Help a survivor figure out how to get medical care.

April 19, 2011 9:12 PM

How do sexual abuse survivors handle getting long-term medical care?

First let me say this: I am in therapy. (I do not yet know if my therapist is a good fit for me, but I am going faithfully to therapy every week and trying to work on this.)

I have a major fear of doctors, stemming partially from childhood sexual abuse and partially from a totally horrific experience with a gynecologist. I don't care that getting medical care is "not a big deal" to most people. It's a big deal to me. I freak out if I have to go to urgent care for something minor. Navigating the waters of the creepy-whispery "well, do you think you're pregnant?" questions leaves me with weeks of nightmares.

And as I said, I'm working on it in therapy. But are there doctors who specialize in this sort of thing? Do run-of-the-mill medical staff get any kind of training in the idea that rolling your eyes at a frightened patient isn't really okay? I'm going to scream if one more person tells me that I should just find a doctor I like, but I don't know how to do that, for one thing, and for another, I'm not in any kind of head-space that allows for anything other than near-emergency medical attention. Most practices require a physical first, the very idea of which makes me want to return to old patterns of self-injury.

Is there a particular kind of doctor I should be looking for? Someone with a particular background or training? How do I do this?

Throwaway email: [e-mail]

posted by anonymous to Health & Fitness (20 answers total)

How about asking a friend to "screen" doctors for you? There is an organization called Project Prepare, just one intervention toward the goal of "how to make [pelvic exams] not suck," in the words of one trainer.

Friends can offer to call up and see what sort of training a doctor has, and maybe if you're in an area where people get this type of training, you could get a friend to ask potential doctors, "What sort of training do you have?" / "Do you have Project Prepare training?" That way, they can serve as a buffer, so you're not calling five different people who actually know not to be jerkfaces about people's concerns around pelvic exams, including people who are transgender and need pelvic exams, to a host of other reasons. Referrals from trusted people is also an option.

I hope this is helpful.
posted by simulacra at 9:26 PM on April 19, 2011 [1 favorite]

Start asking around. Call rape crisis and ask if there are any physicians who are particularly sensitive. Call some offices --- or ask a friend to --- and ask the scheduler if she can recommend someone sensitive to issues of sexual abuse. If she hesitates, move on. When you find someone who doesn't hesitate to make a recommendation, ask her to write it in your chart or somehow give a heads up or reminder that you have anxiety about the visit due to childhood trauma.

And then consider that your first visit can just be talking--no touching. You can discuss what an exam could look like, how it would normally go, and what kind of changes you need to feel comfortable (#1-- no eye rolling please.)

Unfortunately, there's no way to get what you need without asking for it. The good news is, there are docs out there who want to be responsive to what you need...some of them are survivors themselves.
posted by vitabellosi at 9:42 PM on April 19, 2011 [1 favorite]

Project Prepare seems to by and large only train people in California, but I can tell you that a version of this training was done at my medical school and probably is done at many others. It uses a female volunteer to teach medical students how to do a pelvic exam gently and with compassion, and I can't imagine that person possibly gets paid enough....

Anyway, even though every med student in my class got this training, I still wouldn't say that every one of them is just as compassionate and caring as the next. It's a personality thing. If you find a doctor who seems like a nice person and who asks your permission before doing anything that makes you uncomfortable, that will probably tell you all you need to know. I suggest asking your friends (or looking online for reviews) about physicians like this.

If looking at a big medical center, all the staff physicians often also have web pages that list their interests and have a little photo of them. You could try browsing these pages for primary care providers who have a listed interest in women's health, sometimes these pages will also list items that are clues to people's personality, like what committees they serve on or what research they have done. Here's an example of a page like this from the University of Minnesota's "Program in Human Sexuality". I also found this list f experts at the Institute of Sexual Medicine.

Of course, if you're making an appointment at an academic practice, just make sure you specify you don't want to be seen by a student, just by the provider herself.
posted by treehorn+bunny at 9:46 PM on April 19, 2011

I've routinely gotten excellent and sensitive care from nurse-midwives (who do routine well-woman care including pap smears, birth control, STD testing, etc.), much more so than from most ob/gyns I've dealt with. I mean, obviously I can't speak for all of them everywhere (you don't say where you are), but I do think your chances are better with CNMs that they'll be open-minded, gentle, accepting, and focused on your comfort and autonomy, at least in taking care of your gynecological medical needs; and can probably recommend good doctors that they trust as well if you are looking for a general practitioner.
posted by flex at 9:46 PM on April 19, 2011 [5 favorites]

Seconding nurse-midwives; also consider seeing a nurse practitioner at an OB-GYN practice.
posted by scody at 9:53 PM on April 19, 2011 [3 favorites]

CNMs are a subset of APRNs, who may or may not be able to independently practice depending on your state, and who may or may not do well-woman care. I have friends who are Women's Health APRNs who do everything-but-OB women's health, although some are more gyn-focused than others. A FNP or ANP (family or adult nurse practitioner) are other 'generalist' subsets.

You will, of course, have to screen any practitioner, but some of the training emphases are different coming from a nursing model perspective versus a med-school perspective.

This doesn't mean all APRNs are nursing-model-type people (I'm not, I'd be a crappy GP, which is why I'm doing a hospital specialty course) but you may have a better chance looking in that subset.
posted by cobaltnine at 9:57 PM on April 19, 2011

What about getting a friend to go in with you? Having someone you trust can be really useful and might help break the tension of the questions.

Two side benefits:
1) having a friend come signals to the doctor that you are really freaked out, and to be sensitive.
2) doctors that aren't ok with it probably won't be a good fit.
posted by mercredi at 9:59 PM on April 19, 2011

Nthing a nurse practitioner over an ob/gyn -- nothing against the latter, but the perspective on care is quite different. I don't have any history of abuse, but I did have a bad initial experience with gyn care, and I felt much more comfortable in women's clinics (Planned Parenthood or local private clinics) because I knew that the staff would be prepared to handle anything.
posted by desuetude at 10:35 PM on April 19, 2011 [2 favorites]

I had a very good experience at my local Planned Parenthood. My practitioner was an ob/gyn, and she did a great job explaining what she was going to do, and put me at ease. The practitioners at Planned Parenthood and at centers for LGBT populations tend to have great bedside manners, and are specially trained to work with patients who have experienced trauma or abuse.
posted by ladypants at 10:46 PM on April 19, 2011 [6 favorites]

(If you update with your location, maybe someone will have a specific suggestion?)

I saw a CNM practice during my pregnancy, and it was one of the only medical experiences I've ever had where I felt treated completely like an adult. I don't grapple with the kind of anxiety you do, but I don't really dig going to the doctor, either - mostly because I hate being treated like a moron, and find it difficult to speak up for myself when people are touching me.

I had a really good experience with the CNMs. I know the ones I saw also do routine well-woman care, which wouldn't help you if you have a sore throat, but would be useful to get an annual pelvic exam that would be gentle and respectful and with women you could totally say "I have a ton of anxiety about this" to without them being weird about it.

And as flex mentions above, they tend to have the hookup for other kinds of specialists who might be a good fit for their clientele. (Potential downside is that some of the people they refer you to might be on the crunchier side of things, but that's probably easier to screen for than someone who has lousy bedside manner.)

Good for you for trying to find care that's a good fit for you!
posted by thehmsbeagle at 11:00 PM on April 19, 2011

Another thought--a practice/clinic that works with transgender folks is likely to be fairly sensitive to people's discomfort with the whole business. Not that all FTM folks are freaked out by pap smears and gynological care, but I'd imagine some are, and doctors who work with them are much more likely to be sensitive to these and related issues.

The best pap I ever had was from Lyon Martin.
posted by mollymayhem at 11:06 PM on April 19, 2011

I'm from Australia so YMMV, but I got almost all of my gynaecological care from sexual health and family planning centres, and I had nothing but great experiences, and I found the culture at the clinics I visited (in two cities) incredibly open and understanding.

I totally agree that it takes time to find a medical practitioner you like, so I suggest seeking out a doctor/nurse practitioner at a practice like Family Planning in the US, requesting a longer appointment if available, then having a long discussion about your concerns. Write them down before you go there, so you don't get flustered. If the practitioner doesn't take your concerns seriously walk out.

Re-reading your question, it sounds like you're mostly looking for a general practitioner, and I think the same approach applies. Ask people for recommendations, take a friend, work on a game plan, and if they don't take you seriously, leave.
posted by nerdfish at 11:23 PM on April 19, 2011

Oh! And the best GP I ever had worked at a practice catering to the LGBT community, specifically providing care for people with AIDS. They still saw str8 girls like me with endless skin cancers (yep, Australian). I'm also really confused as to why a GP would want to do a physical on a new patient - I just walked into any old clinic when I had a problem before I found my good GP. The US healthcare system confuses me so.
posted by nerdfish at 11:26 PM on April 19, 2011

Seconding doctors whose practices cater to the LGBT community. In NYC we've got Callen Lorde Community Health Center, which is a fantastic resource; there seems to be a higher level of sensitivity toward patients there than at the average GP's office.
posted by brina at 11:53 PM on April 19, 2011 [1 favorite]

You might also be able to find a practitioner who is trained as a SANE (sexual assault nurse examiner) that would be completely empathetic to your feelings and would be extra gentle. SANEs are really good at putting patients at ease, explaining procedures sensitively before they do them etc. Might be a place for you to start.
posted by Saminal at 12:40 AM on April 20, 2011 [1 favorite]

Medicine practiced in the USA tends to be very defensive so if a doctor wants to take you on as a patient they will nearly always do a physical to have a baseline that they can attest to. (This is the info I'm getting from talking to US surgeons at various conferences)

I really feel for you, as the victim of serious sexual violence at 13 I was left with some real pain and scarring issues and my first pap smear was horrific but only because I didn't feel able to tell the nurse beforehand. Now I simply write a note in advance to any doctor who needs to know and ask them to please refer me to the person in their practice best suited to deal with me. I include some specific pertinent detail about what not to do. I have not been disappointed but I don't have the fear you have. (HUG)

I'm wondering if the kind of CBT that helps needle phobics might be a good idea, have you spoken to your therapist about the actual fear. Fear like this could kill you if you avoid going to the doctor and something chronic is not dealt with so please do try to find someone to work with you on the fear itself.
posted by Wilder at 4:52 AM on April 20, 2011

Honestly, I don't think that finding a good practitioner is enough: you need to get to the point where you are willing to go see the practitioner. And you have to build a relationship with the doctor/nurse, so that you have a level of trust and you're willing to go see him/her.

If you're triggered by going to the doctor, then you are in such a frightened and panicked state that you can't advocate for yourself very effectively. That can make the whole experience retraumatizing. The best thing you can do is figure out how to feel safe, protected, and nurtured while going to the doctor.

I came to say what mercredi already mentioned: you need a patient advocate. Your advocate should be with you the whole time during the visit, and can help with talking to the doctors and nurses. Your advocate could be a partner, friend you trust, or maybe could even be a therapist. (Perhaps there are even professional patient advocates? I don't know.) You could make a plan with your advocate beforehand: exactly what do you want to happen? What information do you want to make sure the doctor knows? The advocate will write this information down and be responsible for making sure the doctor gets it. What are your boundaries - what procedures are you willing/not willing to do on this visit? Your advocate helps you stick to your boundaries if the doctor pressures you. Your advocate also helps you figure out what you think of the experience afterward - were you just scared and freaking out or was that doctor a total asshole?

I would also suggest that you take this very, very slowly. Test out a doctor. Tell them when you call that you'll come in for a physical, but you mistrust doctors and you're not willing to have any blood tests or a gynecological exam (or whatever else really triggers you) on the first visit. Maybe even tell them that on the first visit you only want to talk to the doctor and not have a physical exam/be touched at all. Your advocate will help enforce your limits. Tell the doctor upfront that you're an abuse survivor and scared of the medical system. A good doctor will not blink at this - it's incredibly common.

You can do this. It's very difficult, but you can take it slowly. Please make your top priority to make the experience safe - the more going to the doctor is traumatic, the less you'll want to do it. Take it slow. You have lots of time, and you can figure it out.
posted by medusa at 5:47 AM on April 20, 2011 [4 favorites]

2nding a SANE nurse. Your local police department can refer you to one (because they know SANES to deal with rape cases).
posted by WeekendJen at 11:28 AM on April 20, 2011

Most people don't realize that midwives offer routine care to women who are not pregnant or even don't ever plan to be. There are 2 kinds of midwives - ballsy aggressive types and earth-mother nurturing types. You need an earth-mother type midwife. So the only way to find one would be to call a local Le Leche League group (breastfeeding support). And say something like "I'm looking for a midwife (you don't have to explain why) and that you are shy and ask them if they know any midwives in the area that work especially with shy women." Or you can say "works with sexual abuse survivors" if you feel comfortable saying that. Sexual abuse is often a subject of conversation at Le Leche League meetings. So I doubt if the person you talk to will sound surprised.

Then when you go to any appointment never plan to take your clothes off on the first meeting. Or get any kind of touching. You can say you want to make a five minute appointment to meet the person. Most places will let you do this for free. But it really takes the edge off in meeting a new Dr if you are sure you won't be taking your clothes off at the same exact time you are meeting the person the first time. And if ANYTHING bothers you about the first meeting. Get up and walk out. And slam the door. I have done that. (I was treated rudely) If I can do that you can do that.

Yes, bring someone with you if at all possible.

And if you can't find a midwife (1st choice) a family planning clinic is always a good bet. I have always had good experiences there. By going into a family planning clinic you get immediate respect from the staff because the nurses there think "this is someone who is taking care of themselves and cares about others (because they care about overpopulation)". Compared to a regular doctor's office where the staff oftens treats people like "What are you doing here? Is this really necessary - we are busy!" [Sorry for the slight, medical people - I'm just trying to point out a nuance that may make a difference in getting someone to get medical care from somewhere rather than not at all.]

One other thing you can do is take REALLY good care of yourself. Don't eat junk food or smoke or anything else that would make you have to go to a doctor more than you absolutely have to. I actually know someone that uses this method to deal with severe paranoia about doctors!

Have you called a rape crisis center and asked them what they suggest?

Good luck - you can do this!
posted by cda at 11:34 AM on April 20, 2011 [1 favorite]

Xanax- get a scrip and take it before appointments that are potentially stressful. Your therapist can help facilitate.
posted by crazycanuck at 10:05 PM on April 20, 2011