How Patient Modesty Affects Medical Care

Modesty, when applied to a medical setting, refers to the shyness about, or fear of, exposing one's body parts to someone else. The patient is embarrassed because he or she believes their body parts are being judged.

Body parts may include genitals, breasts, or any body part a patient feels uncomfortable exposing for any reason, including too much or too little fat, a birthmark, or some other body attribute.

"Someone else" may include doctors, nurses, or other healthcare workers, whether or not they are of the same gender as the patient. Some patients feel less apt to be modest if their provider is of the same gender they are, but some are modest regardless of the gender of the healthcare worker.

We aren't born being modest because we aren't born feeling judged by someone else. Think back to the first human beings who roamed the earth without clothing, except to keep themselves warm, or to protect genitalia. They felt no embarrassment about their bodies, thus, no modesty.

As human beings began judging each other's bodies, modesty developed. If someone felt as if their body parts were judged as too much or too little, too large or too small, defected in some way, or simply not the same as someone else's, then they covered up that embarrassing part in an attempt to stave off the judgment.

Further, modesty is cultural, including the effect of religious beliefs. Different cultures dictate what parts of human bodies must be covered, or may be exposed. Think about some African cultures where women do not cover their breasts. Then think about Middle Eastern cultures where women wear burkas to cover their bodies and their faces completely, for political and religious reasons. The sexual revolution in the 1960s and 1970s set the stage for more revealing clothing, which affected modesty, too, setting some people free from feeling modest and creating even more embarrassment to others.

Modesty would not exist if we weren't afraid of judgment. It's that feeling that someone will judge us to be more or less than someone else, or in some way failing to adhere to our cultural beliefs that embarrass us, and makes us afraid of exposing those parts of our bodies that we are afraid will cause negative judgment.

Most of us are modest to some extent, but life circumstances allow us to separate our feelings of being judged by our need for medical care. Women get pregnant and choose pre-natal care. They set aside their modesty because they realize it's more important that their babies develop in a healthy body environment, and will be born healthy. Women get the mammograms they need because they want to catch possible breast cancer as early as possible. Men go for check-ups and are told to turn their heads and cough while the doctor checks their testicles. In each case, body embarrassment is set aside for the bigger goal of body knowledge.

But some people develop that sense of modesty to the point where they will not seek medical care because they fear that judgment. Some deny themselves preventive care like check-ups because of that sense of modesty. A report in the Wall Street Journal reviewed a study that showed that only 54% of men get checkups, presumably the other 46% have modesty issues at least to some extent. About 74% of women seek preventive care; again, we can assume that some of the remaining 26% avoid care due to modesty issues. Some are so fearful of that judgment they won't even seek medical care when their symptoms are obviously problematic like severe pain or bleeding. At an extreme, a patient's death could be blamed on modesty as easily as it could be blamed on the disease or condition that caused his or her body to die.

Let's use the analogy of auto care to explain why some doctors just don't understand patient modesty well.

If your car is having engine troubles and you take it to a mechanic, the mechanic will lift the hood, poke around the engine, wiggle the belts, tighten a few screws or bolts, go back to the driver's seat, play with the controls, and by doing all that, he'll figure out what's wrong with your car, he'll know what needs to be done to fix it, and he'll perform the necessary procedures to make that repair.

Which is, of course, exactly what your doctor does.

Can you picture your car mechanic being concerned about exposing your car's engine or choosing not to fool with the controls because he's worried that your car will be embarrassed?

Unfortunately, through medical school, residency, and the example of other physicians, not all doctors have been schooled in the finer points of taking care of human beings. Too often, human bodies are viewed not so differently from the way that mechanic views a car — like something that requires repair without regard to the emotions and feelings that are an important part of working with people. It doesn't seem right or fair, but it's common.

Part of the reason providers don't involve themselves in a patient's emotions is because they are taught not to judge. Doctors and other healthcare workers learn to care for human bodies no matter what size they are, no matter what they look like, no matter how they smell or whether they work the way they should. If something is wrong, they are simply trained to fix it.

Most doctors and other providers won't judge their patients' body parts any more than they will judge their patients' hair or eye color or the length of their fingernails. Are there exceptions? Of course. Are there providers who make seeking care very uncomfortable? Yes, there certainly are. But as professionals, doctors just want to fix whatever is wrong, no matter how private their patients consider those parts.

Another reason some healthcare professionals don't regard modesty with any importance is that a patient's modesty may cost them time and money. Time, because it's much quicker to do an exam or do a procedure without accommodating modesty. Money, because time is money, and because a supply of extra-large gowns, or larger exam tables, or any other equipment that accommodates some forms of modesty will simply cost them more.

That lack of respect for a person's emotions and feelings may be the fault of the individual doctor, the fault of the training he or she has received, a bad approach to patients developed over time, or a combination of all three.

But most offending providers don't realize they are violating someone's modesty because patients have not let them know they feel embarrassed. In particular, because those patients who are most embarrassed, most modest, just don't show up at the doctor's office at all. The issue rarely comes up.

Modesty is a problem for patients but is not really the fault of the healthcare system. A fear of being judged is something society, in general, imposes, making us patients feel embarrassed. Doctors are simply doing their jobs, so it will be up to us patients to be sure our modesty is taken into consideration.

1. Request Same-Gender Providers: In general, one of the best ways to accommodate, or overcome modesty, is to find healthcare providers who are your same gender. Finding these practices or hospitals is, of course, easier said than done. Historically, most doctors were male and most nurses were female. While those roles are changing, that does not mean it's easy to find a doctor of any specialty who runs an office that can accommodate a patient with modesty issues. In particular, male nurses in doctors' offices are difficult to find. You'll want to phone the office and ask the question. This is just one of the considerations when choosing the right doctor.
2. Speak Up About Your Modesty Needs Before and During Your Appointments: If you feel your privacy or modesty is being violated during a doctor's appointment, speak up. Explain your embarrassment, and ask if there is a way the session can be handled differently. Maybe you are male and you don't want a female nurse in the room. Or maybe you are a larger size than the gown they gave you and you want one that's larger. You don't need to be overbearing. You might explain how happy you would be to spread the word that this office was very accommodating if they listen to your suggestions and take action.
3. Report Your Experience If Your Modesty Needs Weren't Addressed: If your modesty is violated in the hospital, ask to speak to a nursing supervisor or the hospital's patient advocate. Explain why you are uncomfortable and ask them what steps can be taken to make sure modesty is a consideration in your care. If you don't get satisfaction while you are still in the hospital, then write a letter to the hospitals' president and board of directors (or trustees) after you are discharged and feeling better. Be as objective as you can in your descriptions, and ask that steps be taken for future patients so they won't have to suffer the embarrassment or humiliation that you suffered. Again, you don't need to be overbearing. Be as objective and factual as you can be and your questions and advice will be better received.
4. You May Have a Phobia: Human beings have many phobias, and an extreme sense of modesty might be one of them. Phobias can actually be treated, just like a fear of flying in a plane, or a fear of heights, or claustrophobia (a fear of being in a closed space) can be treated. Do a search for a ​mental health professional who can treat your modesty as if it was a phobia. The fear of doctors is called "iatrophobia." The fear of being naked is called "gymnophobia." You may have one of these phobias, or both or neither. You may just have a general anxiety. But a mental health professional may be able to sort that out and help you get beyond your modesty.

1. Balance Genders of Providers: One big problem is that the healthcare workforce does not meet the modesty needs of the population. For example, as mentioned earlier, there are not enough male nurses. There are many reasons for this lack of male nurses, but you may be able to increase the numbers of male nurses by contacting your local nursing schools and asking if they can suggest a way to help you recruit more men to the profession.
2. Encourage Men to Enter Nursing: There seems to be a stigma attached to the idea of men becoming nurses, which is, of course, one reason the number of male nurses is so low. Talk about this with your friends in order to begin de-stigmatizing the idea. The more it becomes a general conversation, the sooner the stigma will go away. Encourage young men you know to enter nursing as a profession.
3. Encourage Patient Modesty Issues to Be Taught in Medical and Allied Health Curricula: Contact your local medical school and ask if patient modesty is accounted for in its curriculum for all its students—doctors, nurses, CNAs, and other allied health professions. If not, ask them who you can speak to that would recognize the importance of infusing modesty issues into the education of its students. Then make an appointment with that person and encourage them to add this issue to the curriculum.
4. Encourage Patient Modesty to Be Addressed in Continuing Medical Education: Get in touch with your local medical society and ask if they have any initiatives to teach the extra skills this recognition requires. If not, then ask if they can help incorporate them, perhaps through continuing medical education credits for healthcare workers. While the society probably won't be able to make that happen, they will probably know which entity could.

Some people believe that, as patients, they are "owed" this extra step by providers to be sure modesty is addressed. But no, they are not.

Many providers, perhaps even the majority, understand that patients wish to be covered, want someone to knock on the door, or in general, are modest and embarrassed. Those practitioners will take the extra steps in the best way they know how to address their patients' modesty issues.

However, this is not true for all providers. There is no patient right stated anywhere that modesty must be addressed by any provider. Yes, we should be able to expect respect to be paid to us. But respect is subjective, and from the point of view of any provider, addressing a patient's modesty issues isn't their first thought. Providing good care is their first thought and from their perspective, attending to modesty issues might not even be on their radar, or might get in the way of that good care.

Knowing that smart patients who are concerned with modesty, regardless of their gender, must take the steps necessary to get the care they need even if they find it embarrassing. Modesty is not a good enough excuse to avoid care, especially when problematic symptoms arise.