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.

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