Did this doctor cross the line?

October 31, 2009 12:03 AM

Was this doctor a creep for suggesting a gynecological examination, or am I overreacting?

A few months back when I was trying to conceive, I took a home pregnancy test that was vaguely positive about 2 weeks after ovulation. I started bleeding the following day. I rushed to the medical centre and got an immediate appointment with a random male GP (not an Ob/Gyn) whom I had never dealt with before. I semi-frantically asked him if there was any way to "save" the pregnancy. We did another ultra sensitive urine test which came back negative. Then he said quite intently and convincingly that he would like to do a gynecological examination on me, right there and then in his office. I declined, because he made me uncomfortable with his general creepiness. He pushed it, and tried to convince me that it was the best way to "make sure". I bolted out of there and never looked back.

Having read up on the topic, I realise that I had what's called a very early miscarriage, which is unavoidable and most often due to a genetic/developmental error in the fertilised egg. Surely he would have known this.

My question is: In this situation, would there have been anything at all to gain from him "having a look"? He would be able to see the bottom of the cervix, and what good would that have done? Am I missing something here? Is this normal practice, or did he attempt to take advantage of a young woman in distress?

I'm generally not suspicious of doctors or other professionals, and I'm not much of a complainer. This one just gave me an icky gut feeling, and I'd love some MeFi insight.

posted by heytch to health & fitness (22 comments total)

I'm not knowledgeable enough to say whether he crossed the line or not, but you certainly don't need to justify this to anyone but yourself. Stop worrying about the choice you made- it's your body and if you are uncomfortable with a medical professional's manner it is entirely within your right to seek alternative care.
posted by Syllables at 12:20 AM on October 31

Your most important thing in keeping you safe is your git. Listen to it.
posted by Ironmouth at 12:24 AM on October 31

After a miscarriage, there are a couple of different ways that a physician might use to provide a confirmation of miscarriage. This includes pelvic exams, as cervical dilation can help a doctor know whether or not there is an impending miscarriage. If this was his intent, then he was probably not attempting to take advantage of you... maybe it was just in his delivery?
posted by honeybee413 at 12:26 AM on October 31

Yes, and it's the reason I do pelvic exams daily on "pregnant vaginal bleeders" even though I'd much rather not do them:
1) to make sure you're not having heavy vaginal bleeding;
2) to see if there's any products of conception or blood clots poking out of your external os that he can pull out;
3) to do a bimanual exam to see if your os is open or closed.

Mainly #3. If your os is closed but you're having bleeding (and your pregnancy test was still positive) you're maybe having a threatened abortion. If it's open, you're having a miscarriage. If it's closed and your pregnancy test is negative and used to be positive, you might have had a missed abortion, which needs surgical removal of the products of conception.

(Often women think they "just" became pregnant, when they're actually 6 or 8 weeks when I do an ultrasound on them.)
posted by gramcracker at 12:29 AM on October 31 [3 favorites]

Gramcracker, thanks for sharing your first hand expertise. I realise I may have been quick to judge this doctor. While I won't see this GP again due to interpersonal chemistry, I will rest assured that he didn't attempt to do the wrong thing to me and others in my position.
posted by heytch at 12:41 AM on October 31

If you're trying to conceive you're going to have to get used to doctors wanting to "take a look" down there. That said - if this particular doctor made you uncomfortable you absolutely have the right to decline and say you'd prefer to make an appointment with your regular doctor or ob/gyn. IMO it was totally wrong of him to push the issue.

Some doctors are creepy and make me very uncomfortable, particularly male doctors and what I think it is, is its their overcompensating attempts to seem gentle and caring that just really comes off as creepy, things like their touch being a little too tender/soft and gentle.
posted by missmagenta at 1:16 AM on October 31

I think this doctor was just trying to do his job out of genuine medical concern for you. Here's the thing: many guys aren't naturally sensitive or able to empathize with women, and when their job requires them to "be sensitive" they try their best to act that way but can't pull it off completely. Sometimes it comes across as "creepiness"...perhaps it would be been better for him to just act naturally, i.e. like a cold hearted sonofabitch, instead of trying to be nice to you.

If this is the case, then I can totally relate to this doctor's predicament. I (a male) work as a children's ski instructor, which is no piece of cake. In my first year on the my job I would try to console and soothe crying kids. I learned the hard way not to do this -- it's much better for the parents to mistake me for an asshole than a child-molester.
posted by randomstriker at 1:42 AM on October 31

IMO it was totally wrong of him to push the issue

You can criticize the doctor's lack of bedside manner all you want, but are you sure it's "wrong of him to push the issue" on diagnostic medicine? It seems from what gramcracker said that there are some important things a pelvic exam could've revealed. Why would pushing the issue be wrong if the doctor felt it was the most likely way to have the best outcome?
posted by TungstenChef at 2:01 AM on October 31 [3 favorites]

You can criticize the doctor's lack of bedside manner all you want, but are you sure it's "wrong of him to push the issue" on diagnostic medicine?

"No means no" applies to doctors too. The OP wasn't comfortable being examined by this doctor, he should have explained the reasons for the examination - as gramcracker did here - and then let her make her own informed decision.
posted by missmagenta at 2:17 AM on October 31 [4 favorites]

The doctor thought you needed the examination, and there seem to have been good reasons for it - but the professional thing for him to have done when you got edgy would have been to say "I can see you're uncomfortable, would you like me to find a female colleague who can give you the examination?". OP, if you find yourself in that sort of situation again ask to see another doctor - you can give reasons like wanting to be examined by a woman, or someone you already know. A good doctor won't mind.

As other posters have said, he may not have been a creep, but had been taught to be 'nice' in a way that wasn't natural to him and so made him look like a creep.
posted by Coobeastie at 3:25 AM on October 31

Missmagenta, that's a very good point. I would indeed have considered (and probably happily gone through with) the examination if he had explained the reasons to me like Gramcracker did. Instead I got the "just because" and uncomfortable vibe - loud alarm bells, get me outta here.
posted by heytch at 3:28 AM on October 31

I agree with everyone above who says 1) that wanting a looksee after an apparent miscarriage is very common and within the realm of best practices. (I've had two early miscarriages, and I believe both times I had a gyn exam. And 2) If you weren't comfortable with it or didn't want to do it at that time with that doctor, you have every right to say no.

But also 3) keep and eye on yourself and if you are trying to conceive, find yourself a gyn you are comfortable with and let him/her take a look just to make sure all is ok.
posted by Bueller at 6:12 AM on October 31

Lots of doctors seem to assume that you don't want or need to know the whys and wherefores; I've seen doctors that didn't want to tell me what they thought I had, how certain they were about it, or what the treatment options were; just that I should take the offered prescription and leave.

In addition, they are often in a big hurry, since their appointments are lined up back to back through the day and they may already be running late. This means that they can't spend time getting to know you or making you comfortable; their goal is to get through the appointment as efficiently as possible.

Obviously this can be discomforting at the best of times, and even more so when it's a gynecological issue. But maybe you can see why from the doc's point of view, "I NEED TO LOOK UP YOUR FANNY RIGHT NOW" is just another part of his day to day "let's fix things as quickly as possible", even while to you (and probably most other women) it's creepy and disturbing.

I've generally found that female doctors and specialists in "problems down there" are much more aware of how to be sensitive and explain what's going on.
posted by emilyw at 6:48 AM on October 31 [2 favorites]

He can be right AND creepy, of course. I don't see why he couldn't just explain what he needed to do instead of trying to push the issue when you were obviously upset.

Good for you for listening to your gut, and I hope everything goes well for you.
posted by kathrineg at 7:07 AM on October 31

Just another thing: it isn't strange for an internist to conduct a pelvic exam, this isn't something strictly within a GYN doc's purview. I get my annual pelvic exam from my (internist) PCP. (Which doesn't address the fact that you were uncomfortable, but does address a possible "internists doing pelvic exams is weird" idea you may have.)
posted by teragram at 9:56 AM on October 31

Male family doc (who does a lot of obstetrics) here. A pelvic examination is pretty mandatory with first trimester bleeding. Some doctor might argue that "the pregnancy test was negative, so I didn't need to worry about anything" but this is very early pregnancy and a urine test isn't super reliable. You said you specifically asked the doctor if the pregnancy can be saved and the *only* way to answer this question is with a pelvic examination -- if the cervix is dilated or there is tissue at the cervix the answer is 100% unequivocally no. If there is no pelvic examination, any advice is simply a guess.

The other thing here is that there are any number of other things that can cause early pregnancy bleeding and one of them is life-threatening: ectopic pregnancy. A tender mass in one of the fallopian tubes would mandate some emergency steps to save your life and the best way to pick this up initially is on a pelvic examination.

The standard of care here in the U.S. would be a pelvic examination and if everything looked ok and no definite miscarriage identified, you would then do a serum betaHCG and probably repeat in 48 hours. If I had perceived that the woman was uncomfortable with me doing the examination, you bet I'd get a female colleague to do it and I wouldn't feel bad about it in the least. Patients have a right to have an opinion about who touches their parts.

I certainly sympathize with being creeped out by a male doctor whom you've just met, but if the entire basis of your discomfort is him asking to do a pelvic exam, then I think you're a bit out of line here. You've not told us anything specific about whether he said something inappropriate or that he treated you disrespectfully. Of course being creeped out could be based on a bunch of intangibles and you certainly have a right to decline anything, or request a female provider, but "bolting out of there and never looking back" and then posting about the experience on a random internet forum seems a bit irrational.

By the way, are you still bleeding? Do you have any pelvic pain? Do you still need to get that exam?
posted by Slarty Bartfast at 10:19 AM on October 31 [5 favorites]

When you say he "pushed it and said it was the only way to make sure," do you mean he explained to you that it was necessary and, briefly, why?

In further defense of the doctor, I think it's unfair to say that he should have given an explanation like gramcracker's. Many women would not want to hear about the "products of conception and blood clots poking out" when they've just experienced a miscarriage. If a doctor were that graphic in an office setting, he'd be criticized as insensitive.

He probably would have been happy to let a colleague perform the examination, if he'd had any idea that's what you were upset about.
posted by palliser at 1:25 PM on October 31

And -- this is going to sound insincere after I was just critical, but I do mean it -- I'm sorry about your miscarriage, and I hope any continued efforts are successful.
posted by palliser at 1:28 PM on October 31

"No means no" applies to doctors too.

Hello?? The phrase "No means no" is usually applied to the context of sexual assault, i.e. where the woman protests but the man ignores her and physically forces himself upon her.

Unless the OPP is leaving out some major details, nothing even remotely resembling that occurred here. All he did was try to change her mind for what in retrospect it seems are for very sound medical reasons, albeit not very tactfully.

Please, let's not conflate a ham-handed bedside manner with assault.
posted by randomstriker at 2:42 PM on October 31 [2 favorites]

I think that it seems pretty safe for a doctor to assume that a patient who comes in with a suspected miscarriage is going to be ok with the idea that the doctor may want to see or touch her naughty bits, and not to be prepared for presenting the medical evidence for such an examination being worthwhile (especially to someone who is 'semi-frantic'). I (Not a Doctor) would also assume that the patient is aware that the visit is likely to involve this and so would not think that they might like most of the visit to be with a different doctor.
posted by jacalata at 6:16 PM on October 31

Yes, a pelvic exam is to be expected, but that doesn't make it wanted or comfortable. As ladies, we deal with unwanted touching and sexual advances from men frequent enough that it creeps into even the most non-sexual things as medical exams. The asker is not wrong for feeling uncomfortable, and neither is any woman who has a man she doesn't know recommending he touch her genitals, even if he is a doctor. I don't think this doctor had any bad intentions, but I do feel that the bedside manner of a good doctor who met resistance in this situation, if he really felt the exam was important or necessary, would be to offer a female doctor or a transfer to an OB/GYN specialist. A good doctor, and I'm not one, but I have opinions on these things, especially one dealing with immediate public, should be intuitive to possible race, ethnic, and gender issues. At least an explanation of the reasons for the test might make you feel more comfortable. I think you were in the right to refuse the test, as long as you saw your own doctor shortly after. Know that should this happen again, and I hope it doesn't, you have the right to ask for a female doctor/gyno, and a doctor who intended the test for actual diagnoses would happily find you one.
posted by itsonreserve at 11:01 PM on October 31 [1 favorite]

There are a ton of reasons for you to feel threatened or creeped, but that doesn't mean he was doing anything wrong medically. This was a new doctor who wanted to look under the hood during a possible miscarriage. Perhaps you've never had an exam while bleeding or you were worried it would be painful or worried that his poking around would make a miscarriage more likely. Maybe you would have been more comfortable with a random male GYN than a random male GP.

It sounds as though he could have been a bit more empathetic, but he was on the correct course to protect your health.

I'm sorry for your loss. If you haven't been to your regular GYN since, I encourage you to go now for some follow up care.
posted by 26.2 at 1:10 AM on November 1