The naked patient: Modesty movement won’t take it lying down

Patient modesty might seem like an oxymoron when those seeking medical care are routinely told to remove their clothes, put on a flimsy gown, lie back and let the professionals do their work.

But to many people, everything about those instructions induces anxiety and even anger. They fear the vulnerability that comes with it. They can’t relax when they’re ceding control over what’s happening to them, and it’s irrelevant that physicians and nurses have seen thousands of bare bottoms or private parts.

“I don’t have some magical switch that I can turn off in my head that makes me feel completely at ease with another man having intimate access to (my wife’s) body, just because that man went to medical school,” complained a contributor to a modesty blog.

The reasons for modesty can be cultural, religious or intensely personal. To a woman committed to purity or to a man who fears how his body will react to a woman’s touch, accommodations are so important that they will shop around for providers or in extreme cases, forgo care. There even have been lawsuits, including one in Illinois some years ago in which an appellate court, siding with a couple who wanted no males in the delivery room, wrote: The fact that the plaintiffs hold deeply ingrained religious beliefs that are not shared by the majority of society does not mean those beliefs deserve less protections than more mainstream religious beliefs.

Requested accommodations can range from same-gender caregivers to wearing special shorts during a colonoscopy and can engender understanding, hostility or something in between, say testimonials on the website of Medical Patient Modesty (www.patientmodesty.org), a fledgling nonprofit based in North Carolina that offers emotional support and practical resources.

A willingness to make accommodations depends to a large extent on providers’ commitment to patients’ emotional health as well as their medical care, say those in the modesty movement, but also on the size and location of a medical facility. Small towns and rural areas tend to have fewer specialists, complicating requests, for example, for same-gender treatment. Yet a small office might have more time and personal stake in patients and fewer financial constraints than a clinic or hospital.

Katherine Johnson, 32, of Loveland, Colo., was searching about a year ago for the right team to back up the midwife who was to deliver her baby. She needed assurances that, should an emergency arise, she would have a female obstetrician and nurse on standby. She also wanted to avoid an epidural or any other anesthesia.

“I’d had problems with sexual abuse,” she said, and was not comfortable with a man in that physical proximity. “And I had to be awake, to know that I could run away.”

Even though she offered to have her psychologist, whom she has been seeing since she was 15, present the reasons behind her demands, several facilities told her that guaranteeing an all-female team was impossible, particularly because she was on Medicaid.

“They made me feel that I was not worthy to have a baby,” Johnson said. Up against the clock for a legal abortion, which she considered when the situation seemed most hopeless, she stumbled upon Medical Patient Modesty and wrote a middle-of-the-night appeal that founder Misty Roberts answered almost immediately.

“She validated my feelings, that I wasn’t some freak,” Johnson said. And Roberts pointed her to an all-female OB practice about an hour from her home. It wasn’t convenient, but she was promised the care she sought. “I found out that I wasn’t broken, that I could be a good mom.”

To Roberts, modesty concerns need to be taken seriously, however they arise.

“It is heartbreaking that many women who do not want male gynecologists under any circumstances are forced to give up their wishes,” Roberts said. “I’ve also been concerned about how many hospitals do not have enough male nurses available for male patients who do not want female nurses to do intimate procedures.”

She calls ridiculous the common policy of making patients disrobe completely, even if the procedure is on a hand or knee, and laments the loss of control that sedation produces.

“Surgery patients are most vulnerable because once they are under anesthesia, they basically have no rights,” Roberts said. “I believe less use of general anesthesia and more regional and local anesthesia will be great for patient modesty issues since medical professionals aren’t going to be able to get away with exposing patients the way they do if they are awake and alert.”

Her organization, she said, is trying to school people on how to achieve maximum modesty.

“It is impossible to change the whole medical industry. It is more realistic to educate patients about how to take steps to stand up for their wishes to reduce unnecessary exposure and unnecessary intimate exams. I encourage patients to not give in and to fight for their wishes no matter how hard it is. Patients are paying customers and deserve to have their wishes honored,” Roberts said.

A Colorado attorney sees the slow demise of what he calls the “God syndrome,” where patients do what they’re told, believing the professionals know best. Physicians should prescribe, not order, he says.

“We should all be able to make reasonable demands. We’re in control of our heath care, and there’s no such thing as one procedure fits all,” said the attorney, who asked not to be named.

He came up against modesty issues almost two years ago when he was living in New York and considering a colonoscopy. He agreed but only after he met with a gastroenterologist, James Salik, who reassured him that what he believed was an undignified screening could be done with him covered, under minimal sedation and with an all-male team. Those conditions became part of the consent form.

“If we don’t want our body exposed, that should be honored,” said the attorney, who, in researching the procedure, came across colonoscopy shorts, an alternative to being unclothed. He requested them but said it isn’t easy to speak up. “Men are afraid to own up to it, afraid of being perceived as weak or feminine.”

Salik, who also teaches at the New York University School of Medicine, asked a colleague to find the shorts and order some, not being familiar with them.

“I understood his sensitivity, though I’d never before encountered that degree of modesty,” Salik said. He saw it as another form of the anxiety some patients feel about sedation - they either can’t abide losing control with it or can’t imagine suffering by going without it. And while Salik knew that the personnel involved in a colonoscopy don’t think twice about seeing an exposed bottom, “(The attorney) was quite easily accommodated and put at ease. It starts with respect for the patient.”