Re: humiliation of pelvic exam
From: AMD (anonymous@obgyn.net)
Mon, 19 Jun 2000 01:12:59 -0500 (CDT)
Unfortunately, it seems that many practices have developed their
"routines" based more on efficiency than patient comfort. It is simply
just more efficient to have the patient disrobe after the nurse has done
the weight/history/blood pressure routine so that the doctor only has to
visit the patient once. I've been to many different doctors over the
years and I have never been offered the opportunity to meet the doctor
and review my history/concerns before disrobing. I have done it once,
but at my request. Sometimes, it is difficult to not feel that this is
a deliberate attempt to make the patient uncomfortable and speed up the
visit.
Probably the most humiliating experience I have had was at the student
health clinic in college. I had been there a couple times before to see
a female NP and her routine was to just have me strip from the waist
down, but unhook my bra so she could examine my breasts. I was seeing a
different NP for this visit and it was the first time seeing a male for
my annual exam, so I was very nervous. I did as I had before, and the
nurse came in and informed me I had to remove my shirt and bra, but they
had no vests or capes. So the only thing I had to cover me was that
stupid paper sheet. The male NP was very kind and as sensitive as can
be, but the set up just sucked.
It would be nice if a less awkward means could be found to get the same
information....
Andrea
At Sun, 18 Jun 2000, D. Ashley Hill, MD wrote:
>
>Some thoughts on this subject:
>
>The overwhelming majority of the patients ny 5 partners and I see seem
>to sail through pelvic exams, even when they have discomfort due to an
>illness. Why? Perhaps we are seeing a skewed population, as these women
>are obviously coming in for exams. Maybe those who feel
>degraded/humiliated by exams just don't visit the doctor very often. On
>the other hand, perhaps it is our patient population of mostly
>middle-income, insured Floridians. Maybe in other areas or other
>patient populations there are more issues regarding exams. We certainly
>see women who struggle through exams, just not very often (and, yes, we
>are aware of those women who have issues with exams and try to identify
>and help them).
>
>In my experience emotional discomfort during routine pelvic exams is
>often cultural or religious. Women from some European countries have
>fewer issues with nudity than in our country. Pelvic exams, which
>involve partial nudity, don't seem to bother them. However, certain
>religious groups have gender and/or nudity issues that make exams
>difficult.
>
>No gynecologist wants his or her patient to be uncomfortable during an
>exam. Talking with new patients first, when they are fully clothed, and
>explaining the sequence of the exam is usually very helpful. Validating
>a patient's angst about an upcoming exam should also help. And, of
>course, being as gentle as possible, and letting the patient know that
>at any time you will stop if she feels uncomfortable, will all help. It
>is also up to the patient to make an effort to recognize that this is
>something the doctor does approximately 5000 times a year, that this is
>an important part of disease treatment of prevention, and that
>(seriously) life is full of unpleasant experiences that are necessary
>and important.
>
>Finally, home Pap smears are a bad idea. No offense to anyone, but why
>does it take 12 years after high school to become a practicing
>gynecologist? A careful pelvic exam involves looking for sometimes
>subtle clues to various diseases, including vulvar, vaginal or cervical
>cancer, and a variety of other problems. Studies have shown that
>patients do a terrible job of appropriately diagnosing even yeast
>infections (they get it wrong about 60% of the time). If that's the
>case, why trust yourself to self-diagnose cancer? There are a lot of
>jobs I would never try to do myself, including being my own lawyer, home
>builder, pilot, brake repair person, or doctor.
>
>Best wishes,
>
>--
>David Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>http://home.mpinet.net/dahmd
>
>My apologies, but due to time constraints I am unable to answer private e-mails.
>
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