How to Protect Your Modesty in a Medical Setting

So if you are like I am and care about maintaining your modesty, how do you do so while still getting the medical care that you need? Here are some practical ideas to try.

Communication
First off: communicate your desires clearly, firmly and in advance. Whenever a medical test or procedure is suggested or planned, ask your medical practitioner to clearly explain exactly what will be done, who will do it and what you will be wearing. That may sound over-the-top, but medical professionals seem to err on the side of take-it-all-off for even some of the simplest tests and procedures. Always ask for details. Even for "simple" procedures. Don't settle for the generalities they usually give you or you will most likely be unpleasantly surprised.  If you aren't happy with the answers, ask them to explain why certain aspects of the procedure are medically necessary and then discuss ways to provide the medical necessities while still maintaining your dignity and comfort.

For example, often patients are told that they must remove all their underwear before a test or procedure. When asked why, we had a nurse explain it was because certain synthetic fibers can cause problems.  The follow-up to that explanation would be: "So what material can I wear that would not cause any problems?" I'd much rather go buy some new underwear than to be stripped bear.  Another example, sometimes people are told they can't wear anything but a skimpy hospital gown into an MRI.  In truth, they just need to make sure you don't have anything metal-- no rivets, zippers, etc.--and it is faster and easier for them to make you take it all off than to sort out what would be problematic. A t-shirt and yoga paints (and underwear, too) go through an MRI just fine. I know. I've done it.

Talk to your doctor in advance about what is actually needed versus what is standard practice. These type of discussions are much more likely to yield results when you aren't already on the clock in the very expensive surgery center, MRI, etc.

Have your doctor include your wishes in their orders:
Nurses, technicians and surgery preps are very concerned with doing what the doctor wants--much, much more than they are worried about doing what you want. So as you have these discussions with your doctor, insist they write the modesty plans you make into the official medical orders. You will probably still have to point them out to the health care workers you encounter (they often don't seem to read all that paperwork) but once you point it out to them, they are unlikely to fight both you AND the doctor.

Play the religion card:
If you get push back on your requests for more modesty, choose your wording carefully. If you just say "it makes me uncomfortable" people are likely to treat you as a scared child who they need to convince there is no reason to be afraid. They will try to convince you that your desires are unnecessary and/or irrational rather than looking for alternatives that will work for you. However, they have been trained (or should be anyway) to be respectful and accommodating of people's religious beliefs. For example, if someone came in saying they needed kosher food, the health care worker would be in big trouble with all kinds of people if they tried to convince them that such belief was stupid and unnecessary. So make sure to clearly frame your desires for modesty as a religious belief. Example: "My religious belief is that it is wrong to let any man besides my husband see my naked body. How will your medical facility work to respect that belief?"

Hold your ground:
Don't let people bully and push you into doing something that makes you uncomfortable or that you will greatly regret later. There is nearly always additional options, even if they would rather not admit it. If you aren't happy with the situation, make it stop until a resolution is found that makes you happy. They have a schedule to keep.  That tends to make health care workers try to railroad you through whatever is quickest and easiest for them. But, if you hold your ground and absolutely refuse to move forward, it becomes quicker and easier for them to find a way to meet your modesty needs.

Blame Aunt Flow:
Ladies have one more option. If you really want to keep your underwear but aren't very good at being firm or making a scene, go ahead and lie and say you are having your period. They'll have no choice but to at least give you some lovely disposable underwear to wear.

Why it matters:
For background info on why patient modesty is important, read our other patient modest post.

Medical Records

It has always bothered me that at most doctor's offices, medical records are treated like secrets. It would bother me that when the nurse left the examination room, she would take the records with her and plop them in the door. Heaven forbid I should sneak a peak at records describing me!

According to the government, "The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule." But actually getting providers to hand over those records can be expensive and sometimes frustrating. 

I have had a few doctors offices that are great. When we asked our cardiologist how we could get a copy of the echocardiogram he was running on our son, he happily popped in a CD and burned us a copy on the spot. When I went by later to get a copy of his EKG, the receptionist printed it out from her computer. Part of the trick is knowing who to ask. When we arrived for the echo, we asked the receptionist if we'd be able to get a copy ad she acted like it wouldn't be possible--in reality she just had no idea. Persistence paid off and the doctor gave us no trouble over it all. 

Many offices and especially offices out-source their records to third-party companies. That means if you want a copy, you usually have to fill out a form and commit to an indefinite amount of money for copying said records. How much they can charge you varies from state to state. You can look for your state here. 

After fun experiences with knee surgery and a decision to never go back to the Carilion hospital near us, I wanted to gather all the records from their system. After talking to the records department on the phone, I filled out the necessary form and submitted it. The records office warned me that asking for all my records could result in thousands of pages and thousands of dollars so I might want to be more selective. I wanted it all so I continued on. I was very surprised when I received a very thin envelope from HeathPort, the 3rd party information company that Carilion uses to store and retrieve its medical records. There were so few pages that it fell into the free category. The documents contained spotty information on a few procedures I'd had done and none on others. We called HealthPort. Their customer service was unfriendly and unhelpful. They insisted that they'd sent my complete records and demanded to know how we could know something was missing.  Hmmm, because they were missing entire procedures! We finally got them to grudgingly agree to try again. A few weeks later we got a larger package. This time it included an invoice for around $20. This time it at least had mention of all the procedures and had a more complete record of the surgery I'd had done. The copies were terrible quality but at least they were there. Still no images, though, even though we'd expressly checked that box on the records request form. No images from EKG, EEGs, MRIs, surgery, etc. We called HealthPort again and were told they don't do any images and that we'd have to contact the hospital. 

Back I went to the hospital record office. I sat there for over an hour while they tried to find and print out my images. They kept asking, "Are you really sure you had it done here? We can't find you?" That is definitely confidence-building. Finally they managed to find and print one EKG. I was told that they didn't have my EEGs. I'd have to try to contact the neurologist who ordered them. And they didn't have any images from the surgery. I'd have to ask the orthopedic surgeon about that. They also told me that I'd have to go to Imaging to get copies of the MRIs. That would have been nice to know before I'd already waited an hour because when I went to Imaging, sure enough, they could burn a disk for me, but it would be an hour or two wait. And no one ever, in the process of getting the MRIs, had let me in on the fact I could get copy of the images or how to do so. They only tell you if you ask. 

It was a long and frustrating day. I still haven't gotten up the energy to go through all that again with the orthopedic surgeon's office, but one of these days, I will.

So why bother getting them at all? Because unless you stay in the same town with the same doctor your whole life, this information will disappear. And someday you might want it. After all this, I realized I should try to get some records from a previous doctor in a previous state. I called... but it was too late. They'd been destroyed. How long medical facilities must keep records varies from state to state. You can check out yours here. 

Even if you stay with the same practice, if your doctor changes it seems to make your records vanish. I requested my records from the family physician's office I've been using. It came from another third party and was decently complete, except that it contained nothing from the first doctor I'd seen at that practice years ago. She was my doctor for several years and then left the practice and I was transferred to another doctor. The records contained none of the tests or visits I'd had with her, and there were a few things I wish I had.

So the moral of the story is: demand what belongs to you. You paid for these tests and treatments. You should have a record of what was done and how it was done. Don't wait for some one to offer the records to you (they won't).  Don't wait until you need them or they may already be gone.

Carilion hospital Patients are denied Emotional Support

Carilion hospital denies patients emotional support

After moving to the area 10 years ago we went to the Carilion hospital (New River Valley Medical Center) for some tests.  We found some of their policies a bit strange and uncomfortable.  We chalked it up to new laws or something.  Over the years we have been back to the same hospital and found the same uncomfortable treatment.  After a extremely stressful situation before outpatient surgery we did some checking.  What we found was it was only their hospital policy and nothing to do with ANY laws.   

Carilion's policy is to isolate the patient from their support to interrogate them.   Right before a medical procedure is a super stressful time and when a patient needs support the MOST.  It is not the time to be isolating them.  Other times it is irritating and annoying but before a traumatic experience, like surgery, it can be emotionally damaging.  Practically all, if  not all, patient advocates recommend patients should have their support person present at all times to listen and assist in preventing errors.  Even Carilion’s own over-site commission (Joint commission) recommends that that patient advocates always be present.

After our emotionally traumatizing experience we contacted the Carilion management and asked why this had happened and that we did not want to be treated that way.  They stated that all their patients are required to be questioned alone.  They said in order to better serve illegal drug users this was the best policy.  They treat all patients that way and will not make any exceptions.  Nice to know my emotional welfare means less to them than protecting illegal drug users.

It may seem like a minor issue but if they will not work with their patients on a seemingly small issue, you can imagine how inflexible their management is on big issues.  It is absolutely not a legal requirement to be questioned privately.  We will no longer allow separation for questioning at any medical facility.  Which leaves us with... 

Since Carilion demands its patients be isolated when questioned they left us with only one choice, change providers.  Which we did and we have found that the LewisGale hospital has more patient friendly policies.  It has been years now and the only time we returned to a Carilion facility was to get copies of our records. (And that was yet another unpleasant Carilion experience).

As a society we do not have to put up with bad service from hospitals.  Everyone should consider carefully where they choose to go.  Do not support business with bad policies.  And above all, never ever let "it's our policy" be the end of the conversation.
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From the joint commission: who oversees Carilion Hospital (New River Valey Medical Center)

Communication with a patient’s family members or friends

" Health care providers can share and discuss health information with family, friends or other individuals who are directly involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). The law allows sharing information when the patient either agrees or if present in the room with the patient, the patient does not object. For example, providers can talk to a patient about his or her condition when a family member or friend is present at the patient’s request. Information about a patient’s needs also can be shared with a health aide, interpreter, or person driving a patient. In some situations, HIPAA also allows health care professionals to use their own judgment about whether the patient wants health information discussed in front of family members, friends, or other individuals involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). If a patient specifically asks a provider not to share information with an individual, then that decision must be respected. (HHS, Office of Civil Rights, Sharing health information with family members and friends)." link


 HIPAA is not about isolating the patient.