Not Patient Centered Care

Healthcare in America is not Patient Centered Care (PCC) as the healthcare industry would like us to believe. It may be Physician Centered Care or even Hospital Centered Care but certainly healthcare in the US is not patient-friendly or even there for the benefit of the patient. The patient is merely the tool in which they use to make money or to control. According to an article by T.R. Reid for The Atlantic, healthcare made more than 3.4 trillion dollars in 2016 or in more plain terms, $1 out of every $6 is spent on healthcare. It is big business but it is not consumer friendly.

So what do we get for all the money that is spent on healthcare? For too many, they get on board the lifetime train of pills and procedures. For some, while they are on board of the train of pills and procedures, they get more than they bargained for by the way of medical and sexual assault. However, to be medically or sexually assaulted while receiving healthcare is perfectly acceptable. Just ask Medicare via CMS vis Livanta. Just ask most any attorney who refuses representation of a client who has been assaulted. Just ask any hospital administrator what they think about when a patient tells them of an assault especially if the patient was a male. Just ask any health insurance provider. No one cares except the assaulted and their families. In the US as I don’t know about any other countries, nurses are idolized. They are put upon pedestals. They can do no wrong. They are the most trusted class of workers in this country. Most nurses are females at over 90% of them being female. Male nurses aren’t normally as trusted or idolized. Male nurses generally are not in intimate care situations with female patients such as in labor or delivery. Most published stories of nurses sexually abusing a patient is that of a male nurse/female patient. Usually conscious women have the option of asking for a female nurse for intimate care. It is when they are unconscious, drugged, or otherwise incapacitated that most of the sexual abuse incidents may happen. For male patients, there are few male nurses. Most of their care will be delivered by a female nurse. Also, the majority of techs in a hospital are also female except mammogram techs are almost always female whereas prostate ultrasound techs are generally female performing such an intimate procedure on the male patient.

However, even when women are having surgery their request for an all female staff may be ignored by the hospital as what they don’t know is okay to happen. After all, while someone is a patient they cannot expect to have their personal dignity respected. Hence is why the US is so reliant upon pre-anesthetic and during surgery anesthetic drugs. Before surgery is when the prep happens. The hospital performs prep with their patients drugged so they cannot resist and also cannot remember.  Prep is generally done in a matter of convenience for the staff and not with the dignity of the patient in mind.  In other words, because the drugs may make a patient submissive, disinhibited, and erase memories, it allows the staff to have the patient totally exposed when not necessary.  The reasoning is that it takes less time and consideration of the staff if the patient is totally naked.  It may save the staff a few seconds of time in the covering and uncovering of a patient but does justify the sacrificing of patient dignity/respect?  Sacrificing personal dignity is of no concern to them because it is not perpetrated on them.  For their care, they generally go to a different facility because being left totally naked for anyone and everyone to see and comment on does matter at least when there are the subject of the exposure.  However, they will tell a patient who may object that they have seen in all before, that don’t have something different, etc. but it does matter to the one who is being exposed. 

I am in no way questioning the sometimes necessity of genitals being exposed for a medical necessity.  There are certain procedures which require it as there as also certain procedures that do not require it.  I am questioning the constant need for medical staff to expose patients unnecessarily without any thought to patient dignity or respect.  It is a question also of how it is done.  Is the exposure explained to the patient beforehand?  Has the patient been given gender care choice?  Are drugs being used to primarily accommodate the staff’s treatment of the patient during the prep time?  Also, anytime a patient is exposed it should be explained and permission granted.  It should be done in a way that adheres to the basic concept that all patients should be treated with dignity and respect.  Has the patient received relevant information above the usage of drugs, what they do, why they are needed in addition to the right of refusal?  The answer to the majority of these questions is probably no.  Most medical providers will rapidly go over the use of anesthetics because primarily they don’t feel patients have right of choice in matter and secondly they are not smart enough to understand.  Many medical providers don’t feel patients have the right to know.  It is a part of the secret workings of the medical community and they don’t disclose voluntarily or freely this type of information.

A drug known as versed which is in the benzodiazepine class is their favorite drug of choice.  In addition to versed, many will receive fentanyl along with the versed.  Versed will be given under the guise of making you less anxious but primarily it is given as an amnestic and it also makes you disinhibited or in other words you won’t object to being naked.  Fentanyl is generally a painkiller.  However, fentanyl has properties that can paralyze, make you not care or give you a high, and cooperative.  Together these drugs are used for many procedures including colonoscopies, heart catheterization, and dental work to name a few.  They also may be given as pre-sedative to general anesthesia.  Why does a patient need this type of cocktail merely for prepping is beyond my understanding?  To me, it serves merely as a convenience to the medical staff so they don’t have to deal with an alert patient thus be more careful in how they deliver their care. 

Many times fentanyl and/or versed will be given in route to the hospital by the EMT service or in ER.  There are cases where these drugs are given because it is easier to manage a patient who has been drugged.  For instance, they can skip giving informed consent for whatever procedure they want as the patient is unable to interfere and the family can be kept isolated from the patient.  This works well for patients who have made it known they don’t want to have what the medical industry considers it latest gold standard of treatment.  The latest gold standard of treatments is usually a huge money-making venture for a hospital.  For example, if you have a heart attack that is classified as a STEMI, they automatically think they have the right to perform a percutaneous coronary intervention (PCI) which is a heart catheterization with stenting.  PCI is preferred over open heart surgery.  It is pushed because recovery time is quicker.  However, most PCI patients will need to be re-cathed at some point maybe more than once.  PCI also requires the use of medicine for the rest of your life as stopping the medicine may cause a fatal heart attack to occur.  It also may not open all arteries that have blockages.  CARB or open heart surgery, takes more recovery time but is more thorough.  Certain medicines may be required for life. However, in an emergency situation, there are more doctors trained to perform PCI than open heart surgeries.  Oftentimes, the ER PCI doctor is one who is needed more experience to be able to attract non-emergency patients.  Most patients having a PCI want an experienced doctor but in what is termed an emergency, you get whoever is on call.  If you are what is termed as emergency patient, do you think that while you are laying drugged and naked on the cath. lab table that all of this is explained to you and that you actually are able to understand it?  That is what they know and count on.  They also count on that you will be so grateful they saved your life that you will not investigate as to what really happened. 

Most people have better control over what happens in a doctor’s office or even when getting a test done at a hospital especially if no sedative cocktail is used.  Many patients do not know the sedative cocktails are not really needed.  In Europe, they generally do not use versed/fentanyl when performing a PCI.  They may use music as a relaxation method.  A PCI procedure is more uncomfortable at times than painful.  The real pain may come afterwards when they may be suturing and then they generally choose not to use any numbing agent because your pain at that time is not really their concern.  They performed the procedure so if you suffer a little pain, you may or may not remember it.  In colonoscopies, the sedatives are very useful for the medical personnel as you probably will not remember how they treated you during the procedure.  It also allows them to perform the scoping more quickly as they do not have to go slower to prevent pain.  However, going faster may actually harm you as there is a greater risk of perforation.  Even if you experience pain during the procedure because the fentanyl didn’t work, the versed will probably erase it from your memory along with other memories.  Some only administer versed because they know it will most likely erase the pain and torture from your memory. 

Female patients may actually have better control over who sees them exposed than male patients.  With the exceptions of doctors, most hospital staffs are overwhelmingly female.  Male patients have very little choice.  However, most stories of sexual abuse that are investigated or published are about a female patient being sexually assaulted by a male staff member.  Too many times this is done by a male doctor even with a female chaperone in attendance.  Always be leery of any male medical personnel member wanting to examine you intimately without any witness even the chaperone solution is not perfect.  I would suggest you have a trusted observer of your own present such as a husband or boyfriend.  It may take years and many victims for this to come out.  It is rare for a fully alert female to be attended to for intimate care by a male medical staff member but it does happen.  It would be more common for a drugged, unconscious, or mentally challenged female to be given intimate care by a male caregiver as they figure what is the harm because the female is unable to complain. 

For male patients, most caregivers in a medical setting are going to be female.  Even for prostate related issues, your doctor may be a male but if you have a procedure or exam done, the chaperone or prep person will most likely be female.  Many male patients feel ambushed as they are not aware of the female presence until they are undressed and at a disadvantage.   Many at that junction will remain silent but very upset and resentful.  For hospitalized male patients, they will most likely have intimate care performed by female staff members.  They will not be asked if they are okay with this nor will many of the male patients actually know they have the right for same gender care.  It is a dirty little secret that hospitals keep hidden.  Too many times male patients may be sexually abused while hospitalized.  Some female staff members may have issues with males as some doctor or maybe even their husband or father added to their male hating practices so they can easily take out their hatred on a defenseless male patient.  This may particularly happen when a male is drugged, older but can happen to a younger male not knowing what is appropriate and what is not.  Female nurses have been known to leave drugged male patients genitals completely exposed without medical necessity so other non medical staff can view and humiliate the patient.  Of course, proving this kind of sexual abuse has happened is difficult because they stick together and the patient has no record of it except their word.  There is not anyone in government, law, etc. who care this type of abuse does happen to male patients. 

For all patients, regardless of being male or female, emergency care is full of personal dignity/respect issues.  Too many times, a patient is stripped and left naked for all to see including visitors to the ER of other patients.  There are some on some blogs that say ER patients should not expect to be treated with personal dignity/respect but that is when the medical staff should be even more vigilant in protecting them.  In fact, that is part of the nursing oath to protect patients in their care.  There is no reason for a female heart attack patient to have her breasts exposed after the EKG leads have been placed.  There is no reason for a male patient to have his penis/testicles exposed when being prepped for a PCI.  There are garments that are specially made to cover the breasts or genital areas so as not to interfere with the needed area.  Every patient should be given these garments to don so as they can have their personal dignity/respect intact.  No patient should go to an ER and leave feeling they have been sexually assaulted by medical staff.  What does that do for the overall recuperation process of the patient?  Does being sexually assaulted encourage patients to return to an ER again for care if needed?  Some say if they are sick it doesn’t matter but it really does.  If they are so careful during a routine doctor’s visit not to have a person of the opposite gender present then shouldn’t that also be as important when they may be unable to defend themselves?  To me, it is even more important when you are more defenseless.  That is when you are most likely to be sexually assaulted.  Some of the sexual assaults are done because they don’t like the few seconds of time it takes to uncover and cover up a body area.  They are just in too much of a hurry to care about you as a person.  Some is done intentionally as it is a way to control and belittle.  It is a proven form of torture that having a prisoner naked in a room full of dressed, uniformed personnel makes them more cooperative and defenseless.  Our society has ingrained in us the need to have certain areas of our bodies covered.  Why should we be expected to be okay with our bodies being uncovered unnecessarily in medical settings just for the convenience or perverted control issues of the medical staff?

It is a scary proposition to think about Medicare for all.  It is scary enough now having private insurance being able to dictate your medical care and having access to all your medical information.   There is no medical privacy for most of us.  All of our medical information is available to whoever, whenever they want.  There is no protection for the average person.  Seniors have the least protection as Medicare does not protect Seniors from abuse by the medically system.  Medicare and its oversight branches like CMS and Livanta only investigate complaints based what was written in the medical record by the criminal medical provider.  They seem to have the idea that medical people do no lie or falsify records for self-protection.  Or maybe they do know and just don’t care because old people are the least important people in this country.  They are in fact, the only class of people required by law to pay for medical care more than twice by having to pay into Medicare and also carry insurance through a Medicare approved private provider along with prescription drug coverage being separate from medical care.  Thank you George W. Bush discriminating against old people!  He will never know as he gets the Cadillac policy for having been president and also he is wealthy and has choices.  But for the rest of us, it is different.  Medicare doesn’t protect the people it is supposed to serve.  Why would we want everyone to have to have Medicare?  (I will write about this travesty later because there is so much wrong with Medicare.)

Most people will never know they have been medically or sexually assaulted.  The drugs usually take care of them knowing.  Most people will never realize that surgery prep involves them being totally naked even when they may only have foot surgery.  Most people may never realize the doctor and nurses have lied about them consenting to a procedure when they were brought into ER.  Most people will never know if something inappropriate was done to them while they were drugged such as a picture of them being taken on a personal cell phone because the nurses thought a male patient had a penis they needed to post on Facebook for their friends to see.  In fact, most trust nurses and most people do not want to admit that female nurses can and do act in a sexual fashion towards male patients.  Most female patients are leery of male medical staff but somehow society has not been able to admit that female medical staff can and do act in the same predatory fashion.  Most males who have suffered abuse remain quiet if they are aware of what has happened.  Most people do not and would not believe a male patient if he told them he was sexually assaulted while in the hospital or seeking medical care.  This is what those female predators count upon. 

Most people do not know that hospitals routinely do procedures that patients have not consent to have done especially if they have been admitted to the ER.  Most people do not know informed consent is not informed consent if it is done while they are drugged.  There are warnings issued for patients who have procedures done with versed/fentanyl not to make any major life decisions for 24 hours following the procedure.  So why would anyone think it is okay for informed consent to be given to a patient who was drugged 30 after 100mcg of fentanyl and immediately after receiving 2mg of versed with an additional 50mcg of fentanyl and the hospital would label that person alert x3?  Most people do not know that the new gold standard of treatment in the American healthcare system is medical and sexual assault.  Not only does it make them loads of money but it also gives them complete power and control.  There is no system out there to challenge them so they will carryon and even become more emboldened. 

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