“You feel them now?!?!”
She literally grabbed my hand by the wrist and pushed it up, well…
I’m not sure it’s really appropriate to say, to be honest. Let’s just say the ‘them’ she was referring to were her ovaries. For those who are confused, during a sensitive female exam you can press upwards from the ‘exam portion’ and downward from the abdomen and actually palpate the ovaries, especially in younger, thinner individuals.
The ‘patient’ in question was a volunteer, paid for her time, tasked with teaching first-year medical students too scared to lift a breast a sensitive female exam. These are students who struggle listening to the heart in a buxom female patient. Who stare at a child with an ear infection with a mixture of fear and loathing. Who pray every medical experience they have can just feel like shadowing as they sit in the back of the room and check social media outlets on their phone. Teaching the sensitive exam is no small task. I’m pretty sure I downplayed my own nervousness by mumbling something about my hands having an “essential tremor.”
Yeah, I was just a big wuss.
To be honest, I’m not sure the outside world really understands this part of medical education. They see these socially-inept nerds who ruined their college science classes – adding an element of stochasticism to what should have been smooth bell curves and asking shitty questions no one cared about to their professor for five minutes after the class let out because they were going to become an “orthopedic surgeon.” [What an asshole.] Then they see these smooth-talking, sometimes callous, sometimes chipper, white-coated interns breezing through hospital wards, assuming they’re doctors, not really understanding how little you really know after your first four years.
Some element of the change comes from learning the sensitive exam. For some reason, I think of a talk one of NPR’s leadership, Jason DeRose, gave at St. Olaf College many years ago. He told us that the job of the journalist, or maybe not the job, but the essential function, of the journalist, was to enter into ‘unearned intimacy’ with the lives of the reported. It requires learning and then disseminating knowledge about individuals in as unbiased a way as possible, trying to determine the facts both because of, and in spite of, their personal stories.
What else am I doing when I ask a patient if they’re sexually active? [“I ask these questions to all of my patients.”] Multiple partners, or just one? [“Your wife sounds like a real keeper.”] Female or male? [“No, I didn’t mean to imply anything. It’s a routine question.”] Any history of illicit drug use? [“You wish you did because of your wife? Funny joke, sir”].
But why should we care? Because sometimes you diagnosis that monogamous, elderly male in my office with full-blown AIDS. Because sometimes you find out the ‘drug-seeking’ woman in the ER is giving her boyfriend the pills because she’s homeless and without the trade he wouldn’t give her a place to stay. Because sometimes that young woman will tell you about the time she was raped, and that’s the reason she doesn’t want you in the room during the sensitive part of the exam.
In this career, you learn to be surprised by nothing.
And sometimes you learn the best way to care is to go into the one place it hurts the most, and ask the questions and do the things no one else will.
In a much more benign way, doing the ‘sensitive stuff’ well - i.e. making patients feel like sharing it is normal and doesn’t matter - is just good medicine. In fact, the other day, I was in the ER. Scrotal cyst. Turned out to be some folliculitis, likely secondary to a new soap product he reacted poorly towards. The small nodule had already been drained – I didn’t have to do any procedure. Yet, some clever questioning and a more thorough exam made me decide we should test him for syphilis. To be honest, it will probably come back negative.
But then again, maybe it won’t.
What struck me afterward was how easy it was. How easily I could do the exam in two minutes with gloved hands. Ask those questions. Probe deeper about his partners and his sexual practices. I felt like a natural.
Which brings me to my final anecdote. This one, a counterpoint to the woman and her ovaries. The male sensitive exam. In the first room I entered, an elderly male volunteer sat in his hospital gown. The exam went without a hitch. Scrotal and penile exams are a breeze, especially for a male student like myself. Then, in the second room, a younger male patient. I realize I’m near the end in a long line of medical students that have examined him. He’s tired and frankly, not paid that much. I doubt he wants another drawn out, hesitant prostate exam. So in front of three of my colleagues also in the room, I lube up a finger, go in, palpate, and exit in a matter of seconds.
Which would have been fine, except…
“That was amazing! That was the fastest prostate exam I’ve ever had! You’re like Dr. ____, a real professional. You should be a urologist. I barely even felt that! Are you sure you did the whole thing? WOOOOOWWWWW!”
And a smartass classmate smirks at me and says, in a voice loud enough that everyone in the room can hear it, “You should add that information to your dating profile, Patrick.”
The man turns ashen. Looks to the ground. The room is silent. I take off my gloves and wash my hands with soap. I mumble something as we leave the room about “having a good afternoon.”
‘Unearned intimacy?’
Perhaps.
Maybe I’d just make a better urologist than an OB/GYN.
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