Thursday, April 22, 2010

Things not to say to your massage therapist. Part III: Taking your clothes off.

(Today's entry is Part III in my series describing an insider's view of a medical office and how to make your experience as painless and simple as possible.  Check out Part I and Part II for more.  As I mentioned before I want to include a disclaimer:  Please note- The opinions I'm expressing here are my own and not those of my past, present, or future employers. This is meant purely for entertainment, doesn't constitute official or licensed-though I do have two licenses-medical advice, and isn't a reflection of any official business policy I've ever had, spoken or unspoken.  That said, I will be as flatly honest with you as possible.)

Whether you're getting under the sheets for a massage or dropping your trousers for the old turn-your-head-and-cough routine or getting your annual pelvic exam or showing your doctor a rash in a hard-to-see place or even just putting on one of those paper gowns that makes you feel more naked than when you're actually naked, chances are at some point in your life you'll need to take your clothes off at the doctor's office.


Don't panic.

I get asked all the time if it's awkward to have strangers take their clothes off around me.  It's not really easy to answer because there are lots of different sorts of nudity I experience in my day-to-day job, and they are not all equivalent.  In general, no it's not awkward at all.  In a sense, the people I work with aren't even strangers.  If you liken me to a car mechanic, it'd be like saying Toyotas were "strangers".  I may not know everything about you, but I've got a chart full of basic demographic info I can glance at for clues, and the chances you have a problem or a condition or a physical piece of anatomy I've never seen before are slim to none.  I've been at the work of healing people in one form or another for almost fifteen years and I think as far as nakedness goes, I've seen pretty much all there is to see at least two or three times.  But this isn't about ME, it's about YOU, and this is all new to you.  In fact, the idea of getting naked in a doctor's office is often petrifying to many people. 

There are a few things to keep in mind when doing so that will make your experience a lot easier.  I'll get to the "do's and don'ts" in a bit, but I think we should discuss for a moment the environment you're putting your naked body into.  First of all, virtually every medical worker with more than a year or two of experience, from attending physicians right down to the lowliest nurse assistant or patient tech, has seen hundreds of naked people.  Hundreds.  I'm not exaggerating.  Up close, and in full real-life HD.  It's not as scandalous as it sounds.  Of those hundreds, most of them were either very young children or elderly people, because those are the groups that get the most medical attention.  In between, however, you can be guaranteed that any experienced professional medical person has seen every size, shape, age, sex, and condition of human body there is at least a half a dozen times, and while your naked body might seem pretty darned unique and special to you when you're home looking in the mirror, it's really nothing new to us.

And I have more good news: in this context, it doesn't matter one bit if you're obese or trim, tall or short, attractive or not.  We will not judge you in the slightest for having the body you have.  Yes, for real.  It's trained into us from almost the moment we set foot in whatever training programs we went through to do our jobs, and it's reinforced by our work environment.  We feel no different around your attractive or unattractive body than a car mechanic feels around a Jaguar and a Datsun.  They're just different, and for the most part they work (or don't work) just like every other body does.  The Datsun owner's money is just as good as the Jaguar owner's and it's our job to fix them, and to do the most professional job we can doing it no matter which sort of car comes in.  When was the last time your car mechanic made you feel either especially good or bad about the type of car you own?  This means there's a certain level of expectation you should feel perfectly comfortable having, and other expectations that you might as well just leave at the door because they're either impossible to meet, meaningless, or both.

That said, there are a few things you can do to make absolutely certain that you and your body will become the stuff of water cooler or break room legend, and not in a good way.  I'll let you in on these, too, so you can steer clear.  In the spirit of my last, post, I'll frame this advice and explanation in the context of what's appropriate and what's inappropriate.  We'll start with the appropriate first.

Let's say you have a rash on your groin.  Not making any judgements here about anyone, but just for a place to start, let's say you have a rash there.  We've all had this, right?  When we were children at the very least.  Feel free to substitute whatever problem you want here as long as it theoretically involves taking your clothes off in front of a medical professional.  Here's a few helpful hints just as guidelines, with the most important one first:  You do not need to take all of your clothes off unless specifically directed to do so! 

This seems like an intuitive concept, except you wouldn't believe the number of times I've handed someone a pair of paper shorts to check their knee incisions or given them a gown to look at their shoulder or told them to go ahead and climb under the sheets for a massage and I come back in the room greeted by a completely naked patient.  People mistakenly strip down completely for things like X-rays and shots in the arm all the time.  When I hand people gowns, I always include some specific instructions about how to put them on and how many clothes need to come off.  I don't say this just to hear my voice rattle off of the inside of my skull.  

So, if you're taking notes, there's the first "inappropriate" flag.  If you're unclear about how naked you need to be for a certain procedure or treatment, just ask.  Medical people get these questions all day long.  Being ultra-confident and going buck-wild commando on us will probably not ruffle our feathers much at that moment, but you can believe once the moment is over you'll be thought of as a bit of a wingnut.

In most cases pants only or shirt only is perfectly fine and unless you have a problem directly concerning your genitals, you can keep your bra/underwear on.  Exceptions to this include some forms of complete physicals, emergency room visits, and dermatology visits where they're checking your entire body for lumps/bumps.  In these cases, you will be told that you need to disrobe completely and you should get a gown.  The doctor generally will leave the room while you take your clothes off.  Here's the second "inappropriate" flag, and this one has to do with your medical/massage staff.  If they ask you to disrobe completely and (1) don't leave the room while you do it or (2) don't give you a robe or gown to cover up with, you should ask them why.  State laws vary, but professional standards really don't.  If your doctor, clinical staffer, or massage therapist asks you to disrobe and stays nearby watching, this should be a red flag for you.  I'm not talking about taking a shoulder out of a bra strap or shrugging your pants down low enough so they can get to your lower back.  I'm talking about getting completely naked, because like I mentioned above there are only a few cases where this is ever necessary and when it is you should be able to do it in private and replace your clothes with something like a gown to keep you comfortable.

A massage is something a bit trickier than an exam because the rules are a little different.  When you're getting a massage, you're generally welcome to take off whichever clothes you feel comfortable taking off.  Since it's usually your dime, it's your prerogative.  All medical people eventually reach a level of comfort with handling bodies in one way or another, and massage therapists get the master course.  We learn how to move and manipulate people's bodies in virtually every way you can imagine while simultaneously keeping you feeling comfortable and modest.  We are trained to work on people fully clothed, fully unclothed, and people in every state of dress between.  We are trained to use strategic towel and sheet placement so that we more or less only expose which part of the body we're working on.  Therefore even if you decide to get completely unclothed to get a massage, it's important that you do, in fact, climb under the sheets before the massage therapist comes back into the room.  Again, I say this as if I'm talking to a ten year old, but you'd be amazed how some people get this mixed up when it's their first time.  In fact, here's a fun insider massage therapy tip: if it's your first massage and you're nervous or you don't want it to be distracting and ruin your relaxation, just wear a pair of shorts and (if you're a woman) a workout tank top or sports bra.  This way you can be assured everything that needs to stay covered stays covered and you can just focus on getting worked on.  Once you're comfortable with the person that's working on you, go for the real deal the next time.

I want to stress that it's relatively unlikely you'll offend your massage therapist or doctor even if you get something mixed up and pull a "hello, I'm completely naked".  So if this was you, don't worry.  These sorts of understandable mix-ups are just par for the course and we usually shrug them off and forget them.  There are a few things that will offend them, however, and they are: (1) refusing to correct your error and (2) having very bad personal hygene. 

The second one is just aggravating because no one wants to touch someone who obviously hasn't bathed in days or wears oppressive scented cosmetic products.  I've been a shower everyday man since I was a kid, but I'm well aware that many of you are not.  You're robust!  You shower right before you go to bed at night and then not again for three or four days because your bed is clean, right?  Wrong.  There is no hiding it.  Even if you have a really, really strong cologne or aftershave or perfume.  Just.  Take.  A.  Shower.  Hot water and soap.  It's not rocket science.  This also counts for after you workout and you're getting a massage.  Hit the showers first, please, even if it makes you a minute or two late for getting on the table.  If you want to live like that the other 364 days of the year that's your business, but if you're going to be in an eight by nine foot room with us for an hour we'd appreciate it if we could breathe freely. 

The first problem, refusing to put clothes on when directed to by your doctor, is a bit more serious.  It's something I haven't come across except for the overconfident folks or Euro-types that insist it's easier to just take their shirts off and be "modern" about it instead of fussing with paper shorts or a gown.  This is perfectly understandable, but half the time we give you the gown for lots of other practical reasons than just to keep a barrier of cloth between you and us.  Gowns can keep you warm in cold exam rooms, keeping a barrier between your wounds/suture lines and the floor/furniture, and they can maintain a communal modesty when you walk down the hall to go to the washroom.  Just because you're ok with nakedness and generally so are we doesn't mean the entire world is. 

When I was in orthopedics I would occasionally get first-generation foreigners that would completely disrobe upon entering the exam room just because that's how it's done in the Soverign Nation of Wherever.  This is an honest mistake and they brushed me off matter-of-factly when I tried to insist on them using the gowns.  In a medical environment, this is usually not a big deal and most doctors will be sensitive about cultural differences except for maybe a roll of their eyes at their nurse, but you should know that in some cases in order to recieve massage you MUST be covered to a certain extent.  This is a law and there's no way the therapist can or should bend the rules for you.  Even if you're perfectly comfortable being bottomless or (for women) topless in a massage and rolling over without a towel, it's actually illegal for the massage therapist to continue the massage if you do.  So keep that in mind, and don't push their professional boundaries. 

In a similar vein, it's also not appropriate to wear suggestive or inappropriate clothing in a doctor's office.  So that means your plunging necklines, bikini tops, shorts with no underwear beneath (this means you, too, guys), protruding thongs coming out of your jeans, etc, should be left at home.  No matter how attractive you are (or think you are), remember you're still just at best a Jaguar in a car repair garage.  It's not a place for showing off so save it for the club or whatever.  In addition to being fashion trainwrecks, it makes everyone around you including the doctors, nurses, staff, and other patients uncomfortable and ultimately also falls into the general behavioral category of "not being a douchebag". 

Now that all the heavy theory is out of the way, here's seven things to not even worry about:

-I didn't shave my legs! 
No one looks, or cares.  In fact, we wouldn't even notice if you didn't point it out.

-I need to hide my bra/underwear in my purse!
Again, if you feel embarrassed about your skivvies, feel free to stash them somewhere, but it's not necessary.  No one looks, or cares.

-I have loads of body hair!
So do medical people and everyone else on earth.  Not a problem.

-I haven't brushed my teeth!
Only an issue if you've got pathologically bad breath.  In fact, it's 1000 times more likely that your doctor or massage therapist is more concerned about his or her breath than you are about yours.

-I farted!
A little awkward, maybe, but only for you.  It happens to us all the time and it's no big deal.  Just press on and it'll be forgotten a minute later. 

-I accidentally got an erection!
More awkward than farting, but not the end of the world.  When men lie on their backs, their bladders sink down and directly apply pressure to their prostate.  It's involuntary and though a first year twentysomething massage therapist might get slightly flustered by it, a real professional will realize you're probably mortified and just ignore it.  If you want to avoid the possibility of this happening inadvertantly during a massage or medical exam, be sure to empty your bladder before beginning.  If it becomes a recurring problem, you'll most likely get politely referred out or our schedule will become suddenly too full for us to see you again.  Ever. 

-I have bad acne on my back/shoulders, athlete's foot, warts, or severe dandruff!
This actually a good doctor or massage therapist should pick up on and may suggest you see a dermatologist or aesthetician.  This is a medical issue all its own and derserves some attention, if only to make you more comfortable.  Nothing to be embarrassed about, but perhaps cause for concern nonetheless.  Don't be embarrassed if your doc brings it up, they're just trying to help and a lot of people genuinely don't know how to go about fixing things like this.

That's about all I can think of at the moment from my own experiences that's relevant to your next trip to the doctor's office, so I'll wrap this segment up with a funny little side-statistic that might cheer you up:  In fifteen years, I've only met a few people that were completely melt-down neurotic about taking their clothes off around medical professionals and chances are you fall into the category with most of the rest: where it's something slightly awkward that you want to do right but there doesn't seem a "cool" way to do it.  Don't worry, there isn't a "cool" way.  I've tried to outline the background subtexts going on as well as I could, but if you still leave feeling a little sheepish, take heart.  For every person I've met that was visibly afraid to disrobe for their doctor, I've met fifty who were absolutely mortified to take off their shoes and socks so a doctor could examine their feet.  People are much, much more nervous in general about their feet than they are about any other part of their body.  I have yet to figure out why, but I could almost write an entire article on the awkwardness I've experienced trying to talk, cajole, and coax people into taking off their socks and shoes.

That's it for this week.  More soon!

1 comment:

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