Modesty, Privacy, Dignity

By Eric Hodson, Critical Care Nurse

Modesty is a quality that defines a person as classy, valuable, proper, humble, of upstanding character, and commands respect.

Religious people of most religions hold modesty as a sought-after quality, and modesty is woven into our sense of dignity. When someone is paraded around nude, they are said to have had their dignity stripped away. Their clothes, the usual vehicle of modesty, is also a symbol of dignity.

In my job, the first thing we do when we have a customer is to request they take off all their clothes. We then offer an impossibly complex chef's apron made out of an old tablecloth as a replacement for their ordinary and simple clothes. In this way, we delicately balance the needs of the machine we call a hospital, while at the same time maintain human dignity. Gowns are designed to be simple covers that can be easily placed or removed if a person is incapacitated. If the person at the time of disrobing has all their facilities, then the hospital gown may seem better suited for a fraternity initiation stunt then the first step into the most advanced medical care in the world. For most patients, conscious or otherwise, the hospital gown is rarely a confidence booster.
The deep and foundational respect we in healthcare have for the modesty of patients is also seen in how we are careful to maintain privacy and anonymity. When we call your name over the PA system in the Emergency Department lobby, the near intelligible crackle helps to disrupt those less attentive from understanding who is being called. We also invest in special sound-deadening curtains so that you are not in any way repulsed or disturbed with the doctor's intimate examination of your neighbor. Thanks to patient safety standards, we'll ask you to repeat your name and birthdate out loud every time we ask for information or perform a procedure to help you feel confident that we know you personally and respect your privacy.
Medicine is not a boutique experience. People in crisis don't have the capacity or opportunity to choose who cares for them or how they are cared for. This is why we are so strict with our patients Bill of Rights and other measures that promise advocacy for patient needs. Patients are a vulnerable population because they have so little power and familiarity in our workplace. Modesty, Privacy, and Dignity are not provided by posters on the walls, curtains or unflattering clothes. Though these things serve an important role, no matter how hard you try, everyone can hear you retching.
Medicine is a group activity. The less sick catch glimpses and rumors of what is happening to the sickest, not unlike noticing someone’s underwear sticking out on a bus or in line at Starbucks. Each, in turn, shifts their gaze and attention, and each gives their respect to the other. Very few ask about the other patients, and we as advocates remind this inquisitive bunch that we don't share their situation, and we won't be sharing anyone else's. Modesty, Privacy, and Dignity happen at the human level. The small interactions where we slow down to find a provider the same gender as the patient when needed and keep conversations professional and quiet. The art of lifting up a breast to place EKG stickers should seem as unobtrusive as a handshake. No policy, or a curtain, or even a complex Rubix cube of a gown can provide respect. Providers provide. We are the ones who transform the unusual and frightening into something blasé and even comforting.
So I beseech thee, do not grow lazy to the needs of your patients just because you are in a hurry. Instead, strive to be better at your job so that you can save the minutes elsewhere to spend on the patient that needs it. Remember always:
Fast is slow Slow is smooth Smooth is fast.