A Thank-You Letter to My Gynecology PA
Last week, I went into Manhattan and walked up four flights of stairs to a busy ob-gyn office. My feet dragged — who wants to get a pap smear? — but I dutifully signed in, filled out the forms, and headed to the examination room.
A few minutes later, the door opened, and a physician assistant introduced herself. I expected her to tell me to lie back so we could get down to business, but instead, she asked me, gently, “Would you prefer to start with the breast exam or the pelvic exam?” Pleasantly surprised to have the choice, I went with the breast exam. As I put each arm above my head, she explained that she was checking for lumps or skin abnormalities and gave me advice about how to do the same at home in the shower. Next, we moved to the pelvic exam. “First, I’m going to put two gloved fingers into your vagina and then I’ll press down from the outside. I’m feeling for the size and shape of your uterus and ovaries…” Throughout the exam, she explained every move she made, how things might feel, what she was watching out for, and what she was seeing.
Honestly, I was amazed. I realized during the exam that it was the first time a gynecology practitioner had truly walked me step-by-step through what was happening. And I’m 47 and have birthed two children! I’ve always trusted my doctors and nurses, of course, but during every annual gynecological appointment, I would just “lie back and think of England,” as the saying goes, with fingers and specula put inside me and a fluorescent ceiling light shining into my eyes. This was the first time an appointment had unfolded with such warm kindness and direct communication. In my blue cotton robe, and nothing else, lying vulnerably with my legs spread, I felt deeply respected and completely safe.
So, thank you to the wonderful physical assistant who, during her busy day in downtown Manhattan, takes care to treat each patient as a whole person. I’m especially glad for all the teenagers and young people who will meet with her through the years. What a beautiful example she’s giving to them about how people can and should treat you and your body. xoxo
On a similar note, this made me laugh: “I have a friend who is an OB nurse practitioner,” commented Katie on Big Salad. “She just got a vanity plate that says SCOOTDOWN, and it is delightful.”
Thoughts? Do you have love notes for people who have cared for you? Do any readers have careers in the medical field?
P.S. 11 pressing questions for an ob-gyn, five ways to teach kids about consent, and why I regularly talk about periods to my sons.
(Top photo by Sergey Melnikov/Stocksy.)
Tags: personal
Comments
142 commentsI hate to say it… But routine breast exams are not the standard of care! Neither self exams NOR routine clinician exams are supported by scientific research. There are tons of false positives and it can cause so much harm when women get unnecessary followup testing. Mammograms, ultrasounds, and MRIs are much more accurate. https://pmc.ncbi.nlm.nih.gov/articles/PMC4831582/ https://www.aafp.org/afp/2021/0101/p33 https://www.aafp.org/afp/2021/0101/p33
I had this with my new dentist. She is very thorough AND explains everything. At first I was super confused, but now I love it. I always want to give doctors/nurses who work with me as much information as possible because I believe that this could potentially inform better diagnoses and decisions. Most times they act indifferent or annoyed though :D But if THEY explain stuff TO ME, I can ALSO use this information to get a better understanding of what is happening with my body. Win-win!
Y’all. As a women’s health nurse, I am so sad to hear that anyone has had a gyn exam where the above was not the minimum, basic standard of care. A word of advice: midwives and NPs are trained to take care of people, while MDs are more trained to diagnose and treat diseases. OB-GYNs have to go out of their way to learn the human way to care for humans. And many DO go out of their way to learn those skills! But it’s not part of the standard curriculum, and really a different philosophy of caregiving. So, if you don’t need a surgeon for your care, see if you can find a midwife or NP. Maybe CoJ could interview a sensational midwife (cough, cough, Stephanie Tillman) one of these days! :)
<3<3<3 My mom is an NP (or was…she just retired), but sometimes when I want to feel a burst of happiness I will google her to read her patient reviews about how much they appreciated her.
Maybe this is a US opinion? As an ObGyn in Australia, we were encouraged/taught/trained to deeply care about the patients we care for and not a day goes by where I don’t. Yes we can diagnose and operate, but a lot of our work is care and communication. Are these skills universal? No, of course not, but they’re also not for many a midwife/nurse. Let’s resist the urge to doctor hate and focus on general good women’s healthcare provision :)
nothing makes a person appreciate today’s obgyns more than watching the very first episode of mad men, and that’s all i’m going to say about that.
I’m a PA and when we were in school learning how to do gyn exams, this exactly how we were taught to do them! We also performed our first exams on nurses who were trained to coach us, and point out exactly what we were doing well and what we could do better.
I’ve never liked gynecological exams. The last time I had an IUD inserted, I was so nervous. My mom understood my fear and wanted to come with me as support. During the insertion in the examination room, my mom stood next to me and spoke calmly to me the whole time. She squeezed my hand when she saw me tense up. Told me when to take deep breaths and stuff. I’m glad she came along.
This is so lovely. This is the type of mom I hope to be to my daughter (she’s 3 right now). Good job, mom.
Ob/gyn NP here, SO glad you had such a wonderful experience. Thanks for the shout out to a great mid level provider. 😘
Let’s call ourselves advanced practice providers, because there is nothing “mid” about the care I provide as a PA
I developed a paralyzing autoimmune disorder in 2020 (because THAT was a year that needed jazzing up, right?) and had to re-learn to walk. After hundreds (thousands?) of tests, interventions, pokes, faceless specialists… I started physical therapy. As soon as the PT did my initial assessment, she helped me sit up on the exam table and said, calmly, with eye contact: “I’m sorry this happened to you. You didn’t ask for it, and it’s not fair. You’re a working mom and you just want to take care of your kids and do your job and live your life… But if you listen to me and work hard at this, I promise you that we will make it better, together.”
Wow!
SOB!!! Hope you’re doing better, Jessica!!
After my second child was born I hemorrhaged at home and had to rush to the ER. What followed was a very painful, difficult procedure to remove all the blood clots. It would have been much more traumatic if it wasn’t for the wonderful doctor and nurses with me in that room. I still think of them every once in a while. Three women, all close in age to me. The nurses would take turns pressing hard on my abdomen while the other held my hand. I ended up having to stay the night, missing my six day old baby and almost two year old son immensely. All the nurses that checked on me the rest of the night through the following morning were just so kind and comforting. You never forget people like that!
I am cursed to be in fairly poor health for an otherwise normal person. But I have been so blessed with doctors, nurses and caregivers.
I have a complex, yet not terribly uncommon, spinal issue. I spent 3 excruciating years suffering through terrible care because my employer only offered insurance through an HMO (if you’re in the Bay Area, you probably know which one I’m talking about!). Despite seeing some of the doctors there multiple times in short span of time, every time they walked into the room it was like the first time they’d ever met me. After many requests for another option, my employer finally offered another health plan and I was able to go to UCSF’s Spine Center. The difference in care has been life changing. Every single person I’ve seen there, from PAs to nurses, to non-operative spinal specialists, to spinal surgeons has not only impressed me with their knowledge, but more importantly, they’ve treated me as a whole human being. They recognized how terrified I was by what was going on and addressed it directly with kindness, honesty, and reassurance rather than just rushing to get down to business. The compassion they’ve shown in their interactions with me has taken my anxiety down from an astronomical level to a manageable one. Treating patients as people first makes a world of difference. I wish more medical practitioners were able to do that.
This just happened to me too! I saw a new, younger doctor at my last visit and she asked, “do you generally do ok with this type of exam? I can stop at any time.” It was so nice—no one had ever asked before. Maybe training in this field is getting better?
I’m an elderly millennial certified nurse-midwife. What you are describing is definitely the standard of care with younger ob/gyn providers — it’s referred to as “trauma-informed care.” Patience, transparency, and permission are essential to helping people feel protected.
This reminds me of an OB who I will forever keep in my heart–trigger warning, miscarriage: I was in an outpatient facility for a D&C after my first pregnancy resulted in a missed miscarriage. A week earlier I went in for a first trimester scan only to discover that my little bean didn’t make it. I’d taken the oral abortion pills but they didn’t totally clear my uterus. So I was in for a minor surgery. The intake nurse at the facility had just had me take a pregnancy test. It was positive. She was very clinical and professional but not very gentle. I was a mess, totally heartbroken. The OB who was there to perform the procedure found me in the pre-op area in tears. She took my hand in hers and sat there and said 2 sentences I’ll never ever forget: “This is hard. You will get through this.” And then she sat with me for about 10 minutes quietly. No talking, no probing. Just sat there still holding my hand in complete understanding. I love this woman.
My 13yo son had a not-terrible-but-not-great appointment with a locum at our general practitioner’s office (tailbone injury that wouldn’t heal), and refused to go back. After some hesitation, I brought him to a chiropractor that I had visited for a couple of appointments for sciatica years ago. The chiro had such a good “bedside” manner, and my son was full-on laughing at a couple of points. It was also such a good way to practice consent – he could say “no” or “stop” at any point, and he knew that if he was uncomfortable, we could leave the appointment in the middle if he wanted; we didn’t have to “finish” it. I appreciated that experience both for him, and for his future partner(s)!
I’m a nurse practitioner & have always spoken to my patients during an exam as your PA did with you. I was recently stopped by someone who had come to me for a GYN exam more than 18 yrs ago at my previous practice. She asked if I was an NP & then I asked her name. She answered, “you don’t really need to know my name, the important thing is that I remember you”. She went on to explain that she remembered the comfortable way she felt with my exam & she never had the same experience with other clinicians This is easily one of my most treasured interactions with a patient!
So beautiful, Anne! I’m a nurse-midwife and hope that my patients leave interactions feeling like this. Thanks for the work you do!
I just had this exact experience, with a PA, for the first time for my annual! I love PAs. They have time and that’s lovely.
As a fellow PA, I am so happy to hear you were provided a good experience. Proud to be a PA!
same, and same!
Wow I didn’t realize that communicating what was happening wasn’t the norm. I think it’s always been done for me because I tell each practitioner that I have a history of assault. It’s reached the point where that information is in my file and I don’t even have to disclose. They just always check in with me.
Forever singing praises to my glorious labor and delivery nurse Sarah. To this day, it brings me great comfort to know she’s out there supporting the people who are birthing little people.
OB/GYN resident (and mother) here. I’m having such strong emotional reactions to the comments — both the good stories and the tough ones. I hope for thoughtful and conscientious providers for all of us. The good news is that communication and empathy are being taught and demonstrated much more commonly now! I was lucky to go to a medical school that really prioritized this, and I have learned from amazing teachers, and I try to model this for my students. Sending hugs to you all!
Trigger warning- child loss My dear friend just lost her baby- 11 days after he was born, following a very high-risk pregnancy. Does anyone who has been adjacent to a similar situation have any advice about how to best show up for a friend facing such insurmountable grief? She and I chatted nearly every day of her pregnancy and several times a day after he was born through all the ups and downs. She’s in another city and understandably is crippled by grief and doesn’t want visitors. Other than gently texting her that I love her and her baby, and sending food delivery credits, does anyone have other suggestions? She knows the moment she feels up to it I’ll be there but I don’t want to put any pressure for FTF at all.
My best friend had a stillborn baby and nothing can compare to that grief. I would say, keep texting and calling, even if you feel like she’s not responding. She may not have the bandwidth to reciprocate, but I’m sure knowing that you are there is incredibly supportive. Also- don’t be afraid to talk about her baby. She may want to share sweet memories or revisit how the baby felt in her arms. She also may not want to talk- maybe you could both put on a tv show/movie that feels safe and watch “together” over the phone. You’re a good friend and she’s lucky to have you ❤️
You are doing the right things. My baby didn’t die, but was very very close many times, both during pregnancy and in the NICU. I know other NICU moms whose babies didn’t make it, but we were not close. The food delivery gift cards were great. One of my big fears was that my baby wouldn’t « matter » or be real to other people if she died so young, before anyone could meet her or get to know a discernable personality. Using the baby’s name, saying that you think of the baby often, etc is meaningful. If there are pictures of the baby, try to comment on something lovely and specific about the baby, even if it’s just the blanket they chose, etc. Keep texting. It took a long time before I was ready to answer people (even though my situation turned out to be a miracle, which felt like winning the lottery), and I was afraid that my friends would just move on because I wasn’t capable of engaging with them for a long time. If your friend has a partner/spouse in the picture, reach out to that person with your condolences but also an offer to be looped in the moment you can help. It was sometimes easier for my husband to recognize when I needed help/when a phone call would do be some good/etc. Put reminders in your phone for the important dates – the baby’s birthday, day he died, due date if the baby was a preemie. When your friend is ready to talk or hang out again, observe and match her vibe. She might want to scream into the night, be distracted by silly gossip, reminisce. Try to be observant and if she is in a happy place, be thoughtful about not bringing her down. One of my pet peeves is that my mother in law, who is otherwise lovely and supportive, often makes comments at random like, it must be so hard to leave the baby and go back to work after she nearly died. It’s like, it truly is, but I was currently talking to you about what to make for dinner and really didn’t need to go to that emotional place at this very second.
You’re being really, really caring. Potentially recommend An Exact Replica of a Figment of My Imagination. And otherwise, I’d say to just keep showing up and don’t let it fade off.
My friend also had a baby pass at 11 days. It’s been years now, but one big thing was asking her to see photos of her daughter. I also put the birth and death dates in my calendar and text her on those dates every year.
Thank you all! I appreciate the great advice and encouragement <3
I don’t want to talk about how I can speak to this but absolutely agree with the CoJo group about remembering really important days if you’re a bff. Leaving flowers on her front door a year from the day of loss, planting a tree in her child’s name… a card saying how much you love her and her baby…. Powerful medicine when someone isn’t afraid to walk on a grief journey with you.
My daughter died at 19 days old. I think the reminders you are giving are good. the practicalities are also helpful. As others have said, using her babys name and not being scared to talk about the baby are so important. Knowing that others loved and cared for our child and that she would not be forgotten was huge.
So sad for your friend. My nephew passed away in December and it’s been a shit show of a year for our family especially my sister. First of all get really comfortable that nothing you can do will make it better, just anyway that you can show presence and help with practical things. Keep up with the messages and maybe even short audio messages but reiterate no need to engage. Offer admin support, even things like are there things needed doing for the funeral that you could get done for her from your own home. Try to get a sense of how she grieves and then go with that. For my sister who is super social, she liked to have people around each evening so friends would come and cook and then she might wander off to be alone for half an hour then come back. Honestly just be as present as possible and then go with your gut. Mention her baby’s name as much as you possible can, every conversation or interaction if possible. For most people this is helpful, if it isn’t for her I’m sure you’ll pick up on it. Also a friend of my sisters brought a picture of my nephew to the house about 5 days after he died and even though we had pulled out pictures and put them everywhere, it was so lovely to have this beautiful black and white picture of him, so if you have access to any images of your friends baby maybe send something like that? Love to you and your friend.
Enormous gratitude for all caring and kind medical professionals. Having recently being diagnosed with uterine cancer my view of people in hospitals has expanded significantly. With that said if anyone has experience with brachytherapy, I would love to connect.
Thinking of you Hilary. Sending you all the love and prayers for wisdom for your doctors and healing for your body.
I have an amazing NYC OBGYN rec if anyone wants. He is male, which I know is not for everyone, but he’s truly great.
Following up – loved that you updated the title from Gynecologist to Gynecology PA to give our profession more recognition! Signed, a PA and long time COJ reader.
As a PA myself who rarely sees the profession mentioned in the media, this made me SO happy! I see an APP (advanced practice provider…includes PAs, NPs, midwives, etc) for every single appointment for myself and my kiddos. I’d also like to thank this PA, for making us all look good!
Sounds like an amazing PA! 💜 Breast exam no longer evidence-based per ACOG.
What does this mean? Would you please explain?
To clarify–breast self-exam no longer considered evidence-based, but provider exams still are!
I mean- it doesn’t ever hurt to do a breast exam in case you feel a lump and can get it checked out. Not sure why this would be advised against, even if not 100% evidence-based.
I found a lump doing a self exam. It was something that had not been detected on my last mammogram. It was cancer and luckily caught early enough that I am now over 5 years out after surgery and radiation. From my own experience, I think it’s important to know what’s normal and what seems like a new lump. Early detection is so incredibly important with all types of cancer.
Nevertheless, I detected invasive ductal carcinoma via my own self-exam.
To clarify, “not evidence based” in this case just means “doesn’t usually catch things early enough, so isn’t any substitute for mammograms”. Obviously, if you feel a new lump in your breast, get it checked out!
This comment requires context. Clinical breast exams — where a nurse/PA/midwife/NP offers an exam during an annual, are not a great tool for screening for breast abnormalities in patients with zero symptoms. Many providers still offer them and use the exam as an opportunity to discuss breast self-awareness (knowing what your breasts normally look/feel like) — this can be declined by a patient, of course. Clinical breast exams remain a helpful tool when a patient reports a breast change/complaint though!
PAs are just the best— I’m always glad to see one.
My first child was induced (my blood pressure was climbing and they were worried). It took about two days (I didn’t want the epidural, he was my first and I wanted the experience (a decision I kind of regret now, ha!)). It was a difficult birth and I had a 4th degree tear (awful, took 1 year to fully feel better down there). When my water broke with my second, and I wasn’t progressing quickly enough, I got the pitocin and an epidural. I sailed through that labor. The on call midwife who I had never met, was so kind and said “you had a difficult first birth, didn’t you? Well, don’t worry about that happening again, this one will be better”. She put me completely at ease, and my daughter was born soon after.
I’m a first time mom having twins next week, so naturally I’m a little terrified. There have been some complications recently that led me to believe one of my babies will go straight to the NICU and my husband will go with him, leaving me alone in the OR. My OBGYN and her nurse have been together since I started seeing them right out of college 15 years ago. Kind of impulsively, I asked the nurse if she was able to scrub into the surgery as a back up support person for me. I didn’t realize how much trust and comfort I had in her until then. She came over and hugged me and we both cried. She said, “absolutely. You’re family to us, and I can wait to see you the minute you become a mom.” Basically an SSRI in human form.
This made me tear up Molly! I’m loving all these stories given some of my past with the medical field. Gives me hope!
My daughter needed to go to the nursery for oxygen as soon as she was born via c-section and my husband went with her, so I was alone in the operating room while they stitched me up and in the recovery room for a few hours. Honestly, I was so out of it that I didn’t really even notice! We FaceTimed while he was in the nursery with her and I was distracted by drinking ginger ale and eating crackers and squeezing colostrum into a syringe. I felt very supported by the nurses – for some reason we talked about Gilmore Girls for a long time! Hang in there – you’ve got this!
NICU mom here. My first time in my daughter’s hospital room after delivery, Nurse Jen took me by the shoulders, looked me in the eye, and said, “No Mom Guilt.” I needed that. We were there 11weeks and our medical team was the village and the family we needed, even alongside our own. Eight years later, they remember us and celebrate the beautiful growth and thriving of our sweet girl.
I love this! Just yesterday I met with a nurse practitioner in a breast surgeon’s office about a prophylactic mastectomy for BRCA mutation, and she was warm, funny, and even shared about her own mastectomy experience. I left the appointment feeling empowered, informed, and cared for. Shout out to Hannah in Knoxville! :)
That’s a courageous decision, Julie. It’s one I made thirty years ago, and I have no regrets. The peace of mind has been worth it. Glad you have a good connection with your NP. Sending hugs your way!
Thank you so much, Diane. I’m glad it was the right decision for you! I think it is for me, too. :)
My twin sister and I both had this surgery done (on the same day with the same surgeon!) last July, and it was one of the best decisions I ever made. Good luck to you, Julie, whatever you decide!
Before she started, for the first time in my whole life, an NP asked me if I had had any negative experiences during pelvic exams in the past. I was astounded that she asked and also surprised that no one else ever has asked. It was very thoughtful and makes me think training around this stuff is changing.
that’s such a thoughtful question.
I think you are right, change is coming. If you google “We deserve better”, you will see a renewed focus on funding and studies for women’s health and a commitment to change some of the unacceptable practices of the past like pelvic exams under anesthesia or holding birth control hostage for yearly visits. I’m personally very excited for the self-administered HPV test! If it were for men, I’m quite sure it would be standard by now. So frustrating!
I work in healthcare (pharmacist) and absolutely training around talking to patients is definitely changing! It’s empowering to see.
I have a wonderful, gentle, and kind chiropractor who always does the same! I always find it so comforting that he does it.
I live in Canada and had a procedure this week where a questionably big fibrous polyp had to be removed. The nurses and doctor were so nice. Pre procedure I was given a warm blanket and hot water bottle for my stomach. While the hospital was nothing “fancy”, as a busy mom of three I felt pampered. So cozy! Throughout the procedure they were calm, informative, and comforting. Afterwards, I got cheese, crackers and juice. In my pre-op meeting I was offered general anesthesia if I thought my pain tolerance needed it. Everything looked benign but will be sent to lab for testing just in case. All free of charge. Feeling grateful.
And that is why Canada/Europe is superior to America. Not only do we pay absurdly for health insurance, we still have to pay the hospital bill after a procedure for whatever insurance doesn’t approve or cover. Many Americans are choosing to go without necessary healthcare due to cost. Reading your post reminded me of what could be – and what USA chooses not to do.
Last summer, when I was 5 months pregnant, I found out that I had lost my baby and would need a D+C. I was traveling and at rural hospital and felt just gutted and terrified. On the morning of the D+C, I was greeted by a nurse with tender eyes who said, “What I shit situation. I’m so sorry, I have no words.” In that moment, I felt so seen in my grief, and a little less alone in it. What a gift during a terrible time. Bless the nurses (especially Nurse Lisa!).
Emily, I’m so sorry for your loss – and in such conditions, no less. Bless the nurses indeed.
Giant hugs, Emily. I too lost a baby (in my case, I was hemorrhaging so badly that they put me in an ambulance to cross the street!). One of the EMTs held my hand the whole way. I will never forget him.
Oh Emily I am so so sorry.
I recognize that office – they delivered both my babies and saved my life ❤️
Reading this is giving me yet more confirmation that I need to find a different GP after a truly horrible recent encounter. Why is it so hard to find good care? It is so exhausting.
Don’t give up – good providers are out there, even if they are hard to find! It shouldn’t take so much of our time and energy to search for them, but once you find a great one, it will have been worth it.
Sarah, I’m the original poster and I have no idea if you’ll ever see this since it’s been weeks, but! Your note prompted me to really take action and not give up, and I’ve found a new GP who seems truly wonderful. Thank you for the encouragement!
SCOOTDOWN I am cacklingggg!!! such a universal but never spoken experience! the kernel of excellent comedy.
Every year I swear I have “scooted down” enough. But, nope, every year I have to scoot a bit more!!
“scootdown” lol i am dying over here too
I went to see midwife for the first time since I’d moved the other day and she offered a blanket for my lap so that I wouldn’t get cold during the pap smear :) So thoughtful!
Another reader who works in the medical field! I was an ER doctor for 17 years. This year at age 45, I made a massive career pivot and am doing a fellowship in hospice and palliative medicine. Excited for this new journey!
Wow I’m so proud of you! We’re the same age and I already feel I’m too old to make big shifts even though we’re somehow only halfway through??
Since the roll out of the HPV vaccine, Australia is now on track to eliminate cervical cancer by 2035. And in 2021 there was not a single case of cervical cancer diagnosed in Australia amongst women aged under 25. This is just amazing! Screening is now recommended for low risk women every 5 years here, with the option of providing a self collected sample. Fingers crossed the rest of the world will adopt these important public health measures soon
So happy you had a good experience. It saddens me though that the bar is truly on the floor re patient care. No scooting down possible.
This post got me thinking…..for the past 33 years, my medical care has been primarily through military medical, due to my husbands military service, now retired. As I was reading the post, my thought was…”Isn’t that how it always is?” Your experience describes the majority of my OB GYN visits at military hospitals….I feel very fortunate, even when I didn’t always see the same doctor, Haven’t had a pap in 4 years since my hysterectomy…don’t miss them.
When I was in labor with my first baby, one of the nurses pulled my leg up into an awkward position. I said ” that kind of hurts” and she just said “yep, it’ll hurt” in a confident voice which for some reason gave me a feeling of great trust. I felt like she just had things handled and I didn’t have to figure out how to position myself because the staff had it covered. Later I thought of her calm attitude when I had a post partum patient (I do not work in OB but sometimes get their post-surgical patients. Did you know you can hemorrhage 12 days after giving birth?!). I took her to the bathroom and we both stared at her in the mirror as the blood drained out of her face. I half-dragged her onto the shower seat and she fainted. Later I overheard her say approvingly to her mother, “my nurse isn’t that big but she really manhandled me. I could have fallen in the bathroom.”
I love that you received such trauma-informed care! I’m also here to toot-toot my nonbinary horn and remind cis folks that women aren’t the only ones who get pelvic exams. I’ve been so fond of your blog for so many years and as an AFAB person who has spent so much time in spaces with folks socialized as women, it stings extra to when NB folks aren’t included in these ways. I do love all the ways the CoJ team does include queer perspectives! :D
Thank you so much for this reminder, and I’m so sorry for the misstep. Really appreciate you xoxo
Thank you for advocating for visibility and inclusive language. And I will second that I love reading the diverse perspectives of the COJ community!
My first ultrasound for fertility assessment the OB asked if I wanted to insert the ultrasound wand into my vagina myself. Being able to do what for me is one of the hardest parts at my own pace helped it feel so much less invasive. She then helped me sit in position rather than lie flat. I still wept through the whole thing but clarified I wasn’t in pain and didn’t need comforting just needed her to explain everything analytically. She honoured that completely. Both mattered: being treated with gentleness, and being treated as an independent equal rather than a broken patient.
I live in Australia, where there is a huge focus on patient-centred care and my experience almost overwhelmingly has been AMAZING. Aspiring med students need to do an interview beforehand to assess that they have the right personality to work in medicine and I believe that patient-doctor communication is a big part of their training. Step-by-step explanations, choices and lots of opportunities to regive/withdraw consent are the absolute bare minimum of what I would expect from a doctor, especially in the context of women’s health.
My OBGYN doctor is awesome! I’ve always had great experiences with every OBGYN doc I have encountered. Thoughtful, caring, competent, comforting. They are bosses! So much experience. They bring lives into the world every day and save lives by treating gyn cancers, etc. I am so impressed by them. I always feel cared for when I am in the clinic room with them for appointments.
My primary care physician and her practice partners are amazing. Similar to your experience with consent, they are kind and compassionate when conducting gynaecological care. This is a BUSY practice and I every time I think of it I am grateful have them as my doctor (s). Integra Heath in Toronto this is a shoutout to you!
I had the most wonderful midwife for both of my pregnancies who is full of zingers and rage against the patriarchy, but always delivered with a smile. When she gave me a Pap smear she said “I don’t use stirrups because they’re a tool of the patriarchy so lay however you’re comfortable.” When my first birth was scary and ultimately resulted in a necessary cesarean, she told me that being a mother is full of making compassionate choices for our children and sometimes our kids need that right at the beginning, which means we sacrifice the birth we wanted. She helped me prep for my VBAC with my second son and always always always kept me informed and asked for consent. Three cheers for all the providers creating safe, empowering environments for women in vulnerable moments.
Oh I wish I had more good experiences with doctors but unfortunately I have way more WTF- nothing egregious, but going to the doctor is such a hopeful thing for me (I have this problem or concern and they are the ones who can help me fix it! Hurrah!) so when the care is lacking even on a mediocre level it’s so very disappointing. I tell the primary care doc I put on 30lbs in the year since moving to the US and the response is “Welcome to America!”, I score high on the depression sheet and I’m just told to pick up an antidepressant at the pharmacy on my way out, I mention a bunch of things that seem related to perimenopause and am told “you, sounds about right!” and that’s all the help offered, my annual check up shows I have gained 40lbs and am now in the obese BMI category and the doc in the next breath say “so, I see no need for any tests today!” and I have to demand at least a check of my cholesterol and A1C! And I feel so extra let down because all of these docs are different and all are women. I don’t know why I expect better from women, they’re just people…and people working in the same lousy healthcare system that allots 10min to a visit. But I long to feel like I am actually being helped by a doctor who wants to figure out a fix or a plan rather than check off another patient from the list.
These are the exact types of outright neglect and belittlement that have turned me as far away from the AMA (standard American healthcare) as possible and to natural and alternative medicine. I first research everything on my own, with tons of cross-referencing to educate myself (super annoying when any form of healthcare costs so much – I mean, what am I even paying for if I have to educate myself?), so I can go in informed to protect myself from neglect and mis-management. Plus side is I take exceptionally good care of myself to avoid issues. If anything major happens I will embrace medical tourism.
Unfortunately in the US, you will have to strongly advocate for yourself. Also, the BMI scale is fully made up BS that has no real science around if you are healthy or not. But if you feel you want certain tests, you will have to ask. And ask again. Then insist. Then argue. Then, get the test and pay yet another bill. “Welcome to the US”, indeed.
This is everything🥹
I don’t think I’ve ever commented before, but have read here for many years. I had a baby girl last summer who would have died without three amazing doctors (and of course a whole huge team). Most of the doctors we met believed believed that my daughter didn’t have any reasonable chance of survival to birth, but my amazing MFM did, and lobbied and pushed and cajoled for an experimental surgery to be done while she was still inside, and then a major and rare surgery as she was being delivered. Through months of anguish, this doctor was honest and realistic, but also joyful. He measured the length of my baby’s feet to tell me her « shoe » size and always referred to her by name. He told me she was very sick, but also active and stronger than they would have guessed, considering everything. He told me her brain looked perfect, even if her heart was struggling. When he drained my amniotic fluid, which was literally overflowing, and it was the colour of port, he joked that it was his special vintage, to keep me calm. I asked him to do everything to try to save my daughter, and it ultimately worked. She has plenty of medical issues, but she giggles and laughs and is wonderfully real because of him.
This is amazing. I’m so happy for you and your little one.
I love my reproductive endocrinologist but have never had a trusted OB, midwife, etc. Maybe it’s because I went through infertility and reproductive trauma? And I know I’m not alone in this.
Every day is a tell-show-do day!
I will never forget the nurse who helped me pee and made a lovely ice pack underwear situation for me right after I delivered my first baby. She was so maternal, funny and deeply kind. Women are the best.
Wow, thanks for the memory refresh. I completely forgot until now that one of my L&D nurses also made ice pack undies for me shortly after birth and gently helped me step into them before wheeling me down to the recovery suite. She also NEVER griped the multiple times she had to readjust the natal monitoring sensors as I moved around the birthing suite. She fed me popsicles as the nausea came and went, stroked my head, held my hand, cheered me on… And helped keep my bum covered per my request while I was roaring through transition. Women are the best.
Have a unicorn situation–a wonderful internist who has been my primary care doctor since I was about 30 (I’m 57 now). So grateful for this long-term relationship and how it has supported my well-being. She is a great listener, very thorough and always “working the problem.” In addition, she’s a lovely person who I really enjoy visiting with during our appointments. On the Gyn end (so to speak) I have just in the last few years switched to someone really good, who is only a Gyn, not an OB. She’s the first doctor who has ever asked me if my sex life was working for me. And was able to troubleshoot some of those challenging menopause issues. Similar to Joanna’s experience, I was struck by the novelty of the experience. But really, isn’t that how it should be? Wishing everyone out there good care.
As a Nurse Practitioner, thank you for recognizing the personalized and competent care that APPs (advanced practice providers to include NP, PA, CNM et al) provide for patients. I prefer these providers when I need care and always find I’m treated more like a human by them. I’m so glad you had a great experience and am sorry this is the first time you were given choices during the exam.
Second! From a Family NP with 20 years of practice. Even after years of advocacy APPs are often underrepresented in dialogue about medical care. Thank you for recognizing us, Joanna.
My OB retired when I was 16 weeks pregnant with my oldest. I had so much anxiety during that pregnancy. I’d had a hard time getting pregnant and I’d had a miscarriage previously. (He performed my D and C for that and was so kind.) I was nervous to see a new Dr and when I got to my first appointment at the new practice the Dr said, “I got an email from your doctor. He said ‘take good care of her, she’s one of my favorites.’ He made me feel so taken care of!
I recently had my second, heart-wrenching, miscarriage. Lying in the operating room, a nurse leaned in to whisper “you’re safe here” in my ear while grabbing my hand and squeezing it until the general anaesthetic kicked in. Her kindness in that moment was so appreciated.
I am so sorry for your loss, Nish
Sending love. So happy she was there with you.
A midwife here who specializes in gyn. Welcome to the wonderful world of advanced-practice nurses and PAs; it’s a whole different paradigm of care. We refer when we need to, and work collaboratively with MDs, but our holistic approach can offer a real shift in the way that high-quality, evidence-based care is delivered and received.
The SCOOTDOWN plate immediately reminded me of Laura Ramoso’s incredible gynecologist impression. If you want to laugh so hard you cry and probably pee yourself, please give yourself the gift of a watch: https://youtube.com/shorts/wYvNf5k1RHo?si=Dde-ld0F5ZWnMZ84
Omg hahaahahahahahah
She is HILARIOUS!!
Oh gosh I’d forgotten that one! Thanks for the reminder and laugh!!
Laura Ramoso is the FUNNIEST. Had somehow missed this one. Thank you for that.
Yes!! I don’t even have to click on the link, I know this impression by heart, because I’ve watched it so many times:D:D
I’m a family doctor and do pap smears in my clinic almost daily. My patients frequently come with a history of trauma and I have tried to modify the exam to be as trauma informed as possible. With every procedure I start with “You’re the boss, you say stop or take a break and we will do it immediately.”. Also, sorry to be nitpicky but manual breast exams aren’t that sensitive and aren’t recommended unless there is a specific concern – just get annual mammograms starting at 40!
The more people who can validate that they don’t feel any questionable lumps and bumps, the better, as far as I’m concerned.
Another comment mentioned that breast exams are not evidence-based. Why on earth would we ignore the experience of people younger than 40 who are not at mammogram age and found a lump that turned out to be cancer? Sorry, but I’ll keep up with self-exams to search for something abnormal. If anything, we should be doing MORE to ensure we catch abnormalities earlier. I’m shocked a doctor is suggesting that it’s not needed.
To clarify – feel free to do self breast exams at home! It’s good to know what your breasts feel like normally, especially as they change through your cycle. I specifically meant that breast exams aren’t recommended for routine screening by a provider, just like we don’t do abdominal exams to screen for ovarian cancer, etc. When my patients come in with a breast concern, I 100% do a thorough breast exam. We just don’t want patients to feel falsely reassured if our physical exam is normal, most cancers are too small to feel initially.
Shout out to nurses everywhere! I have been so lucky to have been cared for by amazing nurses – after two C-sections, when my 2 year old was admitted for 4 days into the hospital, when my mother had a bad fall, when my step mother was hemorrhaging after a routine colonoscopy, when my husband had knee surgery… They are freakin angels from heaven and deserve all of our respect and also better working conditions and HIGHER PAY!! But for now, i’ll just offer my sincere gratitude for their compassionate care.
This just made me cry because of how much I wished I had a gynecologist like this. My dismissive, gaslighting gynecologist is the reason I’m scared of doctors.
I’m so sorry. That sounds awful. Does your plan allow you to find a different one?
It may take research and effort, but please don’t give up searching for a kind and gently doctor. They are out there. Read patient reviews and if you call to make an appt, let them know you are fearful and if they are a good office, they will care about that.
I had a very difficult pregnancy and delivery but felt very cared for by my OB-GYN, who was a trusted doctor. Six months after giving birth, I was at my general doctor’s and she told me my OB had called her to see if she’d heard from me. He was worried about post-partum and wanted to make sure someone had seen me. He also called periodically to check in and make sure I was okay. It meant a lot due in a very hard time.
Sorry for the double comment but all of this made a memory come screaming back to me, my first OBGYN when I was in college telling me “nice girls in college don’t need to be on birth control.” I promptly went to a planned parenthood by campus and have been a PP supporter ever since. (Insert gif of JLD saying in veep that if men could get pregnant, you’d be able to get an abortion at an ATM.)
Same! I’m loving these beautiful comments but will never forget in 2006 (wow that was a fast 20 years!!!) being told by my gynecologist that people who have premarital sex usually also have extra- marital sex!!! WHAT. Never went to her again. What a thing to say to someone while they are in stirrups.
I had a similar experience in 1999. I’ve honestly questioned that it happened in recent years, so I appreciate you both sharing your similar experiences. Just awful.
Was this before we got the vote?
PA here – thank you for highlighting this positive experience! As mentioned in a previous comment, unfortunately any feedback we usually receive from patients (and by we, I mean all of my fellow colleagues…PAs, NPs, physicians) is the negative stuff. Thank you so much for recognizing the wonderful experience your PA provided- if I received this feedback from a patient, it would make my month!
Some of the best and kindest care I’ve received in my life (and I’m old) have come from NPs and PAs.
I recently told my new GYN about a gentler suction-based alternative for the tenaculum (the friggin metal HOOK used to hold the cervix open during IUD insertion). They ordered it right away, and it’s gaining some traction in NY and CA. Might be worth mentioning to your OB/GYN practices. I’m not affiliated with the developers or anything, just tired of being hurt and hopeful that gentler practices can prevail. https://www.aspivix.com/
KG – have you ever been offered a local anesthetic for the cervix during an IUD insertion? I had an OBGYN in the early 2000’s put in my first one and she told me that most practitioners didn’t offer it, but she thought that was barbaric and she always numbed the cervix of her patients. After hearing so many friends’ horror stories about incredibly painful IUD insertions, I started shouting from the rooftops – DEMAND A LOCAL! I did that w/ a different OBGYN after I had my kiddo and she looked at me like I had three heads and was like, oh you should be fine, just take some ibuprofen – NO THANK YOU, PLEASE GIVE ME A LOCAL. Recent articles (like in the NYTimes) have raised the profile of the medical profession finally clueing into the need for pain management for IUD insertions. But too many women have excruciating experiences unnecessarily! (gift link) https://www.nytimes.com/2025/05/15/well/live/guidelines-iud-insertion-pain-management.html?unlocked_article_code=1.gVA.KxFD.o1sg1pIMem09&smid=url-share
To Candace–your mileage may vary, but my worst IUD insertion was with a local. The shot hurt like hell and did almost nothing for my pain, sadly.
First insertion was excruciatingly painful. Removal and replacement had a local and while still painful, it was better. Now can’t get an appt anywhere anyway, but no one offers locals and a bit of gel is the best they’ll do. It’s barbaric.
Amazing!! My IUD insertions somehow felt more painful than my two actual births (that I did au natural, unmedicated!!!) – I never knew why. Had no idea there was a hook involved! I always dreaded those appointments – my husband had to literally help me put my clothes on after the first one and help me walk out the door. I have heard it’s not as bad for other people….but blargh. Truly, the thing we go through as women….
I’m glad your practice was receptive to ordering this device. Other alternatives to the tenaculum (which is more of a clasp and less of a hook — it doesn’t open the cervix, just grasps it) include ring forceps or an allis clamp, which do not have sharp clasps and may be associated with lower pain scores (these devices are generally stocked at most OB/GYN offices).
I had a pap smear recently in Australia and they now give you the option of doing it yourself! It is exactly like the swab in your nose for covid except you swirl it round the vagina a few times! It was so easy and I was so relieved to be given that choice.
Yes! I was so pleasantly surprised to read this when I got my reminder letter recently. So good.
Wow! I doubt here in America they’ll ever allow that lol is this done at home with a kit and sent to a lab, or in a doctor’s office?