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November 11, 2012 4:25 AM   Subscribe

Metafilter, what is your biggest gripe about visiting your OB-GYN? [Attempting to educate doctors as to what it's like]

I am doing some general research on systems engineering in healthcare and I would greatly appreciate any personal stories you have or general suggestions as to what you particularly hate, despise, or merely dislike about your women's health visits. I'm trying to get a feel for the human side of the equation.

Naturally I would think cold rooms, cold equipment, awkward chatting, long waiting times alone and less-than-gentle treatment would be at the top of the list but I thought I would ask and see what else came up, since I really have no idea at all.

General gripes about the miserable state of healthcare in the USA are not unwelcome but are not really the focus of this question.

Thank you for your time.
posted by hobo gitano de queretaro to Health & Fitness (140 answers total) 20 users marked this as a favorite
 
My OB's office never calls me back. They'll say they will and then they don't. Really annoying.
posted by ThePinkSuperhero at 4:28 AM on November 11, 2012 [3 favorites]


Well I hate the part when they stick what a friend refers to as a "miniature car jack" up my vagina and then scrape my cervix with a little brush. But there's not much getting out of that, is there.

Speaking of the miniature car jacks though, my gyno in the US always used a metal one but was nice enough to run it under warm water before inserting it. Then I find out recently there are PLASTIC ones out there? Why doesn't everyone use plastic?! No more cold metal! No more metallic SOUNDS as they screw it open! I want plastic!
posted by olinerd at 4:40 AM on November 11, 2012 [8 favorites]


My gynecologist has a healthy OB practice. I am not part of that practice. The front desk staff don't seem to believe that. It is especially grating when being seen about potentially fertility-limiting issues to be asked how many weeks along I am. (Zero. Zero many weeks. Negative weeks? Not pregnant. Swear. Y'all can check and that's just fine.)

And yes, awkward chatting during the exam itself doesn't need to happen.
posted by RainyJay at 4:43 AM on November 11, 2012 [6 favorites]


- Waiting a long time alone after you're already naked with your paper blanket. (I don't get that bugged about waiting at other times, though.)

- Not getting enough time to just talk with the doctor. I recently switched obgyns, and with my new one we sat down in his comfortable office before the exam and he went over the medical history I had just filled out with me in a conversational way, talked a little about himself and his practice, and just chatted for a few minutes. I have never had an experience like this at a doctor's before, and now I'm kind of pissed that I didn't.

- Chatting during the exam itself about things not related to the exam. I don't mind the doctor talking about what they're doing and why, but talking about a museum exhibit or something seems weird and forced.
posted by frobozz at 4:48 AM on November 11, 2012 [5 favorites]


From a user who would like to remain anonymous:
Aside from talking to me like I'm an idiot and/or lecturing me that pre-marital sex is bad for me/I "should wait for the ring," the gyn surgeon acting like he has anything to do with billing/insurance filing.

He doesn't and I know it but I believed him anyway when he said not to worry about money, he'd make sure it would be ok. So I was very surprised to hear about the enormous (to me) sums of money his office wants before they'll do the surgery. I am crossing my fingers the surgical center doesn't spring anything on me Monday. Because the surgery is Tuesday.
posted by taz at 4:50 AM on November 11, 2012 [3 favorites]


I once went to an OB practice where you would first sit for a consultation in the doctor's office (desk, family photos, everyone dressed), and then undress and go in to the examination room. I always HATED this -- it's like the doctor and I formed a relationship between human equals in the office, and then suddenly there I am spreadeagled on the table while s/he retained street demeanor. I am much happier when I am examined first and consulted in my street clothes second -- then I feel more like I'm taking my ladybits to the mechanic, and afterward discussing a maintenance schedule.
posted by apparently at 4:56 AM on November 11, 2012 [8 favorites]


If you take my blood pressure five times throughout a visit, even when I've told you repeatedly about my white coat hypertension and when I'm already clearly stressed and unhappy about being at the doctor and when my blood pressure isn't even relevant to the visit, it will only go up. No really, even if you tell me to think of a beach, it is not magically going to drop again. Whereas if you leave it alone and let me build up some level of trust, on one of the later visits you will get a more accurate reading.

It is actually at the point where I am currently avoiding going to the doctor because the whole blood pressure thing is so stressful to me, so some kind of education as to what white coat hypertension is and how to deal with, as well as how to deal with anxious patients in general, would be great.
posted by shelleycat at 4:56 AM on November 11, 2012 [6 favorites]


I second what froboz said: I want to have a face-to-face conversation with the doctor when I am fully clothed. Asking me whether I have any other concerns or questions while I'm wrapped in a paper towel is basically a way to ensure that you don't have to answer other questions. We are essentially required by insurance company policy for our "wellness" visit to be both pelvic exam and everything else, and it would be nice to get to talk about everything else while fully clothed. I honestly don't care that much whether it is before or after (on preview, it seems like some folks do), but I hate it when it doesn't happen at all.
posted by hydropsyche at 5:00 AM on November 11, 2012 [3 favorites]


Ask if they want the rectal exam, don't spring it on the patient right before you do it.
Don't chat with the patient during the exam itself, it is so awkward.
posted by Papagayo at 5:03 AM on November 11, 2012 [2 favorites]


Thanks a lot for the answers so far, if you prefer not to have any information posted publicly but for some reason decide to trust a stranger on the internet, feel free to memail me. I didn't consider that before posting.

To expand a little bit: from my brief experiences in the clinic, as a dude I find the whole process simply horrifying and unimaginable, so when starting this project it was a bit overwhelming to decide on which particular part to focus on improving.

As a sidebar it seemed to me that doctor in this field can get very judgy and paternalistic, for some reason especially the female physicians; when it comes to children, birth control, and STDs.

Although that could just be my imagination. Any thoughts on that?
posted by hobo gitano de queretaro at 5:03 AM on November 11, 2012 [1 favorite]


My GYN is spread so thin that appointments with her or even her RN associate have to be made two to four months on advance. She is regularly so harassed and exasperated when she comes in that I often feel like a burden when I visit for a pap or a specialty consultation.
posted by These Birds of a Feather at 5:07 AM on November 11, 2012 [4 favorites]


I've had consistently great care from my OB-GYNs.

Things that help - talking to me before the exam, being aware of what's painful and trying to work around that where possible, not judging or scolding me for some of the embarrassing / stupid things I admit to.
posted by bunderful at 5:08 AM on November 11, 2012


patient education. What are you going to do, why are you doing it, why is it important? What happens before, during, after. What are your expectations of me as your patient. What should I, as the patient, do in order to make this visit as smooth and stress free as it can be?

Especially if the patient is new to the clinic/office or this is their first OB-GYN appointment.
posted by royalsong at 5:26 AM on November 11, 2012 [6 favorites]


I only have access to an NP for routine visits/exams, which I didn't mind until she insisted, very patronizingly, that there waas no possibility my new hormonal birth control was causing depression or mood symptoms.

Hormonal birth control.

I discontinued it myself, and the symptoms disappeared. When it's time to find another solution, I'll work with someone who's listening to me and into the whole science thing.
posted by availablelight at 5:27 AM on November 11, 2012 [14 favorites]


I select my doctors very carefully and have had some wonderful OB/GYNs. Very caring professionals with pleasant office people. I am more comfortable with a male doctor and the one I have right now is wonderful. He is quite attractive without being sexual, kind of a big brother type. He makes pleasant conversation, is courteous, very polite.
He has a very reassuring touch, he makes a point of placing his full hand on my shoulder or ankle before an examination, to put me at ease.
The main problem that I have with all the doctors that I have gone to over the years is the office. They all have blinds instead of curtains and all the rooms have been on the second floor with windows. I love natural sunlight as much as everyone else and I get that being on the second floor prohibits peepers but I do not enjoy seeing people getting in and out of their cars while I'm naked in a paper gown. It freaks me out a little. I also hate it, passionately hate it, when they have the exam bed angled where your nethers are the first thing someone sees when the door is opened. I have only had one doctor that angled the examination table properly and that doctor didn't have paper gowns. They had real gowns that they laundered. It made a huge difference in my comfort level.
I have never had any OB/GYN act judgmental or paternalistic with me. There are some wonderful doctors out there.
posted by myselfasme at 5:38 AM on November 11, 2012 [4 favorites]


I hate assumptions made about my childbearing plans and .sexual preferences At my old gyn, I also hated that they would not insert IUDs in women who had not been pregnant, so I went shopping for one that would. Bonus,the new doc also knows about reusable menstrual cups, which I had to explain to the old one.
posted by Stacey at 5:39 AM on November 11, 2012 [2 favorites]


As a guy I don't know if my two cents is particularly important, but I will note that when my wife and I were pregnant we went to her OB appointments together and the OB would barely make eye contact with me, let alone speak to me. I understand that my wife was the primary focus of the appointment, of course, but it really off-putting to both of us. My wife was very explicit that I was there with her consent and encouragement, and that we were a team, and the OB couldn't have cared less.
posted by werkzeuger at 5:40 AM on November 11, 2012 [2 favorites]


Be educated about FTM guys. Educate your staff abut FTM guys. We have a horrible track record of getting annuals. That needs to be fixed and it's not just an awareness issue within the FTM community; I've had nurses call me "she" during exams when I very clearly present as male, beard and all. Not cool.

Stuff I think would also apply to cis-women:

I agree on the clothing comments. Also wish I could toss on a shirt after breast exam. I think a lot of doctors really overlook the overwhelming feelings of vulnerability while on that table. Even the smallest of gestures can go a long way to alleviate that.

Not everyone regularly has penetrative sex, for whatever reason, or feels comfortable with penetration outside certain scenarios. Doctors need to be sensitive when a patient complains about when even the non-scrapey parts of the exam hurt or are borderline panic-attack causing. Doctors need to listen to comments about discomfort because, hey, they could help diagnose a fucking problem. Yes, it's pretty obvious the exam will not be comfortable. But if someone is just really tight/shallow down there or is having a psychological block, they should be treated with consideration, not derision. We're told that, during sex, listening to your partner is critical to a good experience. Because it's REALLY fucking easy to hurt someone down there and not everyone is built the same. So, doctors, please listen to us when we say "hey, could you go a little slower, or wow, that really hurt, is that normal, or warn me when x is happening," etc. General comments about sucking it up and how it's bad for everyone makes it really hard for me to not kick you in the face.

Also related: I've had a doctor prescribe a vaginal sonogram when a normal one would do. Not cool - don't hide options, especially when you KNOW one of them causes a hell of a lot more discomfort for me than the other. (In that case, the tech who tried to give me the exam saw I was NOT comfortable and told me about the normal option, bless her. She let me get re-dressed, drink all that water, then come back in. No fuss and no stress. More obgyn people like her, please.)
posted by Wossname at 5:43 AM on November 11, 2012 [26 favorites]


Cold speculums.
posted by loriginedumonde at 5:43 AM on November 11, 2012 [3 favorites]


Although that could just be my imagination. Any thoughts on that?

To expand a little bit: from my brief experiences in the clinic, as a dude I find the whole process simply horrifying and unimaginable, so when starting this project it was a bit overwhelming to decide on which particular part to focus on improving.

I'm sure this is highly variable to each person, but to me it isn't that bad. There are bits of the exam itself which are physically uncomfortable, but they usually only last a few seconds. As I mentioned before, it is also somewhat uncomfortable to be alone in a room naked for more than a few minutes at a time, but this, too, is minor to me. I'm not really self-conscious about nakedness overall, and I don't find the procedure to be demeaning or horrifying or anything. I'll admit that I'm somewhat more hard-boiled about such matters than may be the norm.

As a sidebar it seemed to me that doctor in this field can get very judgy and paternalistic, for some reason especially the female physicians; when it comes to children, birth control, and STDs.


I've heard accounts of doctors being paternalistic and rude about sex, but despite living in two conservative states, having had doctors of both sexes, and having had a bout cervical dysplasia due to HPV, I have never had a doctor be anything other than professional and non-judgmental about this. I have been fortunate in the obgyns I have had.
posted by frobozz at 5:50 AM on November 11, 2012 [1 favorite]


Here are some things that I appreciate, that make the visits better / less awful:
- Meeting and discussing general stuff with doctor before I take off my clothes and am clothed in only a paper sack.
- Making sure that I have time to ask all my questions and not hurrying the conversation.
- Giving a running commentary of what is happening and what I should expect to feel. (Note, some women don't like this, it's pretty personal. But if I was an OB/GYN, I would make a point of asking my patients what they prefer during the actual exam.)
- Recognizing and appreciating that this can be a very difficult and uncomfortable experience for a lot of women, and being compassionate about that fact.

Things I don't like:
- Having to wait 2 months for a regular check up.
- Difficulty talking to the doctor if I have questions after the appointment - my current doctor has a nurse that I can call but she isn't terribly competent.
- Not fully explaining reasons for a particular recommendation. Recently, my OB recommended I go see a specialist and it kind of threw me off balance so I didn't ask as many questions as I normally would've because I was sort of overwhelmed in the moment. She didn't fully explain that recommendation and now I am having trouble getting to speak with her again (see above point).

I've been fortunate that the doctors I've used have been very good - I am very picky about picking my OB/GYN due to the... um delicate nature of the visits. You may want to check out this website, which is a blog that documents some of the more horrible examples of the care that some women receive.
posted by pallas14 at 5:52 AM on November 11, 2012


Top of the list: Zero discretion. Back when I was newly married and on my first disastrous encounter with hormonal birth control, my 95-lb gyn weighed me and announced, WOW, YOU HAVE GAINED WEIGHT in a voice that echoed all the way to the waiting room. It was ten pounds over a stressful three months, but that was completely unacceptable. I was so angry I told her that if she didn't watch out I would eat HER.

She also pushed long-term bp (like implants), without even asking me about future plans for family.

My new dr is lovely and kind. It help that she's my primary as well, because she knows and assesses my full history. She's busy but never seems rushed, brilliant but approachable. Gold.
posted by mochapickle at 5:58 AM on November 11, 2012


One more topic I forgot -- for many teens, they go to their first OBGYN visit before they become sexually active. Which means for many of them, it's their first experience with penetration. That's a scenario that definitely needs to be treated with compassion and communication with the patient on how to make them feel more comfortable in an extremely uncomfortable situation. Don't just rely on thinking momma briefed them on everything.
posted by Wossname at 5:59 AM on November 11, 2012 [22 favorites]


My OB/GYN was fine when I was just getting annual exams but when I got pregnant, and started asking lots of questions, he didn't listen and answered what he thought I asked rather than what I did ask. I could also tell that he wasn't into me being a big part of the birth (just my birth canal) so I switched to a midwife practice. I will never go back. The atmosphere is so drastically different - its warm and inviting. The nurses and secretary are nice and funny and helpful. They are there for me, not for the doctors ego. I've been to a couple of midwife (Certified Nurse Midwife) practices and they were very similar so maybe there is some research you could do in that area.
posted by dawkins_7 at 6:05 AM on November 11, 2012 [2 favorites]


My OB thought it was perfectly fine to perform a c-section on me still awake when the anesthesia failed. And then didn't meet with me at my 2 week or 6 week post-partum visits -- I was passed off to a midwife who was not present during the labor and subsequent unwanted c-section. And then when I was experiencing daily pain months out, I was told it was normal. Until I visited another OB (three month waiting list to get in) who was appalled.

When I very unexpectedly found myself pregnant a second time, I point blank told my husband I was not going to the hospital and sought a midwife to deliver me at home, and everything from my initial consultation with my midwife to the delivery was head over heels better than the care I received from the OB.

I had to see yet another OB to have an IUD put in, and the amazing thing about that OB was that when he found out I delivered at home after having a c-section, he did not express any negative opinion on my choice. He may have thought it a terrible choice, I don't know, but whatever he thought, he kept it to himself --- if anything, he seemed a little impressed. I also think he took the approach that I wasn't there for a pregnancy so there was no point in rehashing what had already occurred. I liked him a lot. If I have an issue beyond what my regular providers could handle, I'd see him again. But not for pregnancy.

For pregnancy, I'll go back to my midwife.
posted by zizzle at 6:19 AM on November 11, 2012 [1 favorite]


Wow, my OB/GYN is wonderful! A few of the things she does that I've noticed that make the experience more pleasant:

-She remembers me from visit to visit. I know she takes notes on what I say in my appointments, and she refers to those notes before she comes into the room. This is in addition to my basic medical history. I'm talking things like what I do for a living and where I work and hobbies I have - stuff she doesn't really need to know in order to be my doctor, but help in making the visit seem less awkward.

-She ALWAYS tells me what she is about to do. I've had a gazillion pap smears and pelvic exams in my life, and have birthed a baby, so nothing about what a doctor does around my girl parts is new to me, but she always says things like "I'm going to touch you now" and "You might feel a little pressure". In my mind, this shows she is concerned about me being comfortable, and not feeling exposed while she does random strange things down where I can't see her. (Although on preview, I can see how other people might feel that a running commentary isn't necessary, or makes things more awkward.)

-Speaking of exposed, I am never more exposed than I need to be. She'll do a breast exam under my [cloth] gown, and only open it for a quick peek, and then close it up again. She never blathers on and on while I am lying there with my legs spread. Any lengthy talking we do is before I lie down, or afterwards when I can sit up.

One thing I do not like, and this is more a reflection on the practice itself, and not on my doctor as a practitioner, is I can't schedule my exams a year in advance, which means I inevitably forget. My dentist has software that lets me schedule cleanings way in advance, so I know it's possible. I don't know why this OB/GYN still uses an outdated postcard reminder system.

If anyone wants the name of the BEST OB/GYN ever, and you don't mind traveling to Chicago's western suburbs, let me know!
posted by SuperSquirrel at 6:21 AM on November 11, 2012 [3 favorites]


I also hate it, passionately hate it, when they have the exam bed angled where your nethers are the first thing someone sees when the door is opened.

Agreed. I have always had consistently respectful, caring encounters with my GYN provider, but she is a nurse practitioner in an all women practice. The speculum is taken from a warming cabinet, the blanket is soft cotton, even the stirrups are covered with soft booties. I have never had to see the doctor, but the NP has never seemed rushed. I have always had time to ask about any concerns when I am clothed after the exam, she is experienced and knowledgeable, she listens and takes the time to educate in a totally supportive, nonjudgmental manner. I wish more doctors were like her.

By contrast, I see a very well regarded (male) urologist regularly for cystoscopies (insertion of an endoscope into the bladder to look for abnormalities). Aside from the paper blanket, cold stirrups, cold saline infused into the bladder, no anesthetic ointment to the urethra prior to the insertion, and the business end of the exam table facing the door, the doctor always seems rushed. The practice just feels like the McDonald's of urology.
posted by zoel at 6:27 AM on November 11, 2012 [1 favorite]


Oh, I have anothe gripe to add: even my punk rock, totally awesome GYN had the nerve to tell me that I would change my mind about wanting children someday after I explained that I wanted to start figuring out super strong BC as I have no desire to be a mom. This was extremely irritating because I expect a GYN of all people to be on my side when it comes to my health.

I also had a traumatic incident with the urgent care GYN once after I had been semi-assaulted by a date and was physically trapped inside my room when I asked to leave after the GYN told me he had called the police so I could report the assault. I was already out of my mind with pain and fear and I needed help, but this guy decided shaming me and trapping me was the right way to administer that. My body is mine and mine alone; a good GYN will always work from that perspective and never treat a patient as belonging to some kind of higher power.
posted by These Birds of a Feather at 6:28 AM on November 11, 2012 [4 favorites]


I've gone to my GP for my GYN stuff for several years and really like her as a GP, but I'm about to switch to another doctor in the practice for my lady stuff. A big reason is that my current doc seems really uncomfortable talking about sex. The couple of times I've brought up something about my sex life she actually GIGGLED and told me, "oh, you're so cute!" as if the idea of a fat, middle-aged woman having an honest-to-god sex life is somehow unseemly.

She's around 40 herself (but skinny, super-cute and looks much younger) and she has three young kids, so you'd think she'd be over the giggles about sex in general and the hilarity of the idea that mom-types (and even grandmom-types!) might still enjoy screwing, but I guess not.

Please tell your docs to get over whatever juvenile hangups and judgements they have about sex and be able to talk about it in a matter-of-fact way.
posted by Serene Empress Dork at 6:31 AM on November 11, 2012 [4 favorites]


I second the "position of the OB bed" comment. I hate it when the nether regions face a door. It never happened that anyone ever walked in, but it makes me feel more exposed than need be.

I prefer practitioners who warm instruments and talk me through the steps.

I don't mind chit chat during the exam.s. Caveat, I don't mind chit chat during the exams when the OB-G is a woman. I had one male doctor perform an exam once and it was a catastrophe. He was awkward and did adopt a paternalistic tone. (Perhaps to counter the perception that women doctors tend to adopt this perspective more).

I hate when I say I don't want hormonal birth control and the doctors try to talk me into it (and into a popular hormone based IUD). There are reasons I don't want hormonal birth control. Please respect my wishes.
posted by Milau at 6:41 AM on November 11, 2012 [2 favorites]


A very long time ago I had an extremely judgy GYN who clearly did not approve of my pre-marital relations. Cut to an abnormal pap smear, and this woman TERRIFIED ME with CANCER! TALK! YOU WILL HAVE CANCER!

No discussion of how common abnormal paps are, how often colps come back as nothing, nothing at all to do with truth, everything to do with her disapproval. She also disapproved of my plans to not have children.

My new GYN of the last few years is amazing, non-judgy, and helpful. I recommend her to everyone.

If you don't want to serve healthy, unmarried women who are sexually active, please just specify that you only want married ladies who are interested in reproducing. I didn't deserve to be treated that way, and no one else does, either.
posted by Medieval Maven at 6:43 AM on November 11, 2012 [5 favorites]


As others have said, it is really important not to assume anything about a person's sexual history or orientation when explaining things to them.

I have been celibate for ten years, but every time I went to my old gynecologist I had to go through this humiliating song and dance with her grilling me about my contraceptive practices and I have to repeat quietly that I'm not having sex. She clearly didn't believe me, so we had to do it every time.

It is a general doctor peeve, but it's particularly bad with reproductive health doctors since I assume they are jaded about people lying to them.

Putting things on the ceiling to look at is awesome. Lolcats are a great favorite with my current doctor.
posted by winna at 6:44 AM on November 11, 2012 [2 favorites]


Doctors who assume one has penetrative sex or sex with men; doctors who pressure me to have STD tests that I know I don't need; doctors who pressure me to get the HPV shot when I say I don't want it.
posted by liketitanic at 6:49 AM on November 11, 2012 [4 favorites]


My first doc was an older male - he was my mom's so she brought me into the circle. His office was awful. I regularly had to wait for 90 minutes to 2 hours to be seen after arriving for my appointment. About an hour of each wait was in the paper robe, shivering in the office. I had some issues early on in my marriage so he performed a procedure on me beginning with hym- and ending with -ectomy (trying to remain honest yet not googlable here) which, 14 years and second partner later, I don't think was necessary at all. But I trusted him, even though once he commented on my less-than-perfectly-shaved legs (it was winter!) He left his practice for a year and a half due to a mystery illness (!!!), which was my golden ticket to find my own doc.

She's lovely. She's a Nurse Practitioner in a very large practice. The robes are cloth. The tools are warmed. There is a little fold-open closet to get changed in and a button to push when you're ready. (As opposed to dropping trou in front of the closed door in Dr. Neolithic's office so that I could block it if someone tried to barge in.) She remembers me from year to year, and I don't even care if she's just reading back well-taken notes. She has never judged me for anything that went on, and when I call the office with a question I get a callback in less than two hours. And I've never been there longer than 45 minutes.
posted by kimberussell at 6:52 AM on November 11, 2012 [2 favorites]


For me, billing is a huge issue. I have been dealing with some sort of coding (? maybe?) snafu that they should have dealt with properly the first time, it's been a huge headache and even figuring out what the problem is in the first place is nearly impossible.

Be very clear about performing actions that are going to be billed to the patient - I almost signed up for the HPV shot, but I'm glad I very clearly asked about billing because they were going to charge me something like 10% of my yearly income, for something I'm not at a high risk for. This is something I have heard from several friends - they got some test or whatever done, and a month later were hit with hundreds of dollars in charges they were never informed of. Any charges for non-emergency procedures should be okayed up front. I think this is an area where systems engineering could bring vast improvements.
posted by fermezporte at 6:53 AM on November 11, 2012 [10 favorites]


I agree with Medieval and others that a judgy GYN is the worst. Medicine should be a fact-based discussion, but many practitioners bring their own religion and/or politics into it.

My primary care doc is my de facto GYN because she is AWESOME. I can talk to her about anything. I can say, "this is off the record" and she won't put it in my chart because she cares more about my health and our relationship than "the rules."

Unfortunately, I don't think you can engineer or administrate this. You can warm up speculae (?) (speculums?), but caring and relating is part of the doc themselves, I think. You can hire for it but I don't know if you can work-flow that part.

Interesting question! Thanks for asking it.
posted by Punctual at 6:56 AM on November 11, 2012


Me: "Oh, I don't ever intend to have children."

Them: "Don't worry, you'll change your mind one day!"

Or worse... "You just haven't met the right guy yet!"

Or even worse.... I can't remember exactly how he said it, but he basically glossed over me saying I didn't want kids ever, and told me I should hurry up and think about getting preggo soon, coming off in such a way that it made me think he simply wanted more baby-business from me, not just the annual check-up song and dance.

My current doctor is my favorite, because she actually listens to me/believes me when I say "I don't want kids."
posted by Squee at 7:01 AM on November 11, 2012 [4 favorites]


I've left two wonderful gynecologists' practices because their staff was abysmally bad. Not returning phone calls, forgetting to update my insurance information after multiple reminders from me (resulting in my having to waste time dealing with both insurers to get it straightened out), and just general customer-service crappiness like ignoring me until they'd finished their own non-work-related conversations and acting like I was an inconvenience for trying to sign in or pay a co-pay.

I know that there are a lot of crappy employees working for many different types of doctors, but I've been to a number of different GPs and specialists and it somehow seems that the office staff in OB/GYN offices is a level below even that. I don't know if they have trouble attracting decent help because OMG vaginas!, or if they tend to get the giggly gossipy types because OMG cute babies!, or if the practices focus on "warm" to the exclusion of "professional" and so don't have high enough expectations of their non-medical staff, or what all is going on, but it's frustrating as hell and, for me, has consistently been the most teeth-grindingly awful part of gynecological visits.
posted by jaguar at 7:01 AM on November 11, 2012 [4 favorites]


Don't put a "Relax and put your trust in God" sign on the ceiling. *You* are the one currently doing an exam in my ladyparts, and I came here for medical expertise, not faith healing.
posted by MonkeyToes at 7:04 AM on November 11, 2012 [5 favorites]


I am lucky to have an obgyn who listens to me and understands what I want, and I've never had an abnormal pap, but I still put off going in for my annual pap because guh I hate getting jacked open and poked around! I wish she'd put some numbing lube on my cervix or something cause oh man is it uncomfortable.

Before I met her though, I was kind of bouncing around from city to city and at one time went to a random obgyn because I was hoping against hope my libido issues were some sort of hormonal deficiency and I could get on meds that would fix it, and she walked in and was very dismissive and haughty about the whole idea. "No. If your periods are fine your hormones are fine. It's cause you're depressed. Go see a psychologist and your libido will get better." I mean, I kind of knew that was the case but that was really offputting.
posted by agress at 7:31 AM on November 11, 2012 [2 favorites]


Two unpleasant experiences, one from me and one from a friend, both involving absolute lack of boundaries and empathy:

1. I had some kind of weird mystery hair-loss thing going on a few years ago. I was really disturbed, not only because I personally didn't want to be bald but because my job is public-facing and I would, frankly, be fired out of hand if I lost my hair. I went in to the GN to have a variety of hormone panels run and not only did the male doctor not believe me (my hair was thinning, falling out a ton every day and some of the remaining hair was getting weird in color and texture, but I had started out with very thick hair to begin with so there weren't bald patches) but as I was trying to persuade him to run the panels, he told me that I (a woman in her early thirties!) should not worry about going bald, because he was bald and look at him! He had a successful medical practice and everything! He was totally serious. He could not understand why I was worried.

(Luckily, it all resolved on its own. A medical mystery!)

2. A friend of mine told me about this years after it happened - or else I would have strongly suggested that she report it. She'd gone in to see the doctor about a breast lump. When the doctor came into the room, she looked at my friend's chest and started laughing. "Your breasts are different sizes!" she said, in the midst of her chuckles. Now, my friend has such slight breast asymmetry that you really have to look to notice (I mean, I never noticed) and she said that none of her partners had ever commented. But now she worries about it! And actually, breast asymmetry is really common! Surgical correction is available if it's pronounced, but generally it's not! Now, you cannot tell me that a mid-career GN had never seen slight breast asymmetry before, or that even if she hadn't it would have been appropriate to burst out laughing.

I can only surmise that because of cultural norms around women's bodies ("Women's bodies are abject! The source of sin and smells and blood, even if also babies! Women's bodies are categorically imperfect and pathological! Women's bodies can be judged by anyone!") there's a sizeable number of awful, awful peoople who go into this field.

My GP, on the other hand, is a saint among men.
posted by Frowner at 7:33 AM on November 11, 2012


I've never found it horrifying...Our stuff is internal, that's how it goes. I'm not sure where you're working!

I had a great experience at a Planned Parenthood recently and I'll tell you why it was awesome:

--They asked about my history of sexual assault and domestic violence and then ACTUALLY FOLLOWED UP on it by asking me if I had had counseling, wanted counseling, etc. I see this question on intake forms all the time and usually get no follow-up or "so, sexual assault, huh?" and then I'm like "yup" and they just move on which seems like a waste of time for everyone. So training on how to be useful/helpful/compassionate to victims of sexual assault/abuse would be up there on my priority list if I were training.

--Privacy. I didn't have to tell the front desk person why I was there in front of a million people. At my OB's office I had to carry my pee across the waiting room. SIGH. It's great pee, no shame in my pee game, but still. Employees need to respect patient privacy.

--Vending machines. I was thirsty. A++++ would drink a Coke again. At least easy access to water and bathrooms.

--Multiple issues. They let me ask them about multiple issues at once. A lot of doctors (for insurance reasons I'm sure) will be like NO NO I CAN ONLY DO ONE THING and as much as I like having metal/fingers all up in my vagina/butt area, I would really like to have to pay for that particular pleasure as infrequently as possible.
posted by the young rope-rider at 7:50 AM on November 11, 2012 [14 favorites]


Oh the thing that sucked about Planned Parenthood was getting metal detectored/wanded and having my bags inspected. So yeah domestic terrorism is a problem for women's health care too.
posted by the young rope-rider at 7:52 AM on November 11, 2012 [6 favorites]


I left one OBGYN practice when I called for an emergency appointment because I had a UTI and not only could no one in the practice see me for an entire week, but then a nurse got on the line and scolded me for missing my 6-week postpartum appointment. Except that I had never given birth due to fetal demise in my second trimester, which I am certain was in my records because I was seen by my OB after the D&C. I was not emotionally prepared for that, and when I managed to tell her what happened, she brushed me off with, "Oh, sorry." I never went back.

I left another practice because although the doctor herself was awesome, her assistant was the worst. She was literally the most incompetent healthcare worker I have ever encountered and I see a lot of healthcare workers.
posted by crankylex at 7:56 AM on November 11, 2012


As a sidebar it seemed to me that doctor in this field can get very judgy and paternalistic, for some reason especially the female physicians; when it comes to children, birth control, and STDs.

For what it's worth, the only judgy gyn I ever had was male.

I don't know if I've been lucky, or I'm just not terribly sensitive, but I don't have many complaints about the actual doctor visit part of my gyn experience. Though, yes, if you're going to use a metal speculum, please warm it up first. And, yes, light on the chatter, and I would prefer to get a chance for us to talk with me fully clothed and upright.

I've found that some are better than others in terms of pap smear pain, but I think that's a matter of technique and not anything I as a patient could particularly recommend.

I've been the most squicked out with male gyns when they ask about my sexual activity in ways that feel inappropriate. I know that you have to ask, but just ask what you have to ask and don't get personal about it. I'd rather, "Are you currently sexually active?" or the like instead of, "Are you married? Do you have a boyfriend?" You sound like you're chatting me up in a bar. And, yes, of course, it should go without saying that my answer to this question should not prompt a lecture about sex outside of marriage. This is is bare minimum "not horrified by my gynecologist" stuff, though, not tips on being an AWESOME gynecologist. An awesome gynecologist can get the necessary information without it feeling like the Spanish Inquisition. I seriously don't remember how my last two (great!) gyns even brought it up.
posted by Sara C. at 8:06 AM on November 11, 2012 [2 favorites]


I don't like being given a paper gown, changing into it, and then waiting for hours - hours - in a cold room. Either see me immediately, turn up the heat, or ask me to change later - like right before the doc is ready. This happens almost every time I go, and it makes me feel really bad.
posted by k8lin at 8:07 AM on November 11, 2012


I have almost universally hated my gyno care providers, and I did universally hate my OB providers (the ob/gyns I saw when I was pregnant with my daughter.)

I hate their condescending attitude, their default belief that I'm less intelligent than they are, that I can't understand science or biology, their dull, rote, prescriptive, knee-jerk responses to most common problems, the finger-waggling, and the quiet attitude that I am a child who must be monitored, poked, watched, distrusted, lectured to, questioned but never talked to and that my body is something to be managed that will fall apart if not for their supervision. I also find them fairly stupid, or at least, so incurious about the latest thinking in their own goddamn profession that they might as well be stupid.

Being pregnant and being subjected to these assholes was one of the single worst experiences of my life, because I got a rotating cast of characters I was required to see because there was no way to know who would be on call when I went into labor. Would it be the condescending thirty-year old female OB or the condescending seventy-year-old male OB? Who can know!

I wound up having a c section, in retrospect I think it was a score.

I love my family doctor. When I talked to him about this problem, and how desperate I was to find a gyno who didn't have these problems, he was very sympathetic and said that he found it sad that the attitude I'm describing is common, and that he couldn't understand why, in essence, these people don't understand that they work for their patients. He's a lovely person and a joy to talk to and discuss things with and talk about studies and drug interactions and he knows how to crack a joke. Unfortunately, he couldn't think of a single ob/gyn to recommend I go see. My dentist, although he delights less in talking about his own practice, is also nice to talk to and always treats me like a competent professional person.

I haven't found the complaints I have to really track male or female -- I've had the same experiences with male and female doctors. It's more disappointing when it's a female, I guess.

So I don't have a gyno, I guess is what I'm saying. Sorry to get ranty, it's really a sore spot because I know I should have an ob/gyn but I also know they will suck it and even just typing this I can feel the impotent rage they inspire.
posted by A Terrible Llama at 8:20 AM on November 11, 2012 [3 favorites]


I just had a baby at an office with one doctor and two midwives in an all-female practice. In general, I loved them, except one midwife was not my favorite. As my appointments became weekly, I met with her a few times because she was new and had a lighter schedule. Anyway, she told me at 36 weeks that the baby was super low and I could go into labor any day! She also mentioned that it probably meant my delivery would be fast and easy. I told everyone!

Except... I didn't. I waited four more super uncomfortable weeks to go into labor. And then my labor was thirty hours when we decided to just get the freaking c-section. Ultimately, I don't want anyone speculating on when/how the baby will come. I'd rather not know than have my expectations be so out of line with the actual outcome.
posted by smalls at 8:22 AM on November 11, 2012 [3 favorites]


One thing to add...also: humility. My family doctor, if he doesn't know about a condition or a drug, will look it up while I'm in the room and make a visible effort to figure it out. He's not so insecure that he's got to fake knowledge or steer me toward a drug he understands and knows about versus one he doesn't -- if there's something to learn, he up and learns.
posted by A Terrible Llama at 8:25 AM on November 11, 2012 [8 favorites]


I have had many good experiences with both male and female practitioners; plain old MDs, NPs and NDs.

The only bad experience was with a male OBGYN when I was a teenager. He asked me questions that felt judgemental and irrelevant (i.e. I'd had what was probably a ruptured ovarian cyst, and he asked if I kept my house clean), and he invited a nurse into the room while the exam was going on but without warning me first that someone would be coming in.

So my main piece of advice is, treat patients (and especially young or otherwise vulnerable patients) as respected, autonomous human beings. Let them know why you're doing what you're doing, and let them know what's coming next.
posted by feets at 8:31 AM on November 11, 2012 [1 favorite]


Ask about sexual assault on your intake form. If a patient discloses, check with her to find out if she needs referral to counseling, help from a domestic violence organization, would like additional screenings for stds, etc. This goes for anyone, but especially in cases where someone has disclosed sexual assault, being very verbal during the exam and explaining what to expect ("now you'll feel something cold as I insert the speculum...") went a long way towards calming me down as I was lying naked in a room feeling unhappy and vulnerable.

If it's possible to let people keep shirts on during the vaginal examination, that is nice.

If you are calling with unhappy results from a test, make sure someone is in a physical location where they feel comfortable hearing negative results and have the time and privacy to ask questions. When I got test results, I was in the graduate computer lab and the woman on the phone just sort of launched into things and I was taken off guard but couldn't do much about it because I was surrounded by colleagues who didn't need to hear my questions about being diagnosed with HPV.
posted by SockMarionette at 8:32 AM on November 11, 2012 [1 favorite]


Two experiences, one funny, one infuriating

I hate it when the nether regions face a door. It never happened that anyone ever walked in, but it makes me feel more exposed than need be.

It goes both ways! I was having my pap on the 5th floor of a building. There were blinds on the windows, but why use them when you're up so high (and there were no other high buildings around). While I'm on the table, in full view, there is a clanging on the window: window washers! My NP ran to shut the blinds and we all had a very good laugh.

Infuriating experience:

In college, I was having terrible shooting pains during intercourse. I went to the campus doc and saw the GYN. She told me that I had to have had an STD because otherwise, there was no other explanation. I told her we used condoms 100% of the time. SHE DIDN"T BELIEVE ME and essentially told me that I was a slut. I was shocked more than anything. I had been brought up to trust in the medical profession and, in particular, women doctors and here was one telling me that I was a horrible person and had this pain because of an STD.

Got tested, of course I was all negative. I think I filed a complaint against her. I later learned that she was universally reviled on campus. You would think that the administration would do something - especially considering that the university has a medical school.

In the end, pain disappeared, no PID, no STD, no edometriosis, and many, many clean paps from there on out.
posted by Leezie at 8:34 AM on November 11, 2012 [1 favorite]


their default belief that I'm less intelligent than they are, that I can't understand science or biology

I think a lot of this stuff is because a lot of people out there (men and women) are not super intelligent, don't keep up on health issues, don't have a copy of Our Bodies, Ourselves at home, think you can avoid pregnancy by douching with coke or fucking standing up, don't use condoms, etc etc etc.

I'll admit that it can be difficult* to have a good bedside manner both for patients who are up on all this stuff and those who are not. I mean, there are probably other women out there saying, "My obgyn is so technical and uses all these big words and it's confusing." This might be exactly the difference OP is looking for -- the ability to deal with a patient where she is at, rather than where the doctor is at or where the doctor fears the patient might be at.

One way to deal with a disconnect that I've been impressed with seeing my current gyn is asking a question openly and being able to judge the level of response you get. For example I had a negative pap smear. My gyn asked me if I knew what that meant. I said that I did, that it wasn't my first, and immediately started asking questions about scheduling a colposcopy. Rather than assume she hadn't heard that and go into the standard, "you have some cells in your special lady parts that are not healthy and need to be tested for cancer", she was able to roll with the punches and just talked to me like an equal about the plan going forward. So flexibility and listening to your patients is key.

*I get all this from being the daughter of a primary care doctor in a rural area, and hearing him talk on the phone to patients, talking to people in the general public who are my dad's patients, etc. For example back home I routinely get people asking me if my dad is "that baby doctor?" because they don't know the word "pediatrician".
posted by Sara C. at 8:35 AM on November 11, 2012 [2 favorites]


My worst GYN experience:

While I'm on the table, the doctor says "At our practice, we do an ultrasound at every checkup." And then, without asking, the ultrasound wand is inside me.

I felt awful. I didn't go back there.
posted by ocherdraco at 8:35 AM on November 11, 2012 [2 favorites]


Gowns that don't fit. I'm not a small woman (6 ft and overweight) and my doc has these minuscule Barbie sized fabric gowns that open in the front. Even if I was a normal weight, these things wouldn't fit me. I have to wear it backwards to not be sitting there with everything that is supposed to be covered hanging out for the world to see. It's humiliating. Surely not everyone in their practice is a size 2!
posted by cecic at 8:38 AM on November 11, 2012 [2 favorites]


One of my gyns let an intern do my Pap smear, unsupervised. It did not go well.
posted by Metroid Baby at 8:39 AM on November 11, 2012


As a contrast to ocherdraco's experience, because it might help the OP:

I had a similar situation at a checkup when I started seeing my current gyn.

I'm on the table, spread-eagle and vulnerable. She says, "We have this nifty new ultrasound machine that we're able to use in well-woman exams. Is it OK if I use it on you?"

I say, "Is it part of the standard thing?" Kind of half worried that she is trying to upsell me on something my shitty insurance is not going to cover (why, yes, I am paranoid about seeing new doctors), and also half worried that this means there is something horribly wrong with me and she is whipping out this fancy machine to see exactly how big the tumor in my uterus is and how quickly I'm going to die of sad lady cancer. Or worse, I'm pregnant.

She says, "Yes, we just got it and it's part of the standard exam now. Everything is fine, this is just going to enable me to look directly at your ovaries and uterus."

I ask, "Can I see them, too?" My inner science geek is showing.

She smiles and says, "Of course!"

I say, "Go right ahead, then!"

She whips out something that, honest to god, looks like a science fiction dildo. I laugh a little. She laughs a little.

And then I get to look at my rad internal organs. She even reassures me that they are looking great and super-healthy.

A #1. Would ride again.
posted by Sara C. at 8:46 AM on November 11, 2012 [9 favorites]


I did not go back to a perfectly nice OBGYN because of her ABYSMALLY bad desk staff. They charged me up front for something my insurance covered, and then failed to file paperwork for three weeks so I could get reimbursed. I finally had to call them about a dozen times to get the papers myself and file them, and after I did, I got my money within a week. There is absolutely no excuse for that.

I really appreciate being talked to during uncomfortable procedures such as blood draws, my IUD placement, etc. It distracts me from the pain, and in the case of blood draws it makes me less likely to faint.

Also, when I wanted to get an IUD, I expected some resistance and was pleasantly surprised that they didn't give me any shit at all. They knew I'd never been pregnant, and when I said I wanted an IUD they said "OK!" Awesome.

My favorite experience ever at an OBGYN was in college, when I was asked if I had any questions about sex or sexuality. Nobody else has asked me that, before or since, and I wish they would. The doctor made me feel safe and not judged, so I felt comfortable asking her about my difficulty achieving orgasm, and she actually recommended a book on female orgasm as well as some tips about masturbation. I couldn't believe it, I never expected to get that kind of help from anyone. And let's just say it DID help...
posted by showbiz_liz at 8:50 AM on November 11, 2012


Feeling pressured to have a baby.
posted by Jess the Mess at 9:02 AM on November 11, 2012 [4 favorites]


My former gynecologist's office left me a message late on a Friday afternoon telling me that they'd found something abnormal and to call back as soon as possible. By the time I got the message, they were closed. I freaked out all weekend and called Monday morning. The abnormality was that I was anemic, something that I had indicated on my intake form!

I later went to a great doc. Before she started the examination, she made sure to tell me that *I* was in charge, that this was *my* body and I should tell her if anything made me uncomfortable or if I needed her to stop or take a breather or whatever. I've never felt more empowered by a doctor before.
posted by kamikazegopher at 9:02 AM on November 11, 2012 [2 favorites]


Yeah that paternalistic attitude is what gets me. "Oh, honey if you ever want to have kids you need to get started soon." Wow, thank you for both judging my life choices (not having a baby) and calling me old. I really appreciate it. It was her birthday and she was wearing a crown at the time, that....didn't help.
posted by magnetsphere at 9:19 AM on November 11, 2012 [2 favorites]


I have problems with sex hurting my vagina and the ob/gyn instruments causing me severe pain. When I go for my checkups (which I'm 2 yrs late on, because I hate my gyn) and try to explain these problems, he just acts like he doesn't hear me or that just can't be true, because he doesn't see any thing wrong with my insides.

I also don't like how he doesn't explain what he's doing, or how quickly he does everything. My ob/gyn is one of the most sought-after ob/gyn's in my town, but from being with him the last 6yrs I can't honestly tell why.
posted by Sweetmag at 9:20 AM on November 11, 2012 [1 favorite]


I had a GYN cloak her religious beliefs inside medical jargon. I found out after the fact (from an amazing GYN) that some of the decisions she guided me to make (decisions I trusted her with, as she was the one who went to Medical School) were counter to my best interest, actually increasing a risk to my well being, because at heart she didn't believe that I didn't want children.

Prior to my IUD insertion I had to have an STD test. Dealing with the billing agents was a fiasco. I actually had to explain to the insurance billing agent what an IUD was, and suggest areas he may find the coding. Then when I questioned the additional $10 charge (for the STD test) that guy in billing couldn't even say it was for an STD. He hemmed and hawwed and actually said "sometimes, ladies who have sex with men who aren't their husbands get these diseases, and we had to test you for that." What the what what? Seriously? While these were umbrella billing agents, part of the larger hospital staff, they should still be educated on discretion and all aspects of women's health.

One practice I went to, one visit only, was on the ground floor of a drafty old brownstone. The doors didn't fit in the jams correctly, probably due to the foundation shifting, so every time the exterior door opened, all of the interior doors swayed open a bit. Incredibly disconcerting when you're spread eagled facing said door. Even more disconcerting to have the doctor chuckle and say "oh don't worry, all of the doors do that." So something as easy as a doorstop goes a long way.

Big bonuses to my current practice: Believing that I don't want children. Believing that I have a brain, and can be spoken to like an intelligent adult, who can make decisions about her own body. Having magazines in the lobby that aren't all Parent or Mommy oriented. Having a private bathroom attached to each exam room. Cloth gowns in a variety of sizes. Not being judgmental about sexual practices or reproductive decisions.
posted by librarianamy at 9:26 AM on November 11, 2012 [3 favorites]


Things I have disliked:
A doctor (at a university practice!) who was visibly upset at my navel piercing, and expressed that she would not be able to examine me if I was pierced "down there"--which were *her words* for my vulva.
Doctors who disbelieve that I don't want children.
Doctors who are confused that a woman could have been pregnant in the past and have no children in the present.
Doctors who make sure to give me enough time to get undressed, making sure that they don't come in while I'm still wrestling with my boots.
Informative decoration/entertainment in the exam room: while I'm waiting, it's cool to be passively learning about health.
Routinely waiting several hours for my doctor while knowing that he may be called away at any time for a delivery.
Doctors who are impatient/suspicious about the fact that I rarely know the date of my last period--they're irregular, and I don't make a big deal of them, so it takes me a while to figure it out. When I was younger, I didn't know that I should do this before my appointments, which wasn't something that I intentionally failed to do to bother them.
Doctors' non-medically relevant comments about choices I make about my appearance.

Things I have liked:
My doctor who speaks intelligently and non-patronizingly about my exam, and in particular, who strongly supported my desire to get an IUD.
My doctor who knew that it would be less uncomfortable to insert an IUD "upside down" because of my tipped uterus--and, more importantly, who explained to me what he would do, and why.
Doctors who *gently* addressed other medical conditions that they suspected they had diagnosed during an exam.
Being given preemptive pain relief for uncomfortable procedures, and not being treated suspiciously when I have asked for this.

A thing I respect and admire but was exasperated by:
My current, excellent doctor has his patients sit up and watch the initial part of the exam, and explains the different parts of the patient's anatomy ("This is your clitoris, these are your labia minora and it's completely common for them to be asymmetrical" or whatever). I know other women who have very little familiarity with those parts of their body, so yay doctor! But I felt like he was walking me into my own living room, pointing out "that is your couch, those are the curtains that match the carpet so nicely." I know, they're mine!
posted by Edna Million at 9:32 AM on November 11, 2012 [3 favorites]


Paper gowns are crappy. Cloth gowns, available in realistic sizes, would be nicer.

Speculums come in different sizes too. I'd appreciate if the office would make a note of which size I prefer and have that one set out for my appointment. I don't mind metal, as long as...

Everything should be warm enough - the room, instruments, lube, the examiner's hands even.

And finally, if your patient identifies as a lesbian, don't call her a 'virgin' and gallop off with assumptions based on that 'fact.'
posted by expialidocious at 9:37 AM on November 11, 2012 [2 favorites]


It'd be great if doctors didn't fat shame (and had gowns big enough for larger ladies). I excercise, eat sensibly, have great blood pressure and blood work up. Still, regardless of why I'm at the doctor--pap smear? You're fat! Sore throat? You're fat! Yes, I did notice that, thanks. But they just can't seem to accept that I'm fat despite heathy habits. It pisses me off, makes me feel horrible, and I dread going to the doctor in case I end up with an asshole.
posted by smirkette at 9:44 AM on November 11, 2012 [8 favorites]


The single worst part of visiting doctors in general (and OB/GYNs are the worst) is the assumptions that they make, namely that every person that comes into their office is cis-female, sleeps exclusively with men, has penetrative sex, and desires to have children.

They always make me fill out a stupid outdated intake form that is so heterocentric that half the time when I check "sexually active" and "no birth control" they freak out at me and lecture me until I tell them I'm having sex with women and I don't need or want birth control thank-you-very-much. Even then, several OB/GYNs I've dealt with eyed me suspiciously as though I were lying to them.

I've started crossing out things and writing in my own answers to make it clear I'm actually sleeping with women. The other half of the time, they don't even bother to read it, and ask about my boyfriend even though I've written that I'm gay on the damn form.
posted by zug at 9:48 AM on November 11, 2012 [2 favorites]


My last gynecologist unexpectedly retired, so I don't see her anymore, but the thing that it frustrated me to realize after I'd already been seeing her a couple years is that because I just look like another white woman, she'd never thought to suggest an adjusted screening schedule because of my ancestry and family and personal medical history. Don't assume!
posted by limeonaire at 9:55 AM on November 11, 2012 [1 favorite]


I had an ob/gyn who answered her cell phone while the speculum was inserted and opened. I never went back, and blanched when my current GP (who I use for GYN services) told me she may receive a call from a specialist she would answer during our appointment-- I explained why I was hesitant, and she reassured me she would *NOT* answer the call if the speculum was inside me!

My current GP is very good at listening to my concerns and questions and answering without judging. She also takes copious notes during our appointments, which I can then refer to later.

The only change I would make in my current office is to have everyone I interact with introduce themselves-- names and roles. I may not remember all of it, but it feels weird when someone I don't know is in the room while I'm near-naked.
posted by worstname at 9:56 AM on November 11, 2012 [1 favorite]


My gyn is great. However, my experience getting an IUD from her could have been better. I haven't had kids so I was happy she was willing to do it but during the insertion, I thought I was going to pass out. So during insertion, they kind of use the car jack thing, put in the IUD, and take out the car jack. Well, for some reason, during my insertion, while I'm fighting to stay conscious, my gyn and a nurse realized they needed something that was down the hall. So they ran to get it while my equipment is just hanging out. That was pretty unpleasant. I like this doctor but this was my husband's first time meeting her and this definitely affected his opinion of her.
posted by kat518 at 9:58 AM on November 11, 2012


I have decent luck with GYNs generally enough to know that the crappy experiences I've had have been anomalies. Some people are really stressed out by GYN visits generally. I am not one of them but many of your patients will be and there's really no excuse, in my opinion, for not trying to make everything as pleasant and calming as possible. So, a few ups and downs.

1. Good & Bad: When I was a teenager, not believing me when I said I wasn't having sex with my boyfriend [and asking a lot of creepy questions like "do you let him do this to you... do you let him do that to you...?"] and running a pregnancy test on me without telling me leading to some annoying fighting with my mom. Upside: getting a birth control pill prescription without hassle later when I said I wanted one.

2. Good: When I was in my twenties the local health care clinic was very friendly and relaxed and gave me my own speculum to take home.

3. Bad: When I had irregular pap smear results, letting me know via phone message late on a Friday so I could worry all weekend about wtf was up and flipping out when in reality many people have irregular results [they do this better with breast care screening but it sucked at the time]

4. Bad: Slut shaming me when I wound up with an STD in college (to be fair, this was health care nurse stuff, not GYN stuff)

5. Not great: having to have a female in to observe when there is a male doc doing your pap smear always seems seems vaguely "We don't trust men even though they are doctors" if it's for my benefit, I don't like it.

6. Good: always being decent about my own reproductive choices and being basically "who cares?" about my choice of partners. Ask if I'm sexually active, that's it.
posted by jessamyn at 10:01 AM on November 11, 2012 [2 favorites]


WARM ROOMS. If I am shivering because I am naked and your room is kept at a meat locker chill, I will be unhappy and less responsive. And I like that my doctor (GP and obgyn) has magazines in every room and that they'll offer water, which makes waiting much easier.

Oh and seriously if I have mentioned I'm not pregnant once already, please stop asking about it. Seriously, just, no.
posted by jetlagaddict at 10:02 AM on November 11, 2012


My requests seem kind of small and silly in the face of all these answers, but here they are anyway. I want something on the ceiling to look at when I'm on the table. I am not all that picky about what - a huge landscape would be good or maybe one of those big cartoony posters that has a lot of small detail to pick out - anything to take my mind off what's going on in my nether regions. Just lying there staring at styrofoam ceiling tiles is not helpful. And yes, I'm tense. If your other patients are not tense when they're lying there, I want some of what they're having. Also, if you're going to take me out of the waiting room and away from my three year old copy of Southern Living to sit in a paper dress in the exam room for an hour, please stock that room with some magazines or books or puzzles or anything, really, other than a drawer full of tongue depressors and a plastic model of the heart. Oh and while it's nice to heat up the speculum, it's possible to overheat it. Please check the damn thing!
posted by mygothlaundry at 10:05 AM on November 11, 2012


Huffing and rolling eyes if a patient is scared. If you're lucky enough to have made it through life without trauma, you're way luckier than a lot of people. Saying "it's not so bad," or "it's not a big deal," does not make the situation either of those things, it makes you an unfeeling asshole.

Also, please do not assume that I'm lying about previous conditions or lack thereof.

Do not take my photo for your records after I've told you not to.

There is no excuse for yelling at a patient, ever.
posted by corey flood at 10:05 AM on November 11, 2012 [2 favorites]


A couple of small, practice-management-type things. I go to the biggest, most popular ob/gyn practice in town, so I have never had a visit where I didn't recognize someone in the waiting room. It's IMPERATIVE that the entire office staff be EXTREMELY discrete, because whether you're there for an annual, an early pregnant visit, fertility issues, or a problem, that should be your business, and that's hard enough when you run into six people you know in varying stages of pregnancy in the waiting room. (I think the office is generally very good about this.)

Because babies don't come as scheduled and pregnant women have so many visits, it's hard to get on the ob/gyn's schedule for a routine annual unless you schedule pretty far in advance. It can be very difficult to get in for non-baby-related timely problems. My practice ameliorated this somewhat by hiring a couple of nurse-practitioners who do NO ob, only women's health, and keeping their schedules a bit free-er. So you can't always get in with your regular doctor on short notice, but you can at least get in to the nurse-practitioner. That's been a really big change for the positive since I started going to this practice, it's much easier to non-baby things dealt with in a timely fashion.

I think most OBs could do a better job with the first visit for first-time pregnant women, on patient education. What to expect throughout the pregnancy, a general outline of how care goes. I had a lot of questions the first time through and would have appreciated some time to talk with someone about them right at the beginning. (I don't know, maybe that's self-defeating, maybe people mostly ask crazy questions about things that will never happen and suck up scads of doctor/nurse time, but I would have liked to ask my irrelevant anxiety questions right at the start until waiting until their proper times.)

And really, it's an ob/gyn. Half the women there have one or more children in tow when they're coming in for pregnancy visits. Would it kill them to have a kid-sized table with some Highlights for Children and a few toys in the waiting room? Maybe one of the larger exam rooms with a few puzzles and books in the corner? There are always women 8 months pregnant and very unwieldy trying to keep a toddler entertained until and through the exam. Not so fun. (I mean, honestly, if you wanted to run a premium ob/gyn office, there has got to be a market for having on-site childcare like the gym does where you can leave the sprog for up to 90 minutes for $10 or something.)
posted by Eyebrows McGee at 10:10 AM on November 11, 2012 [2 favorites]


You may also be interested in My OB said WHAT?!?
posted by zizzle at 10:11 AM on November 11, 2012 [3 favorites]


Bad: Assuming I don't know my own body and telling me repeatedly that my breasts are lumpy and I should do self-exams. Once is enough. But when I was dressed and had my hand on the door knob hearing that it again was once too much.

Not believing me when I said I had no questions about birth control and know how it works. I'm an adult. I understand the human body. I don't need to be talked to like a child and it doesn't lead to trust.

The really good:
I just had the most positive experience at a pap smear in my life on Friday. I'm an abuse survivor and have been having PTSD problems. He was fully prepared to reschedule if I was too nervous, explained what he was going to do at each point and asked if I wanted to continue, said what parts may hurt and apologized for them hurting when they did, did not put my feet in stirrups when I explained I don't like to feel confined.

Afterwards he gave me privacy to get dressed and when he saw I was crying a bit he didn't rush me to get out. He made sure I was in a safe place mentally before leaving and told me I was strong to trust him and that he felt honoured that I placed that trust in him since he doesn't know me that well.

Some women may hate that but I think a lot of doctors panic when dealing with assault victims (especially if it isn't a current assault) and he was kind and gentle without being patronizing and left me feeling empowered by my body.
posted by kanata at 10:11 AM on November 11, 2012 [11 favorites]


There's certainly nothing "horrifying" about a gyn exam -- it's a normal medical procedure, and that's a kind of strange attitude to go into this process with.

I have an awesome GYN now, and although I've had some arguments with her about things like frequency of screening procedures, she's been informed, compassionate, friendly, and accessible. I can email her via my health care provider system, and she's super-fast at responding. I have Kaiser, and they make appointments, test results, etc available via web site, and I love that. I also like that Kaiser tracks when I need various things, like mammograms and Pap smears, and lets me know. That's not specific to my GYN, but it's a system that I really appreciate.

Issues with past providers: heteronormativity. As other people have said above, please don't make assumptions about WHO I'm sleeping with until you ask me. I've had more that one gyn in the past ask if I'm sexually active - yes- and if I'm using birth control - no - and then look at me like I'm crazy. Nope, just queer. I have solved that problem by a) going to Kaiser, which at least in SF has organized its intake form to allow for such options, and b) choosing a lesbian GYN.
posted by gingerbeer at 10:27 AM on November 11, 2012 [5 favorites]


Adding my voice to all the complaints about gowns... paper thin and cold! And I'm a big fat lady, so I've ended up with ones that just end up completely open in the front. (Although last time I went to my GP, in the same practice, I was given a gown that fits, so improvement!)

I also recall from a friend in high school who was going for her first gyno exam... the doctor asked if she was sexually active, and she was, but not penetrative sex. So the doctor used a larger speculum on her and it was painful. I've also had to waver on the 'are you sexually active?' question in times when I was only doin' it with ladies. I was like, "Define that?" and it was awkward.
posted by whitneyarner at 10:27 AM on November 11, 2012


5. Not great: having to have a female in to observe when there is a male doc doing your pap smear always seems seems vaguely "We don't trust men even though they are doctors" if it's for my benefit, I don't like it.

It protects the doctor, too. I prefer that setup because there's no room for misunderstanding.
posted by winna at 10:30 AM on November 11, 2012 [7 favorites]


My biggest annoyances are with billing and insurance. I don't know any doctors (derms, gynos, GPs) that know how much their appointments cost or how much the prescriptions they prescribe cost. When I didn't have insurance many doctors wouldn't even take me on as a patient without insurance, even if I paid that day in full. The couldn't tell me how much a simple checkup would cost until after because "it depends on what boxes the doctor checks." When my awesome GP saw how much I was paying for a prescription she was shocked. So, I guess it annoys me that doctors assume you're paying only a co-pay or have $10 coverage for prescriptions.

I like doctors who talk to me about all of my concerns and are happy that I wrote things down, instead of being annoyed that the appointment takes too long. I also like my doctor who is older than me, but is a successful and busy professional and understands the lifestyle and concerns that may entail and isn't judgmental about it.

The fact that she cites science and studies if I ask a question is really nice. Ever since I stopped going to my (old, male) pediatrician I've only gone to younger, female doctors because I feel like they can understand me better.
posted by Bunglegirl at 10:42 AM on November 11, 2012 [3 favorites]


I once had a male GYN who decided I wasn't far enough down the table come stand between my legs while my feet were already in the stirups, grab me by the hips and pull me down to where he wanted me. I would think that understanding that anything that reminiscent of the sexual was a big no go would be good. Needless to say, I changed doctors. So yeah, being aware that this is a very vulnerable position for a woman to be in would be nice.
posted by Meep! Eek! at 10:58 AM on November 11, 2012 [3 favorites]


I hate it when the doc's fingers are fat and short and he is trying to reach your ovaries. I think they should have a finger standard of some kind. I only go to women practioners for this now a days.
posted by cairnoflore at 11:01 AM on November 11, 2012


Thanks to everyone who posted so far. Definitely given me a lot to think about and brought up some stuff I had not even begun to consider.

In response to the poster who said that a gyn exam is normal thing and not a big deal, I was more horrified at the gap between what I would have thought would be normal human consideration during the exam vs. how people were treated during the procedures I saw in the clinic I am currently assigned to.

For the sake of an example, one incident that particularly stood out in my memory was watching a NP strip the membrane of a late-term pregnant women without explaining what they were doing, why or even that it was going to be painful, right in front of extended family.

Other stuff was the routine use of treatments / drugs without any explanation or even reference to the extremely common side effects. Coming from my last assignment in anesthesiology where everything was extremely standardized and rigorously mapped out to a fault I guess I had naive preconceptions.

Two anonymous replies that were requested to be posted:

My biggest pet peev with women's health issue stuff is being made to feel weird because I KNOW about my body/treatments available.

Anecdata: Noticed I had a little bump on my cervix. Googled it, figured it was a cyst, went to family health to get it checked out any way.

(Male) Nurse: What can we do for you today?
Me: Well, I noticed that I have a tiny bump thing next to the mouth of my cervix, what is up with that? Should I be worried?
Nurse: (shocked face) This has never happened before. What do you mean your cervix?
Me: ? I mean, you know, I can sometimes feel my cervix... and I noticed a bump, and it hasn't gone away for weeks.
Nurse: How do you know what a cervix is?
Me: Because I do?
Nurse: Most people just say they have a problem in their vagina... They don't know the word cervix... THIS HAS NEVER HAPPENED BEFORE! Never! How do you know it was your cervix? How did you feel it?
Me: (feeling a bit stupid, then getting angry because I know I'm not stupid) Well, you know... (Trembling voice, trying to think of a "valid" excuse for touching my own goddamn body)... I was ... Err cleaning myself... And I err.... Noticed a little bump.
Nurse: (repeats more or less word for word what I said, I'm feeling stupid but also angry that he's making me feel stupid.)

Anyway, nurse has a look, turns out it's a cyst, nothing to worry about. We talk about how most people don't understand their bodies. I leave feeling ridiculous. I had genuinely worried about the stupid cyst. I was made to feel weird because I have a thorough understanding of my body.

-

For some reason, in my 15 plus years of pelvic exams (with....several extras this year) I have noticed that female gyns are much rougher than the males. And family medicine doctors and NPs are totally hit or miss with regard to pelvic exam....finesse.

And the ladies are more likely to tell me that I need to just hold still/it doesn't hurt that bad/it'll warm up quickly/only feel cold for a second (the icicle duck lips).

Somehow the men seem to know their own power. Or something.

As for getting an ultrasound in the office. Teach the technicians not to suck air through their teeth and squint/grimace. It is unsettling. Especially when they 'can't tell you what's there, you'll have to wait for the doctor.' (triple bonus points if the u/s tech hasn't left her introduction to imaging techniques textbook on the counter of the room. That was just...not getting my vote of confidence. And was a different occasion from the air sucker.)

posted by hobo gitano de queretaro at 11:04 AM on November 11, 2012


I wish that they'd be more aware of mental illness and anxiety disorders. These are very much invisible, but a ton of stuff gets triggered in the doctor's office way, way, way before you get to the point where someone's demanding you get naked and let them touch your genitals. I've had good luck and terrible luck on this one; I'd have more stories if I was consistently able to get myself to make appointments and show up to them.

Probably the very best doctor so far is the one that's letting me come back again and again to get more comfortable before we try it. The staff have also have stopped asking me if I'm sexually active and now she personally asks about my mental health and what's been happening in my life lately. It's possible that if I do become sexually active, she'll find out before the therapist I see every week. She'd certainly find out before my psychiatrist. She's my primary care physician, actually - she manages all of my stuff other than the psych meds, and she offers input to my psychiatrist when she sees/hears something that she's worried about.

The worst ones are the ones that don't notice any of the several dozen clues (on high doses of multiple psychotropic medications, says "bipolar" and "OCD" and "agoraphobia" on the intake forms, jumped about two feet when you opened the door and three feet when you touched her hand) that I'm someone you should be freaking CAREFUL and sensitive around. When I say "I don't even hug close family members much and I rarely let anyone touch me at all except handshakes," that should give you an indication of how this is probably going to go down. If you are in clinical practice and you don't know how to handle a panic attack, I respectfully request you switch to research.

Doctors in family/general/not-psychiatric practices really need to be MUCH more aware of how many of us out here appear like basically functional adults - we have private insurance and jobs and decent clothes - but have severe, really important, affects-everything-yes-even-our-reproductive-systems issues. Like the friend I have with Bipolar I who is undermedicated (in close, weekly contact with multiple professionals) in order to have a baby. Or the three married/engaged women in my support group, all of whom have been hospitalized for severe manic or depressive episodes. Or the girl who's schizophrenic and living with a supportive boyfriend. We all go to doctors, and many of our doctors are oblivious to how psychiatric stuff impacts the entire experience. Lots of agoraphobic and OCD girls I know have never been to a gynecologist - I only managed it at the age of 28, and I only got myself there because I was really sure I was probably dying of cancer or something. It took me three years of constant struggle to get myself to make the appointment, and I had a panic attack the night before just thinking about it.

Oh - and for the love of all that is holy and wonderful and even merely adequate in the world, KNOW YOUR FREAKING DRUG INTERACTIONS, DOCTORS. I take four medications that interact with hormonal birth control in various ways. My psychiatrist literally says "this messes with your HBC, by the way." One of my doctors (the one who kept asking about sexual activity when I said explicitly I was a virgin and he'd seen my insides ten minutes earlier) didn't even bother to look at the meds list before writing the pill script; he still thought I was probably sexually active and emphasized that I should take it at the same time every day, but didn't mention that my meds mean HBC cannot be relied upon as my entire pregnancy-prevention strategy if I do have sex.

Luckily for freaking America, my pharmacist (who filled both scripts on the same day) DID notice this. I had to forcibly insist that my next pharmacist record all of my prescriptions (all but one of the psych meds are mail-order) before they noticed that I had this hugely significant interaction in place.

(Several other people I know have been under psychiatric and gynecological care for years and learned this in a support group, and not from any professional. I am quite certain if I'd been sexually active and less curious/independently capable of research, I'd have gotten pregnant. As it is, we have to be very mindful of this in terms of manic behavior.)

One good thing: I am a huge worrier. My favorite doctor moment ever was the one when my first gynecology exam ended with the doctor saying I had perfectly normal looking reproductive organs. Second favorite was when they looked me in the eye before and after and acted like the whole thing (including the panic attack and non-stop weeping) was totally normal and OK. Third favorite was when they asked me if I had any special requests and if I wanted to have the female nurse to hold my hand or stand way back and just watch. Fourth favorite was when the nurse said "don't worry, honey, you're not even half as bad as the worst stuff we've seen." They didn't even care about the blood. All of that happened on the same day - it outranks every other doctor experience in my entire life, and it's why I even can consider the possibility of maybe doing it again someday.

I strangely had that visit (my successful pelvic exam to date) at the sliding-scale private clinic that is next door to where you have to report if you are on probation/parole, and across the street from a big church that gives food to the homeless, and two blocks from the biggest hospital that takes Medicaid and Medicare patients in town, in the middle of the very poorest neighborhood in my city. I sort of suspect that doctor sees more people on psych meds and with abuse/trauma histories than any other single OB/GYN in private practice in the entire city. They didn't seem to take note of how I was dressed or my race or what my insurance was - and as far as I can tell, treat me or anyone there any differently from anyone else.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 11:07 AM on November 11, 2012 [6 favorites]


As a sidebar it seemed to me that doctor in this field can get very judgy and paternalistic, for some reason especially the female physicians; when it comes to children, birth control, and STDs.

Huh, funny you think this. I've had a bunch of OBGYNs -- no judgy women, but a couple of very judgy men.

Things I dislike:
* When I was in my twenties, a number of doctors seemed to feel free to express their opinions about whether and when I would get married, have kids, etc. I HATED THAT. The doctor's got access to information about e.g. my sex life for medical purposes, not because we're emotionally intimate and I want their opinions. Some were I think just wanting to be friendly and others were more Voice of God about it, and although the latter was worse I found both inappropriate.
* When I was a teenager I was unclear about doctor-patient confidentiality. (Didn't know whether the doctor was obligated to tell my parents certain things, or had the option, or was legally prohibited.) And, I was too young to take charge and ask. I would have very much appreciated a doctor kicking off our first appointment with a little briefing on this.
* I hate it when the OBGYN seems less than competent on the basics of their field, or lazy or cavalier, and I feel like I've seen a fair bit of that. When I'm being prescribed birth control, for example, doctors have said things to me like "practically everyone loves this one" or "I always start with this" or "I usually take women off this after about two years." And then when I probe for why I get unsatisfying answers, and it's obvious they're just basically winging it. Which: for Chrissake, this is science, not art. It's knowable.

Things I like:
* My current OGYN is great. Every detail of her practice is dead on: the staff are competent and discreet, the rooms are quiet and the music inoffensive, and the appointments well-spaced so I don't feel rushed. My OBGYN likes to explain things, and often gives me printouts on stuff we've talked about. And she is unfailingly complimentary and positive: this is really smart, because it means her patients won't feel the need to self-censor anything.

Of course the U.S. medical system is utterly broken: I am lucky to be able to afford to pay through the nose for her, because she doesn't take insurance. Although I have also had good experiences with Planned Parenthood and other feminist clinics, and that's where I'd go if I couldn't see my current OBGYN.
posted by Susan PG at 11:08 AM on November 11, 2012


For the sake of an example, one incident that particularly stood out in my memory was watching a NP strip the membrane of a late-term pregnant women without explaining what they were doing, why or even that it was going to be painful, right in front of extended family.


Yeah, I guess what I would say about OB care is that they should try not to treat women like they're pregnant farm animals. The general attitude (although my OB was usually not like this, he had his moments and I saw a lot of different docs for L&D emergencies/triage) was that you might as well be a pregnant cow for all they talk to you, explain things to you, or let you make choices.

So "treat pregnant women like they are people who understand human language and are completely in control of their own bodies at all times" would be my suggestion there. Not sure how you impose that on one clinic when the broader culture is to see pregnant women as walking, talking incubators for the almighty fetus.
posted by the young rope-rider at 11:16 AM on November 11, 2012 [2 favorites]


My birth control pills are WAY cheaper if I get them through my insurance's online pharmacy, but my ObGyn office can't interface with the online pharmacy. They have to write me a script every year and I have to mail it in. This may be a problem with my insurance, though.

My ObGyn's office has an aesthetician on staff and offers a lot of cosmetic procedures - botox, chemical peels, etc. etc. The doctors have never said anything - they just had ads in the lobby and sometimes send out promotional emails, but this still makes me feel really uncomfortable.

Not great: having to have a female in to observe when there is a male doc doing your pap smear always seems seems vaguely "We don't trust men even though they are doctors",

My female Gyn always has a nurse in the room during the pap smear.
posted by muddgirl at 11:29 AM on November 11, 2012


mudgirl: my doctors can't interface with the online pharmacy at all, and won't sign up for the fax system. This is 99% of the reason why I ever buy stamps.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 11:34 AM on November 11, 2012 [1 favorite]


Nthing the cold speculum.

I got my first pap smear right after I became sexually active when I went to see my regular doctor for something unrelated. He didn't bother talking me through the exam (and yes, a female nurse was there). It wasn't until I went to the Student Health Center at my Uni that I got to watch a film about it. Oh, and he scared the hell out of me by suggesting that I may have become pregnant because I might have been ovulating the last time I had sex. (Which caused me to skip a period because I was so freaked!)

I had one GYN who was a male and a total dick. Very condescending and outright rude when I told him I'd had a tubal ligation right after I got married. (Getting the TL is another can of worms entirely.)
posted by luckynerd at 11:35 AM on November 11, 2012


a thought re office decor: my gyn (who I love anyway) has pictures of her patients' babies pasted ALL over ALL the walls, like wallpaper. And poems that her patients have written about their babies, and all sorts of baby ephemera and trinkets. It's like a baby museum in there. As a woman who is childless by choice, this makes me feel un-celebrated, like I'm being excluded from some important Club. It makes me feel like I'm in the wrong place. I'm sure the effect would be downright depressing and offensive to women who did want a baby but couldn't have one. It's perfectly appropriate for a gynecologist to be enthusiastic about babies, but if it's too over-the-top it can make women without babies feel like oddballs or failures.
posted by Corvid at 11:36 AM on November 11, 2012 [13 favorites]


1. In the middle of a breast exam for a large suspicious lump for which I subsequently underwent a surgical biopsy (it turned out to be a fibroadenoma but nobody knew this at the time), my male gynecologist TOOK A PHONE CALL in the room and left me lying on the table with my breasts completely exposed while he stood a few feet away having a conversation of an obviously not-urgent nature.

2. In the middle of a pelvic exam, with her fingers actually inside my vagina, my female gynecologist turned to her nurse and said, "So, what are you doing this weekend?"
posted by HotToddy at 11:52 AM on November 11, 2012


I don't know what my last gyn hoped to accomplish by body shaming me while in the stirrups, but since she failed to burst into flame and I still have an unhealthy relationship to food - no one had a positive outcome.
posted by Space Kitty at 11:57 AM on November 11, 2012 [6 favorites]


When you go for a Pap smear and they tell you that they will call you with the results if there is a problem but not if the results are routine. I hate that. I'd like to have a phone call letting me know the results and not have to wonder if they just forgot to call.

Also: the whole scheduling process. Making multiple phone calls to make a single appointment.
Loud television in waiting rooms.

As others have said: cold rooms, inadequate gowns, long waiting times, assuming that patients could never have an education in the sciences.
posted by sciencegeek at 12:01 PM on November 11, 2012


When you go for a Pap smear and they tell you that they will call you with the results if there is a problem but not if the results are routine.

Not just for a pap smear. In general. When you do a test, call people and tell them the result. And if it was normal, LEAVE A MESSAGE.

I had a year-long recurrent yeast infection a while back, which I'm sure you can imagine was just fantastic for my sanity. Every, single, fucking, appointment, I was told that probably I was eating too much sugary food. Look, asshole, I have a sweet tooth the size of a planet, and I have been reining it in to try to shake this yeast infection, but thank you for telling me again that my diet is the problem. I know most patients aren't compliant, I get it, but I was and it was tremendously infuriating and upsetting to have my assertions questioned by my doctor.

It turned out quitting birth control stopped the YIs. Now that I'm pregnant, they're back. I switched to a new OB for pregnancy and got the same exact song and dance about diet. I know for a fact that my vagina reacts unusually to high doses of female hormones, and I'm going to go ahead and be a noncompliant patient and eat whatever I want, because I've already tried giving up carbohydrates to try to cure yeast infections and I know it doesn't work. And I know better than to even bother to explain that situation to a doctor, because I know they're sure they know better than me about my own body, and the second I start trying to assert otherwise I become "difficult". I have bigger fish to fry right now what with having to come up with a birth plan with these people. I have to choose my battles.

I also get the sense that not a whole lot of doctors have spent a year with a yeast infection because damned if I got more than one moment of sympathy from anyone.
posted by town of cats at 12:16 PM on November 11, 2012 [4 favorites]


I absolutely love my GYN, both as my GYN and as a caring person. In 2009, I had a medical emergency (due in part to her treatment plan for an ongoing condition, in concert with a rare condition nobody could have known I had) and over the course of the year had six hospitalizations and she had to perform two emergency surgeries on me. She bent over backward to make sure her nurse, her front desk staff and random doctors and hospital staffers treated me well...and on two occasions missed dinner with her husband and small child just to sit with me in the evening in the hospital when there were no family members available to keep me company. My doctor rocks!

That said, my general list of GYN-related grievances: treatment tables facing the door, a cold speculum, being kept waiting in the "little room" when you could have just as happily stayed (until necessary) in the big waiting room with other humans and reading material, and OVER-SCHEDULING. My doctor knows that I'll bring a list and be brief but methodical, and she's unfailingly thorough, but I know she's running late and pressed for time, and that makes me feel like I should rush.

I'd actually prefer paper gowns to cloth -- I'm not sure I'd ever trust a cleaning service over disposables. But my doctor's practice doesn't use paper gowns either, but a combination of a paper "jacket" (kind of like a bolero jacket, kept open at the front for the breast exam) and a paper drape. It's awkward -- my back is covered but only down to my waist, my chest is mostly covered, as long as I hold the jacket closed, and my tush his just hanging out there, because the drape isn't long enough to wrap all the way around me. Someone needs to fix that, pronto!
posted by The Wrong Kind of Cheese at 12:17 PM on November 11, 2012 [1 favorite]


i'm gonna be a certified nurse-midwife in a couple of months, and i just wanted to say that this thread is simultaneously helpful, and HORRIFYING -- i can't believe (i mean, i do believe them, but omfg) some of the experiences here. thank you everyone for sharing.

to share my crappy experiences; i tend to have meltdowns with speculum exams personally (when i'm getting them, not when giving them :P), and it's shitty when a provider doesn't even acknowledge that you're freaking out and doing your best to keep it together.

other irritating things; I totally get it when people ask for frivolous tests and how maddening it can be, but, when a provider tells me that I don't really need blah blah STD screening at my annual exam, I get pissed. trying to be responsible here.

providers being dumbasses: providers who've said that I had to get a pap smear to get birth control ... what a lying !@#@.

i had to go to an OB once in a pinch, and IN THE MIDDLE OF THE EXAM, told me that my parents must have been really disappointed in me for getting pregnant at 16 (why did I even write that on the form, ugh) etc etc. i really regret not reporting her to the board of medicine, whether or not that would have done anything.

for positive things - my best experiences have been at Planned Parenthood, which is where I prefer to get my exams done. the providers have always been personable, very professional, and respectful. like, I went in for a pap, about 2 weeks later I got a phone call and they told me that the state had mishandled my specimen, they were really sorry, and that I could come in at any time convenient for me to get it done again, I didn't need to make an appointment, and the visit would also be free for me. I was so broke at that time. I don't think other offices would have done that.
posted by circle_b at 12:17 PM on November 11, 2012 [2 favorites]


One GYN I went to had two oven mitts on the stirrups. It made me laugh and feel at ease.

I hate having to give a urine sample at my doctor's office because there is no where to put anything down near the toilet, no hook for my purse and the trash can is on the other side of the room. It is too many things to hold onto at once for me and I never feel like I get a clean catch.

My doctor's office calls whether pap results are regular or irregular. I love this. One place I went to didn't call, they sent postcards that said "your test results are normal." This was horrible!

I love it when my dentist explains what he is about to do, how long it will take and why. All doctors should do this!
posted by dottiechang at 12:19 PM on November 11, 2012 [1 favorite]


Never actually encountered this, but I always thought it would be a good idea to have a little sign on the doorknob of the exam room, like the ones in hotel rooms, that you could flip when you were in the gown and ready. Nothing like scrambling into the gown at warp speed because you have no idea when the doctor is going to come in.

Failure to explain the way a medication works and what I should expect. Impatience when asked questions about medication.

Judginess about lack of sexual activity happens, and is weird. As a general rule, nobody needs attempted psychological counseling from their gynecologist.

I've really appreciated when I've been given sufficient time and supplies to clean up after the exam.
posted by ostro at 12:25 PM on November 11, 2012 [2 favorites]


I'm intersex by birth; I was female-assigned and transitioned to male well into adulthood. I could write a novel about all of the alienating and uncomfortable and downright humiliating interactions I've had in the ob/gyn realm . . .

But let me just urge you to remind ob/gyns of this: some of your patients are born sex-variant, and some of your patients will be trans gender. Be prepared for that, and by all means educate yourselves--but don't presume you can use our visits as an opportunity to treat our bodies as teaching tools for the clinic staff. It's interactions in which we feel we're treated like exhibits in a freak show that drive so many adult intersex and trans people from seeking medical care.

Just treat intersex and trans people with respect. When treating intersex patients, don't presume that we need surgical or pharmaceutical treatments that might enhance fertility or reduce genital variance--ask us what we want. Treat us for what we came in for. When treating trans patients, respect our gender identities, and be sensitive to the needs of men who are visiting an ob/gyn. Reduce the awkwardness of the situation as much as possible--both for our sakes, and for those of other patients. (If you send a trans man to sit in a waiting room for a test wearing a floral gown and sitting in a room full of similarly partly-clad cis women, it has been my experience that the cis women are just as uncomfortable as the trans man.)

Just remember that just because you are an ob/gyn doesn't mean you will only be treating women. Intersex and trans patients will be party of your patient pool.
posted by DrMew at 12:27 PM on November 11, 2012 [12 favorites]


Oh one more bad and I think a lot of women experience this:

I get that as a doctor you are concerned about my being overweight and how it may play into my reproductive organs. When you, a stranger, are putting a finger inside me it is not the best time to ask "So what are you going to do about your weight?"...
posted by kanata at 12:36 PM on November 11, 2012 [4 favorites]


From a commenter who prefers to remain anonymous:
The first time my endocrinologist sent me to get an ultrasound from ob/gyn to check on my ovaries (I have PCOS), I had no idea what it would entail. I sort of assumed that something would get swiped on my belly with cold jelly, and that they'd tell me what to expect before getting started.

Instead, I had what basically amounts to a dildo shoved into my vagina without so much as a by-your-leave or here-goes or by-the-way-this-will-involve-penetration warning at all!

I felt furious and violated and freaked out. I mean, hell, this goes straight onto on my "I've never been raped, but..." list!

I switched doctors right after that, to a nice guy who doesn't mind at all if I ask questions and warns me before he does anything involving my bits, each and every time.
posted by restless_nomad at 12:49 PM on November 11, 2012 [2 favorites]


Oh god yes don't weight shame your patients. In addition, don't assume that problems they have are just because they're fat and dismiss symptoms of serious problems.
posted by winna at 12:51 PM on November 11, 2012


It drives me nuts that my ob/gyn's office steadfastly refuses schedule an annual exam less than 365 days after my previous annual exam. This means that over the years, the date of my exam has slowly and steadily drifted deeper into the calendar which now puts me with having an exam in the middle of the holidays. Ho ho ho.

So, mostly love my ob-gyn but dislike her office staff/policies.
posted by jamaro at 1:24 PM on November 11, 2012 [2 favorites]


I'm a doctor, also a woman, and I do pelvic exams as part of my job.

I agree, having the tables facing the door is a common problem in exam rooms - I often have to use exam rooms for pelvic that were not designed for this, and if that is the case it is very important to pull any available curtains (so someone opening the door will see the curtain) or put a sign on the door saying do not enter, or put a nurse at the door telling people not to come in.

I also notice that a surprising number of nurses, med students, etc. are not sensitive to trying to keep patients covered. I think the attitude is that "they're here for an exam, we should be able to expose/look at their bodies as much as we need to". Yes, we're medical personnel and this should be professional and it should be ok to be naked in front of us, but patients still appreciate if you don't just throw back the blanket or sheet that's covering their naked genitalia - I always try to keep them draped with the sheet or blanket at least to their knees, even though you have to be a little more delicate this way than if you just push the blanket or sheet all the way back off the legs.

Another thing I do which I hope women appreciate (not sure because I am not the sort of woman who is particularly sensitive about pelvic exams) is that I always warn them before I touch them with anything, and I always try to touch them with my hand or fingers first, instead of having the first thing that touches them be a speculum covered in cold jelly. I'll say "you're about to feel my hand/fingers touching you" and I'll touch either their inner thigh or labia lightly. "Then cold jelly, and some pressure". You can get a sense of how nervous a woman is about an exam by how close together their knees are as you approach them, and if the knees are really tense and closed up, I'll touch higher up the leg and say "try to relax your knees out to the sides". I think the approach part is important, once the speculum is in then the key things are to focus on what you're doing, don't say anything like "hmm", or "that's funny/weird/interesting", only talk about what you're doing and what you're seeing if you can put it in plain, reassuring language - and get it done fast.

I've read many of the comments so far, because I want to be aware of what patients feel about these exams - I have to admit the ones about being heterocentric really struck a chord as something I need to improve upon. My comments on the above:
- If a male is doing the pelvic exam (or even if a female is doing it, but especially for a man), they should always have a chaperone in the room. This is for both of your protection. There have been instances of healthcare providers sexually assaulting patients, and there have also been some cases of healthcare providers being accused of/sued for sexually assaulting patients when that has not happened - a third party must be present if at all possible.
- If an OB/GYN makes a reference to a woman potentially changing their mind about not wanting children, keep in mind that OB/GYNs see women who HAVE changed their minds about not wanting children all the time. And the reason they see those women is because they subsequently may suffer from infertility problems or because they desperately want to try to reverse a permanent birth control method, like tubal ligation, that is very difficult to reverse. There is legal liability here as well. Anytime you are probably permanently removing someone's fertility there is huge liability. I definitely recognize that this is not the context of all comments about "you'll change your mind/you're going to want children" and I am sympathetic to that, too.
Sorry to those who have had bad experiences on behalf of my profession.
posted by treehorn+bunny at 1:28 PM on November 11, 2012 [14 favorites]


I can say that I had one positive experience in a clinic in St. Louis, in which both (a) the sample cups in the bathroom were in a little basket in a pleasant space, rather than teetering on the back of the toilet in an industrial stall, and (b) the gynecologist did the exam and then met you back in her office *after you were dressed,* thus intentionally removing that strange and counterproductive inequality created by white coat versus nakedness dynamic.

Otherwise, yes, with a metal speculum, can't you at least warm it with your hands before use?
posted by acm at 2:30 PM on November 11, 2012


A lot of women are afraid of having a hysterectomy, or they've heard for years that the medical profession likes to encourage a hysterectomy when none is needed. When I had fibroids, I waited a long time before having the surgery. I was worried about infection and complications. Several of my friends (young than me) have now had hysterectomies, and we all say, "I wish I'd done it years earlier." If you can recommend informative, calming websites with accurate information, it could really help a lot of your patients. You can't spend much time on it at the time of the annual exam, but you could suggest that a woman make another appointment for a 10-minute discussion.

When my gynecologist recommended a hysterectomy, my immediate reaction was, "I'm afraid of surgery." She was understandably busy, but her response didn't need to be, "OK, keep the fibroids."
posted by wryly at 2:43 PM on November 11, 2012


I was once already on the table, feet in stirrups, etc., and the physician walked in the room with a male med student, and without asking me, proceeded to guide the med student's head between my legs for a close look. So if you're a doctor, my advice is to ask before you do something like this. Oh, and if you're the med student in this scenario, say hello before taking a close look at someone's body.
posted by analog at 2:59 PM on November 11, 2012


If an OB/GYN makes a reference to a woman potentially changing their mind about not wanting children, keep in mind that OB/GYNs see women who HAVE changed their minds about not wanting children all the time. And the reason they see those women is because they subsequently may suffer from infertility problems or because they desperately want to try to reverse a permanent birth control method, like tubal ligation, that is very difficult to reverse.

The thing is, you aren't telling us anything we don't already know, and haven't heard 50 trillion times. It's obvious that some women will change their minds (in both directions, actually), and yet the entire culture yammers on incessantly about how we absolutely all will eventually want children --- our family members tell us that, our friends, teachers, religious leaders, bosses, women's magazines, movies, TV shows: it's a total cultural stereotype.

When my doctors used to patronizingly tell me I'd change my mind "when I got older," I was not asking for a tubal ligation. I was just answering a question they had asked me. And I was right, because I knew myself better than they knew me.
posted by Susan PG at 2:59 PM on November 11, 2012 [5 favorites]


I only ever got the "you'll change your mind" dreck when inquiring about IUDs which I knew were often prescribed to childless women. One doctor told me (in 2009) that IUDs are "dangerous" and "never prescribed anymore." The other told me that she would not insert one in an unmarried woman--I'd been in a monogamous relationship for 8 years and was engaged.

(I changed my mind, but it wasn't really relevant to what I was asking.)

I'll add that any comment about my tattoos other than "That's pretty" has generally felt inappropriate. It's bad enough that I get lectured about tattoo removal from my dermatologist when I get my moles checked, but I don't really want to deal with it from my OB/GYN.
posted by PhoBWanKenobi at 3:04 PM on November 11, 2012


I'm surprised no one has brought it up already: I will never, ever see any sort of healthcare professional who requires a pap test for a birth control prescription. Pap tests are optional cancer screening, and they don't have anything at all to do with birth control or ANYTHING other than cervical cancer. The only test needed for hormonal birth control is a blood pressure check. If you want a pap test for a birth control prescription, then you're manipulative and dishonest, and I don't want to be in the same room with you, let alone trust you with my health.
posted by Violet Hour at 3:05 PM on November 11, 2012 [7 favorites]


My male ob/gyn was great, particularly due to my PTSD issues. He was always very explanatory as he did anything and he didn't do any more than he needed to.

I guess one thing that really stuns me in these conversations is just how interventionist the US seems to be. I get a pap smear every two years and only for cancer checks. I've had one breast exam ever. During pregnancy I had an internal exam twice - once to check my cervix and apply the induction gel, the other to determine that yes, the baby's head was RIGHT THERE.

I have to second the whole openness thing - my daughter had an ovarian cyst in utero and my obgyn had never seen that before. So between visits he researched and rang specialists and was able to give me information and recommendations for paediatricians with experience (aka NOT the one who recommended a 32 week c-section). It was reassuring that he had read up on it AND discussed it with other professionals and formed his own opinions, rather than just accepting the recommendation of the first person he came across.

His staff varied though. I waited until I was 14 weeks before getting an ob (didn't know any better) and every single receptionist either took me to task for it, or just wouldn't accept me as a patient once they found out I hadn't screened for Downs Syndrome either. His office did, but only after the receptionist said "well, if you didn't have a 12 week scan how do you know your baby is still alive?" - which was wonderful to hear on my 7th try at getting an obstetrician, on my lunch break, at work, in a pregnancy where I'd had bleeding on and off for the first few weeks. But, when I told my ob about it, he asked a few details about when I called so her could chat to his staff.
posted by geek anachronism at 3:11 PM on November 11, 2012


I had to add this - hasn't happened to me, as far as I know, but wow! Pelvic exams while under anaesthesia.
posted by analog at 3:17 PM on November 11, 2012


Oh man I totally forgot about the worst gyn-related advice ever (from an NP, admittedly, not the doctor.) If you have a patient with athletic-related weight loss, do not tell them that "you know, those birth control pills won't help your bone loss, so you can stop now if you think they'll save you" (still have no idea where that came from) and do not tell them that gaining weight will help them in the cleavage department while looks disparagingly at their boobs. Worst advice ever.
posted by jetlagaddict at 3:23 PM on November 11, 2012


I adore my OB-GYN, and could give a long list of all the things she does right, but they seem to be well covered in this post.

On the negative side, I have a history of missed miscarriages (fetal heartbeat stops but no bleeding or other sign of miscarriage - basically, you go in for your routine ultrasound, only to learn your baby died, and because it hasn't self-expelled you need to get a D & C to remove it). I was shocked to find out that she did not do D & C's, even in the case of miscarriage, because the anti-abortion crazies made it impossible for her to get reasonably priced insurance to do the procedure (and this is in a seriously liberal city and state). I had to find an abortion provider (which took several tries even based on her referral list, because apparently this is a common issue), and schedule the procedure myself, which is very hard to do when you're still grieving. I was also surprised that it took my insistence to schedule my followup appointments after the D&C's to be early in the morning to try and minimize the number of pregnant women I would have surrounding me in the waiting room - I expected more sensitivity.
posted by Mchelly at 3:28 PM on November 11, 2012 [3 favorites]


I was thinking more about the intangible but really positive experience I've had since switching from my pcp/gyn to a reproductive health clinic. A lot of it's been covered, but a couple of things I didn't see yet:

- The bathroom has a little passthrough window where you leave the urine sample so you're not wandering around the practice carrying pee.
- Nice paint colors, it doesn't feel like a clinical space.
- Separating out abortion days from other days so when I go for well-woman care, I'm not wading through protestors, security guards, bag checks, etc.
- *Asking me* what I want to do where feasible, e.g., did I want a cervical block for my IUD insertion? (YES, yes I did.)
- Not much waiting time, cloth gowns in large sizes, ceiling decoration, etc. Covered above.
- Flip side of what someone said above about wanting calls rather than mailed test results. I'd hate calls! If you don't need to see me, please just send me a form letter saying everything's cool.
posted by Stacey at 3:46 PM on November 11, 2012


I just don't want it to take any longer than it has to. Feel my boobs, ask me to put my feet in the stirrups, swab, and let me get dressed. Come back after for questions. My massage people get this, I would like my doctor to get it too.
posted by dame at 3:58 PM on November 11, 2012 [1 favorite]


From my own recent experience:
- If you notice something unusual during an exam or procedure, let me get cleaned up and dressed before we discuss it in detail. Don't make the only time I'm able to talk to you while I'm lying on the exam table with my feet in stirrups.
- Don't have a Bible prominently displayed in your exam room.
posted by beandip at 4:53 PM on November 11, 2012


Waiting a long time alone after you're already naked with your paper blanket.

This.
posted by radioamy at 5:15 PM on November 11, 2012


[Folks, you need to be answering the OPs question and not having some fight with someone not in this thread, please.]
posted by jessamyn at 6:06 PM on November 11, 2012


it seemed to me that doctors in this field can get very judgy and paternalistic

This, this, this damn them. When I was younger, I was too inhibited to talk back. Last time a doctor pulled that shit, I waited till the very end of the exam, and then told him I wanted to speak with him in his office. Read the riot act, and told him I was voting with my feet outta there as well as telling every woman I know that I wouldn't be recommending him. He was livid, and I didn't/don't give a rat's rear.

Big FU:

...To the asshole who told me I couldn't have a tubal, because "what if my husband divorced me, and a potential new husband might want to have children?" What I should have said was fuck'em, and fuck you doc. I am not any man's broodmare. If they have delusions of marrying me for my uterus, then I'm outta there. I don't care about your Mormon or Catholic religion, and I don't want to know your scruples.

...To the asshole who told me that he was certain I had gonorrhea "because it was going around" when I presented with PID. The same AH and his nurse kept quizzing me for three days about STDs and denying analgesics even after my gut shut down from pain, and I wound up with a nasogastric tube. I'm pretty tough--Had broken ribs and collar bone with collapsed lung, been shot, had ruptured appendix, 2 back surgeries and a knee replacement--but PID was the most horrible thing I've ever been through. Three days into a seven day hospital stay, when the results came back negative, they never said a word of apology. By then I had a specialist who was on my side and told them to take a hike.

Peeves: men and women who have no empathy or are rough and abrupt. Tables that face the door. Being put on exhibition for everyone and the janitor to look at the 'bits' without asking or introduction.
posted by BlueHorse at 6:07 PM on November 11, 2012 [1 favorite]


Good things: Being told what is going to happen, for example "I'm going to insert a finger now," etc. That same doctor remembered me from visit to visit, and always spent lots of time talking to me, listing to me, and figuring out the best options for me.

Bad things: My good friend in college once had a gyn tell her she was a "good girl" because she hadn't had sex yet. UGH SO AWFUL. She had gone to the gyn to get birth control, but she didn't ask him for a prescription - she went to another doctor instead.
posted by insectosaurus at 7:20 PM on November 11, 2012


Things I liked
- When I asked about birth control for the first time, she listened to the specifics of what I wanted, and warned me about the downsides of each option. For example, the injection thing couldn't be reversed if the hormones disagreed with me, and an IUD would be painful to put in. She didn't assume that I was planning on kids soon - it was things like acne, mood changes and bleeding that she mentioned.
- She didn't judge me about my sex life, and trusted my answers about it.
She's also my GP, and I like her matter of fact attitude and how she tells me the truth and treats me like an adult.

Not so great
- The room the practice used for surgical type stuff - like getting an implant (Implanon, in my arm) was cramped and communal. There was a GUY I KNEW in the same room, separated only by a curtain. She couldn't do anything about it, but the lack of privacy sucked.
- The practice's records kinda sucked. I lost my record of the date I had a certain thing done, and called them. It took a lot of phonecalls for them to dig out the paper record and let me know when I had to have it done again.
posted by Ashlyth at 7:41 PM on November 11, 2012


For the sake of an example, one incident that particularly stood out in my memory was watching a NP strip the membrane of a late-term pregnant women without explaining what they were doing, why or even that it was going to be painful, right in front of extended family.

On the OB side of things specifically, I noticed a lot of assumptions - on both sides - of "of course you are going to have an entirely 'natural' birth process because anything else would be irresponsible to your precious baby" and "of course you are going to have every medical intervention possible because anything else would be irresponsible to your precious baby".

I had an OB who I'd never met who was filling in for my midwife at my 39 week visit who just assumed I would want her strip my membranes and I was somewhat horrified and said no, that I had no reason to do so and wasn't going to.

Before a provider touches a pregnant patient, especially a late-term patient, s/he should at least ask some basic questions about what the patient's wishes/plans are regarding the birth, even recognizing that those plans can and do change along the way.
posted by judith at 8:02 PM on November 11, 2012


I have had mostly good OB Gyns though the ones at my sons birth were assholes. Anyway, re exams I have a small quibble; Why is there never anywhere to put the clothes you are taking off (don't enjoy displaying my undies) and seldom anything to clean yourself with? That gel is messy. In general I have seen NPs and liked them for routine stuff.
posted by emjaybee at 8:15 PM on November 11, 2012 [1 favorite]


A tip for larger ladies: Take two gowns from the basket. Wear them both! One like a regular hospital gown with the opening at the back, and one over the top like a jacket. I got strange looks when I did this at a recent x-ray but damned if I was going to walk out of the changing room with my rear hanging out.

Add me to those who wish doctors would provide gowns in a range of sizes.
posted by Georgina at 11:25 PM on November 11, 2012 [1 favorite]


Repeating a few things, but figured you'd want as much input as possible...

Dislikes
  • Throwing medicine at a recurring problem without any bother to determine the cause. Storytime: I've had recurring yeast infections for over two years, and at my original GYN, they always just shrugged it off and prescribed the same meds over and over. They had no interest in helping me discover what might be causing it, and refused to talk with me about it because "it just happens, you'll eventually get over it" (turns out, it was the type of lubrication I was using and type of underwear I was wearing - easily treatable - but it took "firing" my original GYN and seeing a PA at my primary care doctor who had done lots of GYN-type work before and was willing to walk me through many ways to narrow down possible causes).
  • GYN who tries to talk me out of getting regularly tested for STDs (every six months) every time I ask. I only get them because I fight for it each time.
  • GYN and nurses who frown at my sex/girly-bits/partner(s) questions and answer disapprovingly, instead of providing clear, non-judgmental, medically-based answers.
  • Making me wait forever in a paper gown. I much prefer to be clothed or at least in a cotton gown for as much of the appt as possible.Also, those two-part vest/sheet things? Terrible.
  • The fact that I have to explain terms like "queef" and "menstrual cup" really bothers me.
  • Administrative/front-desk people who gossip loudly and often, and look irritated when you walk up to sign in or check out. Also, overly excited, bordering-on-creepy friendly receptionists. And please don't use diminutive pet names - I am not your honey, sweetie, or "young lady."
  • Lack of tissues in the room after the exam when I'm changing back into my clothes. Don't make me search for tissues and/or gauze in the drawers/cabinets, please.
  • Seconding this quote from A Terrible Llama: I hate their condescending attitude, their default belief that I'm less intelligent than they are, that I can't understand science or biology, their dull, rote, prescriptive, knee-jerk responses to most common problems, the finger-waggling, and the quiet attitude that I am a child who must be monitored, poked, watched, distrusted, lectured to, questioned but never talked to and that my body is something to be managed that will fall apart if not for their supervision. I also find them fairly stupid, or at least, so incurious about the latest thinking in their own goddamn profession that they might as well be stupid.
  • Jessamyn's comment: Not great: having to have a female in to observe when there is a male doc doing your pap smear always seems seems vaguely "We don't trust men even though they are doctors" if it's for my benefit, I don't like it. // (I did read treehorn+bunny's comment regarding this, though, and understand the reasoning, and very much appreciate her response to the thread!)
  • Muddgirl's comment: My ObGyn's office has an aesthetician on staff and offers a lot of cosmetic procedures - botox, chemical peels, etc. etc. The doctors have never said anything - they just had ads in the lobby and sometimes send out promotional emails, but this still makes me feel really uncomfortable. // HUGE deterrent for me. In the same vein, ads for vaginal rejuvenation in the waiting area are telling me that yet another one of my body parts doesn't meet someone else's standard of perfect. Okay to bring it up with your doctor, or have him/her initiate a discussion about it if appropriate, but is it really appropriate to advertise in the waiting room?
Likes
  • When the nurse/GYN talks to me beforehand about what they're looking at/for, and I dislike small talk about my hobbies and such, unless it's related to the questions I have for my GYN. While being examined, I much prefer a talk-through of what they're doing, rather that personal small talk.
OP - If you do write something up based on all of our responses, would you be willing to post it for us to read? Also, could we share it with our medical providers?

I'm tempted to send them this whole thread anyhow. :)
posted by evolvinglines at 12:11 AM on November 12, 2012 [2 favorites]


Surprising but positive experience during a pap:

My regular doctor (whom I quite like--she is compassionate and does a good job during internal exams) had a med student working with her on the day I came in for my pap smear/exam. She asked if it was OK if he observed the exam (and said that there was no pressure to say yes, and she'd completely understand if I said no). I figured it was probably a good thing if future doctors modeled themselves after my doctor during an internal exam, so I said sure, he could observe.

My doctor did the exam, explaining everything as she went. At one point she paused and said to the student, "In med school they tell you that women don't have nerve endings in this particular part of their bodies [wish I could remember what it was--the cervix?] and so they won't feel pain when you are doing this part of the exam. This is true for some women but NOT ALL. I want you to know this so that you understand it can be uncomfortable or painful for some women."

I was so impressed by that.

So I guess the point I'd like a doctor in training to take away from that is--the procedure you're doing that you were told in med school doesn't hurt? Well, sometimes it does hurt some women. So proceed with that in mind, and believe us when we express discomfort or pain.
posted by Secret Sockdentity at 1:25 AM on November 12, 2012 [3 favorites]


So my last pap smear--and I've been getting these done for the past 13 or so years now and hate them desperately because it's never a good experience--but this last one was the worst. I'd made this appointment ages in advance because that's the only way you can get one but still had to wait two hours to be seen by anyone. When I did, she was very reticent and I felt like I was an inconvenience, but no matter, I just wanted in and out as quickly as possible.

The room had a curtain that pulled halfway across and I was told to go behind the curtain, change, get on the examining table and shout out when I was ready while she stayed on the other side of the curtain. The exam didn't take that long because she didn't bother to do a breast exam. She finished, and told me so. I stayed where I was, waiting for her to leave. She repeated, very annoyed, that I could get dressed now. So I slowly got up, removed my paper gown and got dressed while she stayed at the exam table cleaning up, a few feet away from me. Not sure why I was given a small amount of privacy before the exam but not after.
posted by Polychrome at 2:30 AM on November 12, 2012


My OB-GYN meets with me (still clothed!) in her office before the exam to discuss any issues, etc. That's nice. It's hard to remember what I wanted to talk about when I'm sitting on a cold table, naked. She has cloth gowns instead of paper. She has evening appointments.

One issue I have with her though: at my last exam, she found a mass in one of my ovaries (this turned out to be a an enormous ovarian cyst). All my exams had been fine before. She told me she wanted me to get an ultrasound, left the room to write me an prescription for it, handed it to me and basically ran out of the room. Um. I then freaked out for a week until I had the results. I even asked her straight out, "WHAT ARE YOU CONCERNED ABOUT?" and she didn't answer me. Then when she had the results of the ultrasound, she acted like I was dying, even though she knew the cyst was non-malignant. She really acted like she was giving me the worst news imaginable. When I met with the surgeon she referred me to, he was much more matter-of-fact and was like, "We do these surgeries all the time, it's no big deal, you'll be fine." (Which I was.)

So, while I appreciate that my doctor was feeling empathetic toward me (I'm young, I want to have children, the health of my ovaries is important to me, etc.) and didn't brush me off, the fact that she approached my diagnosis with such obvious dread, was very upsetting to me. I responded far better to the surgeon who approached my issue as a fairly simple medical issue to be resolved.
posted by Aquifer at 3:48 AM on November 12, 2012


Being dismissive, or basically not seeming to have read my file at all. Pap smears and that sort of thing are already so hideously uncomfortable that a dismissive, rude, or irritable doctor can really push a person from "guh I'll get it done" to "hmm...maybe in a few months." Especially in a young person. At least in my experience.

One thing I appreciate is being asked if a trainee or some other random person can watch a procedure, before that person is in the room. I am usually glad to help but I think it would be much harder to decline if I wasn't in the mood if the bright-eyed and bushytailed new person was standing there gazing at me with puppydog eyes.
posted by ZeroDivides at 3:54 AM on November 12, 2012


After the exam or speculum-related activity, give me a towel so I can wipe the lube before I get dressed.

Don't amount-of-sexual-activity-shame me, whether you feel it's too much or too little.

If you feel a lump somewhere and don't think it's anything I need to worry about, take the time and explain why, especially if I'm getting visibly upset. Don't make me fight for a script for a sonogram/mammogram if I'm too young for mammograms. (This happened with a GP, but since OBGYNs do breast exams, it bears mentioning.)
posted by SillyShepherd at 4:23 AM on November 12, 2012


One of my friends had a gyno who told her, out of nowhere, that my friend was so horribly overweight she could never carry children. My friend had gained a small amount of weight due to smoking cessation. Lot of things wrong with what this gyno did, but here are the two biggest:

1) My friend is not significantly overweight. She may have a higher BMI (which is a dubious metric anyway), but her weight is acceptable for her height and frame. She is quite tall, big-boned, and very big-boobed.

2) My friend is a recovering anorexic/bulimic and that is noted in her records. This incident sent her on a months-long spiral of "oh god, a gyno told me I was so fat that my body can't even perform natural functions, I knew I was disgusting and awful".

Even if she HAD been dangerously overweight, the way her gyno handled this was unprofessional and awful.

On the other hand, my gyno is almost perfect. She's courteous and sweet, she never talks down to me, she always makes sure I'm comfortable, and she has never made me feel weird or bad about my history. I'm grateful to have been referred to her by my primary care doctor -- who sends his wife to her, as well.
posted by Coatlicue at 7:50 AM on November 12, 2012 [1 favorite]


As others have said, some of these have already been mentioned but they bear repeating:

- My first gyno was the one my mom had seen, and who in fact had delivered my older brother. He was old-school and Dutch and didn't mention the rectal exam until the second he started it, despite it being my first visit and me being horribly uncomfortable. I was maybe 15, and that freaked me out pretty well.

- After he retired he was replaced with a lovely young female doctor who updated the office (electronic records! fancy!) and even put fun stuff to look at over the exam tables. She came in to talk to me while I was still dressed, answered questions thoughtfully and patiently, and then left for me to get undressed. She narrated what she was doing and why. A-double-plus.

- When I moved away I picked my office arbitrarily for its location equidistant to work and home. My first doctor there was fine, but after my missed miscarriage (as Mchelly explained above) I switched to another doctor there, with whom I'm much more comfortable. He was the first one available the day after I discovered I was miscarrying (at urgent care, which sucked) and he was very sympathetic from the start, which helped, and talked to me like an adult. When my husband asked a question, the doctor responded to him instead of talking to me and pretending my husband wasn't there. He explained why he recommended that I have a D&C but when I told him how afraid I was of being put under, he was immediately reassuring that it was my decision and we'd go with whatever made me most comfortable. Best of all, when I decided to do the procedure, he himself was the one to perform it, as he works part-time for my practice and part-time for a major hospital nearby. That helped a lot with my comfort level.

Various things that have sucked, either from medical staff or office workers:
- Assuming that because I am a foster parent, I am a) religious, b) unable to have children of my own ("So which side is the infertility on?" - a new member at my PCP's office, who I will never see again), or c) interested in explaining all of my life choices that led to this point WHILE I AM NAKED.
- Telling me the test results or levels or whatever "are fine" without telling me what, exactly, they said. What were my hormone levels, and what does that indicate? This was especially shitty after the missed miscarriage, when the urgent care place called me to tell me that my hormone levels indicated that I was "very pregnant" when I was ON MY WAY HOME from the D&C. They didn't tell me the actual numbers, which meant I had to call them back to ask for the specifics later when my head was more clear.
posted by SeedStitch at 12:21 PM on November 12, 2012


One more anonymous anecdote that blew my mind, then my closing thoughts:

I had my first visit to my (male) gyno when I was 13. It turned out that I had an irregular hymen and had to have it surgically removed (hymenotomy) so that I could have my period. At least, that's what was explained to me. After recovering from the surgery, I found that I couldn't insert a tampon, and attempts were super painful (I couldn't before either, but that at least physically made sense). So I went back and asked him, since I no longer had a hymen, why couldn't I do this? As it turned out, he hadn't removed all my hymen. Why? When I asked for more clarification, he euphemistically explained that this way, I would still have the "normal virgin experience". I actually can't remember his exact phrasing, maybe because my mother lost it at him at this point. So, while it sucked to realize that my already semi-traumatic vaginal surgery wasn't performed as originally dictated due to paternalistic norms of purity, it was great to watch my mom model some first-rate feminism.

Well, I was hoping that my experiences with this medical practice over the last several months were unique. But it appears that a lot of this painfully obvious, and yes, horrifying stuff happens far too frequently for a profession that so readily cloaks itself in the auspices of science. I'm not sure what's going on, to be honest, because this is very indicative of a much larger problem in the United States. I can say I have lost a great deal of respect for doctors, which really saddens me quite profoundly.

But there's great advice here, from the sublime (art on the ceiling, fantastic) to the seemingly criminal (explanation of what's going on medically, side effects, follow up including calling with test results should be an absolute given).

I will share my results and formal recommendations on the blue as part of a larger project on medicine in the United States, but unfortunately I am not even sure if they will have any direct effect at this practice. After all, they literally refuses to discuss pricing with patients at the current time. Not their problem, apparently.

After some reflection, I can see that I was brought on because there is a superb level of dysfunction at this practice, but honestly this may be beyond my ability to fix. I don't know why medicine allows itself to be regulated so heavily by private insurance & billing corporations but balks at any thorough federal standardization of practice. I thought I was fairly experienced and knowledgeable with the real-world practices of the other medical disciplines but have really been blown away by OB-GYN.

Self regulation is pretty clearly not effective even in this high prestige, high income field.

I see medicine as essentially very fancy customer service but after visiting all 15 locations the doctors seem to have gone out of their way to hire blatantly disrespectful staff that readily adopt the us vs. them mentality that some of the practitioners use. I'm somewhat shocked that an average telephone queue of 5-10 minutes anybody would bother to come back to this office.

It would be hard to reform this office when so many of my suggestions are basically asking that the practitioner attempt to give a shit about doing their job well and follow the professional recommendations of their respective accrediting agencies, and outline it with specifics.

One area that concerns me is the huge gap in the abilities of the mid-levels (nurse practitioners and PAs) since their field is in some kind of legislative regulatory limbo right now, which is not helped at all when they constantly misrepresent their level of training and capabilities and the doctors go along with it since it increases patients seen per hour. But I'm not particularly impressed with the doctors either, as they definitely do not all attempt to keep up with the current literature (how is that even legal?).

Today I caught a NP documenting that a rather serious treatment, side effects etc had been explained to a patient despite the fact that they did not share a common language and there was no interpreter present. (???) She was not even correctly able to identify the language the patient spoke. I'm pretty sure that is directly illegal but there wasn't even a discussion of whether that was a firing offense. I can't even talk about billing "errors" at this point without losing it.

When it all seems to come down to money for these guys I'm not sure how far outlining the ways for them to do a better job but I'm giving it my best shot. I guess a better question would be why do doctors and other high level people in the medical field go out of their way to not care about their patients more, but I'm not sure anybody would be able to answer that to my satisfaction.

The excuse I keep hearing is that well, we don't have time for that, we only have 12 minutes budgeted per patient. But apparently, they do have time to come in an hour later than the posted opening time, take a two hour lunch and bounce at 4PM with random days off and their salaries are ludicrous in my humble opinion. With an example like that I can see why the support staff doesn't feel any incentive to go the extra mile.

But I am very grateful to the extremely gracious people who shared their stories, I know it will be very useful to a few of my friends who are currently training to practice medicine. Hopefully it will raise awareness for some others as well.

It's certainly given me a lot to think about. My heart goes out to all the people who have had such miserable experiences with medicine in this country, as well to the doctors who do go that extra mile for their patients.

Thanks again for all your help, metafilter.
posted by hobo gitano de queretaro at 8:33 PM on November 12, 2012 [4 favorites]


Everybody gets a best answer! yay!
posted by hobo gitano de queretaro at 8:48 PM on November 12, 2012 [2 favorites]


I think most Americans would be blown away (mostly pleasantly) by GYN care in the UK:

--No stirrups for pap tests, no paper gowns either (you can just wear a long skirt or whatever)
--Generally no pelvic exams for asymptomatic people, since pap tests are done by nurses, not doctors (they just run the swab--no feeling the uterus or ovaries)
--Pap tests not recommended until age 25, and only every three years; only every five years over age 60
--No manual breast exams for young, asymptomatic people; mammograms recommended starting at age 50
posted by Violet Hour at 5:27 PM on November 13, 2012 [1 favorite]


To expand a little bit: from my brief experiences in the clinic, as a dude I find the whole process simply horrifying and unimaginable, so when starting this project it was a bit overwhelming to decide on which particular part to focus on improving.

I actually find this attitude a little saddening and hurtful, at times-- it's the same as when any man talks about the unimaginableness of getting a period, or giving birth, or whatever. I'm actually pretty comfortable with pelvic exams (they're a tad uncomfortable but miles better than getting a strep test) and find it odd when a medical practitioner has an "ain't this lady stuff the worst!" type attitude, even if it's a put on to show sympathy.

As a sidebar it seemed to me that doctor in this field can get very judgy and paternalistic, for some reason especially the female physicians; when it comes to children, birth control, and STDs.

This is actually true in my experience, though I wouldn't generalize it. Female doctors have sneered at me asking about birth control as an unmarried teen (which is why I started going to Planned Parenthood instead of my regular clinic), whereas male doctors have been relatively cool-- but I don't think that pattern holds overall. Maybe it's just the fact that some men are treating it more like an alien experience?

I had a good experience with two doctors last year when I needed vaginal/urethra surgery. My first doctor was old and male and checked out what a nurse had thought was a cyst at the time. He was friendly, and didn't make awkward conversation, though he did make a joke when after I said it wasn't causing me discomfort during sex he said something about guys wondering why I was hiding a balloon in there, or something. I don't know, it was just funny and not creepy at the time. My second doctor (the surgeon) was a younger woman, and she was super nice, informative, told me every step of the procedure, warned me about having a catheter and how long I'd have it, told me the surgery was optional but clearly outlined the downfalls of not having it, and made me feel comfortable and taken care of. She just generally seemed competent and interested in doing her job well and gave me all the information I needed, and got back to me very very quickly when dissolving stitches had me in a post-operative panic. So, that was great.

And yeah, the sexually active question-- I have no idea what it's actually supposed to mean. Kind of sad since I've been asked a few dozen times by now, but I would usually just say "yes" even if I didn't know I was a yes.
posted by stoneandstar at 1:09 AM on November 14, 2012


Oh, weird thing though, after the surgery the nurse led me to a little dressing curtain behind which I changed into my regular clothes. My boyfriend (they assumed husband) was picking me up and they led him right up to the curtain and let him in while I was still half-naked. I didn't mind my boyfriend seeing me naked of course, but I was very close to needing to bring a friend to pick me up after the surgery instead, and that would have been terrible and awkward, to be honest.
posted by stoneandstar at 1:11 AM on November 14, 2012


stoneandstar, re: the OP's comment about finding the whole process simply horrifying and unimaginable--I was concerned about that too, and so were some other posters, but he clarified this about halfway through the thread:

In response to the poster who said that a gyn exam is normal thing and not a big deal, I was more horrified at the gap between what I would have thought would be normal human consideration during the exam vs. how people were treated during the procedures I saw in the clinic I am currently assigned to.

Just wanted to point that out in case you hadn't seen his clarification. It makes even more sense in his "closing thoughts" comment where he gives some more specific examples about issues in the clinic he's working with (they sound absolutely terrible!).
posted by Secret Sockdentity at 8:33 PM on November 21, 2012


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