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If you’ve ever wondered what annual check-ups are like from the other side of the stirrups, here’s a glimpse inside my head during an appointment.
Before I entering the exam room, I take moment to prepare – a quick sip of coffee, a look at your chart, and a peek at your picture (I’m terrible at names, but once I see your face I remember you). Entering the room, my smile is genuine (99% of the time). I really do enjoy the chance to catch up with my patients at their annual exam – preventative health is my passion.
The annual exam is much more than a pap smear. I make sure you are up to date on all screening tests and lab work, especially if you don’t also have a primary care doc. I review your history, all the while typing away at my ridiculous laptop, which prevents me from looking you in the eye. Still, I enjoy catching up with you, especially hearing about your kids whom I delivered a few years back. However if you manage to get me side tracked talking about running, adoption, or literature, I will get far too chatty and then begin to feel guilty for the other women waiting patiently on cold exam tables. Usually, I get myself back on task pretty quickly.
I listen to your heart and lungs then have you lay back on the table for your breast exam. This is one the most important and difficult parts of the exam. I attempt to concentrate completely on the task at hand, carefully palpating each layer of the breast, especially the thicker fibrous tissue. This level of focus must make my face look funny, because you comment that I look worried. I reassure you that I am just concentrating. I then try to relax my face, while trying not to focus on my facial expressions but on the exam. This is hard.
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Next, onto everyone’s favorite part: the pelvic exam. You tell me that “you really hate this part” as you scoot down the table. I assure you that everyone hates their pap smear, including myself. This sometimes gets a nervous chuckle. I then encourage you to scoot further down the table (no woman ever scoots far enough down the exam table).
As I sit onto the rolling stool placed precariously between your legs, I always worry that I will fall forward… (this would be mortifying for both of us). You make a comment apologizing about your lack of feminine grooming. I tell you I don’t care – and I genuinely don’t. The vagina is just another part of the body to me. I see 30 of them a day.
What I do notice, however (but will never tell you), is the smell of your feet. My nose is 2 feet from your vagina, but inches away from your sweaty toes (please put on nice clean socks for your next gynecology appointment!).
After your exam I review the findings with you and make any other medical recommendations. You express concerns about fatigue, low libido, and weight gain. I listen, ask questions about your symptoms, and order lab work to look for any underlying issues, though I suspect that the results will be normal. I know that most of the time, these types of symptoms are related to lifestyle choices and the stresses of modern motherhood. I rack my brain on how to say this in a way that isn’t offensive and will also make you receptive to change. As I discuss diet, exercise, and healthy lifestyle choices, I realize these are challenging changes for everyone and hope I am providing some level of helpful motivation.
As I walk out, I hope that in our brief interaction I‘ve somehow made a difference in your health. Perhaps I’ve simply reassured you that you are healthy, or maybe I’ve convinced you to get that mammogram you’ve been putting off. But mostly, I hope I can empower you to make healthy choices until we meet again.
by Heather Rupe, DOBoard-certified OB/GYN
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