I’ve been on OBGYN for three weeks now. I had four weeks of OB in third year and four weeks of GYN in fifth year, and through it all the speculum examination has always been a bit of a nightmare for me. Visualising the cervix with as little as possible pain to your patient takes practice, like any other skill, but it is also very uncomfortable for most women I’ve seen. Lithotomy is possibly the least dignified position we have ever come up with. Not to mention that an uncomfortable woman in lithotomy will inadvertently tighten her perineal muscles.
So now that I’ve painted that very awkward picture for you, let me tell you what has changed my approach to GYN examinations completely. I noticed that many of the doctors were doing a very specific thing after completing the internal examination: they reached their hand to the patient’s hand – like a hanshake – and helped her to sit up.
The patients are always surprised. I suppose it is because they are used to a doctor that hands them some paper towels, turns around and instructs them to get dressed. At least, that’s how I always saw it done in my previous rotations.
I realise that this happens at the end of the exam and therefore doesn’t do much for the initial discomfort, but I think it makes the end less uncomfortable and changes a woman’s whole attitude towards visits to her OBGYN. Like, just maybe, she won’t look up to it so much. And I also feel that the more I implement the practice, the more comfortable I am when I am about to do a speculum examination, and they pick up on that and feel more relaxed throughout.
Is this a whole lot of cute and fuzzy without substance? I don’t think so. Anecdotally it seems to work, so I’ll stick with it for now.
P.S: I just saw this on PostSecret today and it made me smile. I want to be that kind of doctor!
Whispers Unto the Aether 
Oh my gosh, the graphics just took this post to a whole other level. From that creepy old device (I am SO happy they don’t use that anymore) to the drawing on the devices they use now (haha), they’re so good.
And I do think you make a fair point about how something as simple as helping a patient up afterwards can make a difference. I think sometimes the whole thing can just seem so cold and awkward, which it quite hard when it’s such a sensitive and loving part of ourselves we’re sharing. Sometimes simple gestures like that can make it feel a little less business-like and more personal.
Thanks Asti, I’m glad you liked it. I like your explanation – I get the impression that a lot of doctors TRY to be cold and professional in an effort to have women NOT feel awkward and then it kind of falls flat because it’s NOT “just another body part” for so many people. I think that bit of interpersonal interaction is actually needed.
In my OBYGN rotation now. This gave me something to think about. Thank you dear.
I agree with this one! My OBGYN does the hand up thing, and it’s a nice gesture (particularly when one is heavily pregnant and sitting up is difficult).
On a related note, not being a guy also makes gynecological exams considerably more comfortable.
Hah, I’m sure it does 😛
Ah things to look forward to! I think we are learning exams in sim lab next week!
Hah, awesome! I remember when we learned it in the sim lab. Good luck!
Hahaha oh my God that Pompeii speculum was absolutely terrifying. *shudder*
That’s pretty much my response too!
I’ll definitely keep this in mind when we learn this exam! Thanks for sharing 🙂 (I wish my obgyn did this…)
You’re welcome, I’m glad you agree with it!