*cold ducklips*

[sulingsi.livejournal.com]

hi there, ok, this is my first actual posting. yay!
i'm an aspiring gynecologist who just got accepted to med school. after reading the recent post referring to "annual torture exams", i thought i would just ask- what are things you would want your gynecologist to do differently?
if you have a story about something totally stupid a male gyno did, i probably wouldn't be like that. but i'd like to hear any input people have. and yes, i have seen vagina monologues, so... aside from draping you in velvet... :-)

Comments

[dodogrrl.livejournal.com]

when my gyn does something extra unpleasant (like insert my IUD) she gives me this calming touch on my foot. You know, it's right there in the stirrup... she just kinda reaches down and holds my foot for a moment. Sounds odd but it's so nice!

other than that... just listen a lot. I had one awful female GYN who (1) claims to be pro-choice but won't do abortions, and (2) prescribed me an uncomfortable, unnecessary sonogram even though she herself admitted I probably just had a whatdoyoucallit "cyst" that just meant I'd ovulated, and she could have just checked me again in few weeks instead. Oh yeah, and (3) she refused to consider tubal ligation for a patient who'd never been pregnant. I was like, so I have to go get some abortions first? Way to not give me any credit!

oh and sense of humor definitely a plus! I love my current GYN, have been going to her for years despite her not being covered by my health plan, b/c she's so smart and has a real dry wit.

[mactavish.livejournal.com]

Congratulations on getting into med school. :)

I've had *many* gynecological procedures. Some of my best doctors have been male, some of the best have been female. Some of the worst have been male, some of the worst have been female.

Unfortunately, I need to race out the door for work. I want to give a more detailed answer. Suffice it to say, for now, that the best have been those who have asked me relevant questions, made themselves available for my questions in a non-condescending way, and who haven't gone overboard with "I'm the doctor, you're the patient." I'm setting this aside for myself to finish after work today.

The bad and the good

[geminigirl]

Stupid gyno horror stories:

Gyno #1...I have a latex allergy. A medically diangosed, serious enough to cause me pain latex allergy. The gyno who did our student health clinic in college was the head of ob-gyn at one of the major hospitals in the area. This is a well known teaching hospital, with a national reputation. I was friends with one of the nurses in the student health clinic. They knew I had a latex allergy. It was noted in my chart. The nurse set out gloves that weren't latex. She reminded him to use them. I reminded him I was allergic to latex. The gynecologist's response? "No one is allergic to latex." He inserted latex gloved fingers into my vagina. Needless to say, I was swollen and in tears within minutes.

Gyno #2 treated me like an idiot when I had questions about my colposcopy. His office staff was rude when I called for test results. He left me gowned and in stirrups for 45 minutes while they called the hospital to find out if they had gloves that were a medically appropriate substitute for latex-not on an intial visit; on a follow up visit.


But I have some incredible, positive gyno stories too...

Gyno #3 was fabulous. She used a combination of nutrition, herbs and western medicine to treat me. She didn't make my weight an issue, but was more concerned with how I felt then what the scale said. She listened and answered my questions, and gave suggestions and advice. (I asked for example about switching from my pill to depo, and she advised me not to-her point was made, and she explained WHY-"because you don't have trouble remembering to take it, or taking it off schedule, and you've had some pretty serious reactions to medication in the past, and it would be unpleasant if you had to cope with that for three months.) She asked about the quality of my sex life. Her office staff was kind and sensitive. She had cloth gowns that actually covered you...I'm not a HUGE person, but I am fat, and they weren't trying to make me squeeze into something that clearly didn't fit. And her office forms were incredible; they were open and honest, and sensitive to people who were something other than heterosexual...are you sexually active with men, women or both, monogamous or not monogamous relationships, tell me about your menstrual history and periods, what are your concerns, etc. Just competent and sensitive

Gyno #4: Similarly sensitive, and competent. Asked both gender identity and orientation identity questions. The bonus to gyno #4, which is really important...I had some bruising on my breasts which hadn't quite healed. It was in that green-yellow phase, just before it goes away. And she looked at it, and said, "I noticed some brusing. Is that from sex play or something else?" I told her it was from sex play, (I'd done some s/m play with a lover, and had thought the bruises would be gone but they hadn't healed quite all the way yet.) She asked if I had any questions or concerns about it, I didn't, but she referred me to some appropriate resources just in case I did later on and that was that. She wasn't invasive or intrusive, just honest and upfront. She was at a clinic that one of the local AIDS Service Organizations offers (they do tremendous amounts of lesbian health stuff too...including the gyn clinic) and I actually refer women there instead of planned parenthood if they're comfortable with the environment.

I'd suggest reading the book Health Care without Shame by Charles Moser. It's not a great book, but it's helpful for patients to learn to advocate for themselves as healthcare consumers, especially if they're in "alternative lifestyles" and it's got some stuff for providers too.

[one-more-grrl.livejournal.com]

My first gyn experience was in july. i hated it so much because I went to Planned Parenthood and they weren't really sensitive. Like, the thing that really pissed me off the most was when they were doing the exam and sticking GOD KNOWS WHAT up my twat, so I made faces and stuff so I wouldn't cry or scream or bite them, and the nurse had the AUDACITY to laugh at me. Like, alright I probably made weird faces and all, but DON'T LAUGH AT ME. girls are self-concious enough as it is.

[cuzgoatsrkool.livejournal.com]

well both times i had a male doctor that i had *just* met do it...so i dont think that it helped that he said "this will feel uncomfortable..but wont hurt" as if he knew...jeeshh
lol..well..both said something similar to that
i guess i wouldn't be good for advice since I had males...i think a female doing it might be better because they know what it's like so it wouldn't feel as awkward

[inanna.livejournal.com]

Well, i agree with most everything others have said. In addition, my midwives use just-about-body-temp speculums.... so it doesn't come as a shock at all. Explaining what you are doing is a BIG one, too..... not only what, but why. Yeah, you are squeezing the s&%t out of my ovaries.... but WHY? Ok, now i know why, but i didn't for several years..... i was so excited when i found out. :) Do rectal exams.... i am disappointed that so many don't include rectal exams during annuals (i don't enjoy them, but there is good information to be obtained and if i am going through all this, i want my practitioner to get the fullest picture possible).

Follow up.. make sure you (or someone from your office) calls about EVERY test you give... pap or otherwise... if that is your office policy. i had a midwife (normally they are great, this one f-ed up)... she told me she would call if (and only if)anything was out of the ordinary on my pap.... that was her office policy. She never called. When i had my next pap 3 years later (indicated as i was monogamous, no unusual paps, etc.), it came back Class IV.... i ended up having to have 7 diagnostic biopsies, a cone biopsy, and a D & C..... when i got the copy of the pap she did (to give to my new PCP and the specialist), it showed irregular cells. i ran into her at the grocery store and mentioned to her that it showed abnormal cells (she asked how treatment was going), and she said, "Well, it wasn't bad at all, just a few cells and that is 'normal,' so that is why i didn't call" (i was hoping that perhaps somehow it had gotten filed w/o her seeing it by someone else at the office - but no, she knew and chose not to tell me)... but IF i had known about the few cells, i would have had follow ups. BLEH. i was so mad at her i switched midwives! My new ones (midwives) are incredible! :)

Good luck in Med school!

[inanna.livejournal.com]

so... aside from draping you in velvet... :-)

What's wrong with the velvet idea???? :D

Re: The bad and the good

[graeviking.livejournal.com]

So what did the $%^%^&-hole do after you had an allergic reaction right in front of his eyes? I just have to hear the rest of this story! You could have had a major lawsuit there...

[humaazul.livejournal.com]

that does sound like an awful gyn. i'm sorry. i would like to point out that abortions are fairly complicated procedures. being pro-choice doesn't instil the knowledge of how to do one. there are very few doctors who know how. i agree that it sounds horrible, but that part might not have been her fault.

[humaazul.livejournal.com]

i want to be a gyn too! i'm finishing my ba in may, but i have to go back to school for my pre-med stuff. any advice?

don't forget....

[sulingsi.livejournal.com]

insurance is the evil behind lots of bad things in medicine.

gynecologists already have some of the most serious problems of any field with being taken to court for malpractice. that is why they do things that may seem extreme to patients who don't know the extent of the millions of dollars a practice has to pay for malpractice insurance every year. this is why they don't want to risk doing a tubal ligation on someone with no kids, and ending up getting dragged to court because "but she didn't tell me it was really truly irreversible!" or not doing a sonogram and then "but it wasn't a cyst, and my doctor didn't take the proper measures to save me!" :-) not saying you're that type, but they have to be careful.

[iris-opal.livejournal.com]

Congratulations!

I'm in the UK, but to be honest the worst idiots I ever had were female. Not sure about the annual exams - sounds like insurance type stuff and we have the NHS and go to the local Dr unless refered.

Suggestions: First internal exam - explain what you do before you do it (say that it may be uncomfortable, state what you are doing while you do it (asking if it is uncomfortable), then ask if there are any questions.

Warm Speculums - or at least warn of a cold one!

My first smear was done by a female nurse at a Family Planning Clinic - she was rude, ORDERED me to relax and told me to stop fussing when I was in actual tears. Never went back.
Next few were done by the nurse at the local Dr - she had me curl up on my side, with my knees up -more difficult for her but she got a coperative happy pt :)

I did go to a Gyne when I was about 14, Irregular periods and mum was worried (regular from day 1) - She asked if I was sexually active - OK question, but Mum was next to me....
Guess my answer!

(it was the truth, but still!)

[krasota.livejournal.com]

Let's see.

I like talk-throughs. It's nice when the practitioner doing the exam and such talks about each step and asks if everything's okay.

I have latex allergies and I've had some really STUPID practitioners inflict horrible reactions because they didn't listen or don't believe in latex allergies. Listen, folks, I can DIE from contact with NR latex. Don't put it anywhere NEAR me. Don't put on latex gloves under the non-latex. It's NOT safe. Don't leave me stuck in stirrups in a room where you happen to store all the extra boxes of latex gloves in closed cabinets and then wonder why I'm covered in hives and not breathing so well when you walk in. Don't blame me when I'm scared because I have no clue why I'm having an anaphylactic reaction--I don't open your cabinets to check and see because I don't know if the *surface* is safe for me to touch. Actually, a latex-free practice would be divine and much safer for people like me.

Stay up to date on all the latest news and equipment. I bled and cramped (for days) after pap smears for the first few years. Last year, I mentioned it to my doctor (she wanted to know why I'd not had an exam in the previous year and I explained that the gyno she referred me to refused to believe in my latex allergy, didn't do the requested diagnostic procedures for ovarian cysts, etc) and she ran from the room and came back with a different brush. I've never been pregnant, so I have a super tender cervix. They now make super soft brushes and I didn't bleed or cramp at all this time.

Cloth gowns instead of paper. I'm not modest by any standards, but the paper sheets and vests are just inconvenient. Cloth gowns are so much nicer, comfortable, and warmer.

Talk talk talk. Ask your patient about any fears or apprehensions. Don't assume all women sleep with men. Don't assume we don't. Don't assume we're lying about using protection nor about how many partners we have. Don't assume we're all monogamous, don't condemn those of us who aren't. Provide open, honest communication and you'll be a favorite of mine. ;)

[sulingsi.livejournal.com]

my advice: don't stress too much. try to get good grades, but you don't need to live at the library like i've seen some people do to get into med school. make sure you are seriously committed to some good extracurricular activities as well because they want well-rounded people.

[puttysan.livejournal.com]

My first doctor was my mom's gyno. My mother loved her brisk, no nonsense bedisde manner. However, it was completely horrible for a terrified 17 year old. She left me dressed in paper for 45 minutes, alone and crying. Got pissed at me for being scared. Was very rough with me. It was a horrible experience.

Luckily, my next (and current) doc was much better. She talked to me clothed first, just to discuss any concerns I might have. She joked with me through the entire thing. And she even kept a box of tissues right next to the bedside, for those like me who still get tears in our eyes.

One other thing that bothers me, though I don't know if you'll have any control: Don't let the business end of the table face the door. I wouldn't care about a nurse popping her head in, but a lot of time there are male reps from drug companies at the desk, and I certainly don't want them seeing me in that position. My doc now has the table in a large room, and facing away from the door, so anyone opening would see the top of my head and my sheet covered legs. Makes a big difference.

[sulingsi.livejournal.com]

thank you guys, this is all very useful stuff. i think some doctors start out with the best of intentions, then have trouble maintaining the level of awareness throughout their career. i just hope i can keep you all in mind whenever i start getting worn down or desensitized. :-)

[dodogrrl.livejournal.com]

no, actually she was kinda smug about it.

[emmeangel.livejournal.com]

be nice to the young first timers. i'm deathly afraid of going, and when it even gets MENTIONED i start to cry and go on the defense (cross my legs tight). also, keep the "business end" as someone else said away from the door. it makes it uncomfortable for first timers. hell, we don't want you seeing anything down there anyways, and to have everyone else see it is even worse. oh, and make "getting to know you/ get comfortable with it" appointments with her before you actually do an exam... it's very overwhelming to get to know you 5 minutes before you poke around down where i don't want you to be in the first place. i haven't even BEEN and i get super scared talking about it. i don't want anyone (except a certian someone) looking down there and poking around.

that's just my 2 cents.

[herbalgirl.livejournal.com]

This probably sounds obvious, but be thorough in testing. Don't just brush off symptoms with no blood tests. Twice in 4 years I went to this gyno with very obvious symptoms of a hormonal imbalance (irregular periods, weight gain around the tummy, joint and muscle pains, dizziness, and low sex drive and infertility on the second visit) and he didn't even do blood tests. Fortunately, my awesome new GP caught the hypothyroidism and I'm getting better now. But please don't ever tell anyone "you're just supposed to feel like that. Some people are just abnormal"!