Today started out at 8am with me giving a pap smear to an OB/GYN... It was a crazy experience that I am not sure I will soon forget. The patient was a doctor [a DO] that was in for her yearly well woman's exam. We chatted with her for a while about OB and how she had her own practice and then after about 20 minutes Dr. X started to get into her medical concerns and did a breast exam. When that was over and we were about to do the pap smear she looked at me and said, "do you want to do it? i mean, would that be weird for you?" i laughed and said "no, would that be weird for you? if your ok with it im ok with it." So there i was, doing a pap on a women who was talking me through it/teaching me about it while another doctor stood behind me and gave me pointers. talk about being nervous. i def messed up a bit but what medical student wouldn't under that kind of pressure!
Another interesting part of my day was when a lesbian couple came in. one being pregnant and the other being our patient with back pain. the notable part about this patient was not the lesbian part [im not that politically incorrect] it was the fact that she is a chiropractor and we did OMM on her.... trying to adjust a chiropractor, thats pretty much what they do all day! we walked out and dr. X said "talk about intimidating, trying to adjust a chiropractor is pretty hard on the ego." we both laughed since both of us tried and neither of us were able to get any results in our attempt at lumbar HVLA.
in the afternoon we had a mom and daughter come in, each having their own separate appointment. First, we talked to the 18 year old daughter who had a history of severe cramps and the birth control we started her on were making her nauseous so we switched her to something else. I sat and listened to dr. X explain to our patient that she may have endometriosis and what that diagnosis meant. I worked in OB/GYN for 6 weels and never did i hear such a well formulated and easy to understand explanation of the disease. the more i listen to this doctor the more i admire her. she is SOOOO good at explaining things to patients but yet she doesn't make them feel stupid. she is great and i really hope i can be just as good at it as she is. she really is helping shape me into the doctor i want to be.
Then, we roomed the mom in the next room and had the daughter wait in the waiting room. The mom patient was in for a well women's exam and man was it an educational patient visit for me.
we started out the visit like we always do, chatting with them about how their lives are going and just getting a feel for their lifestyle. as conversation progressed, we slowly started to get into this woman's relationship with her daughter. it sounded like they had a healthy teenage daughter/mom relationship and that right now they were struggling with starting the conversation about the daughter's sexual activity. when we started to explore this area, we learned that this patient [the mom] had a lot of trouble talking to her daughter about self-respect and setting boundaries with men because when she was an adolescent her step-father sexually abused her along with his friends. because of this experience, she became very open sexually and for the rest of her adolescence whenever she liked a boy she would just have sex with him because that is the only way she she knew to be. so now with her daughter, she knows this is not the way to teach her how to be but she doesnt know how to express appropriate advice because it is so foreign to her.
being a doctor at this point in a visit is not about medical advice, it is about being a counselor/listener/advocate for your patient. we are the official 'secret keepers' and really, that alone is enough for some people. i think we helped this mother out extremely by giving her an open ear and also some advice on how to go about speaking with her son and daughter about their relationships and self- worth while also making the mother realize that she is a good person, a good mother, and more importantly, that she is doing a good job despite her insecurities and doubt.
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