it's ok to have your dignity compromised. I don't think most do it intentionally, but it causes me to question their common sense when things like that happen.
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Your approach sounds reasonable to me! I hope they understand. (In my case I'm seen by a male doctor, the female nurse comes in first and covers my lower half with a sheet. Oddly, I see this doctor in a social setting from time to time and once I said to the nurse "if you're really worried about my privacy we should cover my face!"Had to explain..! )
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Oh man, don't get me started! As a RN, nothing PISSES me off more than uncaring physicians, especially those who demonstrate that to MDs-in-learning. And the replied comment about "It can't hurt that bad", OMG, I would have one harsh word with that Dr! There is NO excuse for that level of unfeeling.
I do have a question for you John. Are you having a sigmoidoscopy or anoscopy? Please see my page for the photo of the slotted anoscope that they should be using. Sigmoidoscopy is much more invasive, requires prep, and is not in the NCCN recommended guidelines.
It is very unprofessional to not ask for permission before having students/observers in the room, and I am very proud of you for planning to assert yourself, because some docs are just dense. And they should be explaining before any procedures. Question: did you have to sign a consent for this? Who explained the procedure to you beforehand? Anyone? Or were you just asked to sign the consent?
I think I expounded on my initial shock when I visited the CR doc for followup somewhere in my posts. I refused to just disrobe and be ready when I had never laid eyes on this doc before, and if he gave me the creeps, I was LEAVING! Thankfully, that did not happen. But it was pretty funny when I heard the loud whisper through the door, "She doesn't want to take her clothes off"
One more thing: It is ALWAYS appropriate to request Xylocaine jelly, I had to ask every time, after the first time it hurt. There are so many nerve endings and the skin is very fragile post radiation. So I just requested it, (and you'd think they would have just done it automatically anyway!) I am constantly teaching other nurses, being the PIA I am. But it is important IMO.
Sorry you went through this. Positive thoughts being sent for next time :)
It was a sigmoidoscopy. There was a small amount of prep on the morning of the scope. I did sign a consent form but was already disrobed and did not want to get "off the table" to read the fine print. I really appreciate everyone's comments on this blog because I feel like "it's not just me". It seems this kind of physician behavior is more common than it needs to be.
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Sorry you had to deal w/this John. And good for you for speaking up. Everytime I go in for my "butt exam" the nurse will give me the courtesy of letting me know that he/she will be staying for the exam. Yes, I agree with you; it is way more respectful to ask and confirm with the patient.
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Sorry you had to go through this.
Happy birthday week!
John, Lucky like this comment
Thanks! It's been a great birthday weekend!
Lori likes this comment
Happy birthday John! Hope things have settled a bit for you and you do something fun for your birthday.
Thanks! I have had some great fun over the past few days! Just celebrating life and being thankful!
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First Quarterly Check-Up

Went through the regiment of my first quarterly check-ups -  CT Scan, Doctor Visit & Sigmoidoscopy.   All good news!   I am curious as to what to expect in the first two years - post treatment?

Very thankful for the insights & support from this group!

Olga, Thom like this post.
Easterly sent you a hug.
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It's different for everyone; I don't know about the male complication; only women's (ouch). A lot of it depends on your age (your a youngster) and your activity level before.
Being my age 70 now; it really changed my endurance on every level. 4 years out, and I have to rest when my body tells me to; rest makes a huge difference in my normally optimistic outlook.
How's it going so far?
Most of us have Anascopies or HRA's (High Resolution Anoscopy) every 3 months for the first 3 years and CT scan/PET scan yearly. Your doctor should follow the NCCN.org guidelines; you can ask.
Best wishes on your recovery!
Big hugs.
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I’m almost 2.5 years out. The first two years I went to the surgeon to get checked every three months. Every six months I had a ct scan and saw the radiology doctor. When I hit the 2yr mark now I only have to get checked every six months with the ct scan. Yay! It took me a long time to start feeling my new normal and I’m still healing! Still have accidents. I carry extra underwear and wipes with me everywhere. Still have a lot of aches in my hips and lower back. It’s a slow process! So glad your on your way to healing and enjoying life! 💙
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Doing well now? I would expect you can expect more of the same! Keep us posted.
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I am doing well now - still some urgency when going to bathroom but energy and mental outlook has improved ALOT! The check-up test make me a bit nervous and anxious due to the akwardness of the test. I don't see anyone doing a good job of taking the patients time into account when scheduling the appointments. This is really tough for those of us who still work.
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You are right about the inconvenience. Can you book your future quarterly test now so you get the time you want? That’s what I did during the five-year post treatment testing (lots of PET and CT scans) and was always able to get the day and time I wanted. Good luck!
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Yep we are all different for sure. I just had my second follow up surgeons appt. no scan here until one year. It also could not have gone better though very painful and still pretty painful after 2 days so not sure why. My first one put bacteria in my system and wound up in the hospital for a week so I changed doctors. Congrats on the great results! My plan is visit him every 3 months. for 2 years. Oncology and Radiologist also every 3 for the first 2 years I think. Scan once a year and this new doc wants a colonoscopy in a year for now then 3-5 depending. Still having little surprises too and very frequent BM's but things are working so much better.
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I think where you mention "still pretty painful after 2 days" you are talking about the follow up anoscopy. Having a doc I have full confidence in helps (I changed docs too) but still; the square footage get smaller; so what I'm trying to say, it's normal, after what we went through.
Great news! So happy for you!
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The most challenging element for me was adjusting to the "new normal" and learning to manage my rear end so it was possible to travel or have morning meetings! As others have noted, I had anoscopies every six months, and continued to see my oncology team about the same frequency....in effect, their work constituted my primary care! Hang in there and keep posting...we'll help you manage your transition..
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Vital Info

Posts

January 9, 2020

Houston, Texas 77006

March 9, 1963

Cancer Info

Anal Cancer

Anal Cancer

October 7

Stage 1

1.1 - 2.0 cm

Grade 1

No

No

MD Anderson

November 27

Weekly infusion of Cisplatin and 5 days a week of 5FU

Radiation Dates: 10-24-19 through 11-27-19

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