Doctors, Definitions, and Decency

August 9, 2018
Posted by Jay Livingston

So there I am, sitting on the table, wearing nothing but one of those smocks. And the doctor comes in. My new dermatologist. I’d been to him once before. Young. Looks like maybe he’ll be eligible for a bar mitzvah in a couple of years. And with him are these three girls – women, females, whatever. Also young. “This is my team,” he says.

My friend Martin [not his real name] is about my age. He has some skin condition that requires periodic check-ups.

He says they’re interns or residents or med students, maybe it was one of each, and do I mind if they observe. What can I say? So he does the whole examination. I close my eyes, partly ’cause of the bright examination light, but really, I don’t want to be making eye contact with anyone.

It’s a thorough exam – head to toe. Literally. I mean he’s looking at my scalp, my toes, front and back. You never know where another one of these damn things might turn up. So basically I’m naked.

Then it’s all finished. I sit up, wrap the gown around me. He says it’s all good. He found nothing. And then it’s time for him and the team to leave, and he says,, “We’ll just let you get decent . . . “

So I say, “You didn’t seem to mind when I was indecent two minutes ago.” He gives a little embarrassed laugh. So do the women.

So here’s the thing. Two minutes before, they were all looking at me naked, and that was OK, decent. But now that I’m in my gown, for me to change back into my clothes while they’re in the room would be indecent. In fact, maybe he was saying that me wearing just the gown was not decent.

It’s Joan Emerson, I tell him.

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In 1970, Joan Emerson published what became a classic article on how doctors and nurses in gynecological exams make sure nothing seems sexual. The full title of the article is “Behavior in Private Places: Sustaining Definitions of Reality in Gynecological Examinations.” As the title suggests, the definitions and reality — what something is —  are sometimes up for grabs. In a gynecological exam, doctors do things that in other circumstances would be seen as sexual. For the exam to run smoothly, the medical staff have to make sure that the patient too defines all the looking and touching and questioning as medical and not sexual.

The major definition to be sustained for this purpose is “this is a medical situation” (not a party, sexual assault, psychological experiment, or anything else). If it is a medical situation, then it follows that “no one is embarrassed” and “no one is thinking in sexual terms.”

The medical demeanor extends to even to the choice of  the rather than your —  “the vagina,” not “your vagina” — and “the vulgar connotation of ‘spread your legs’ is generally metamorphosed into the innocuous ‘let your knees fall apart.’”

My friend’s dermatologist and his students sustained the medical definition of nakedness. They didn’t really have to do anything. Everyone just accepted that definition. But once the examination was over, that definition no longer applied. His nakedness or near-nakedness was closer to what it would be outside the examination room – not decent.

In the situations Emerson observed too, the fabric of the medical definition could become threadbare.

Some patients fail to know when to display their private parts unashamedly to others and when to conceal them like anyone else. . . . .  The medical definition is supposed to be in force only as necessary to facilitate specific medical tasks. If a patient becomes nonchalant enough to allow herself to remain uncovered for much longer than is technically necessary she becomes a threat.

My friend’s comment about indecency posed a similar threat. After the medical definition was no longer necessary, he was reminding the women that they had in fact been looking at his genitals — the genitals of a man who was no longer covered by the medical definition of the situation.

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In the movie, “Love and Other Drugs,” Anne Hathaway goes to see her doctor. In the examination, she has to remove her blouse and bra. Also in the room is Jake Gyllenhall. She assumes that he is another doctor, so it’s OK. But a minute or two later, when she realizes that he is a drug salesman, not a doctor, she is less accepting.

Note  Gyllenhall’s line about “all the arrogant, faceless, cut-off asshole doctors out there who’ve treated you like a non-person while peeking at your breasts.” Doctors too, not just drug salesmen, may be hiding voyeuristic motives under their white-coat medical definitions of the situation.