One of my favorite blog authors (Renee at A Baker’s Dozen http://bakersdozenandapolloxiv.com) recently wrote a post about how she lost faith in doctors that has gotten me thinking about various issues in medicine, especially why I wanted to be a doctor in the first place.
In my application essay for medical school, I wrote something very poetic about how I wanted intellectual stimulation and to “be the change you seek in the world.” Basically, I’m a science geek and I want to help people. Very original, I know.
I think we were all lying; at least by omission. Because sure, some of my classmates really, really do want to help people, and almost all of them are science geeks. But those weren’t our real reasons.
For a lot of people, the real reason is something along the lines of, “my dad was a doctor and this is the only way he will take me seriously.” Similarly, “I want to be a respected and impressive member of my community and enjoy all the perks that go along with that,” is a popular option. “I was good in school and didn’t really know what else to do with myself,” is also common.
For me, I wanted to be a doctor because I hated doctors. I wanted to prove I could do better than the doctor who took care of me growing up. I wanted to prove that medical care could be nurturing rather than degrading. And, as a fringe benefit, I figured that as a doctor myself, I would never have to go to another asshole doctor in my life (ha!).
My pediatrician was a pensive guy with a bushy beard and lots of novelty ties. I don’t think he was a pioneer of bedside manner with either kids or parents, but he did ok. I got my shots, I earned some stickers. When I had terrible sore throats that my mother was convinced were strep, he would peer into my mouth and declare that my throat looked, “not too bad.” He wasn’t a great doctor, but I had no complaints.
Until I was twelve, and my mom brought me in to his office for “vaginal discharge.” She had noticed crusting on my underwear.
Being dragged to the doctor for this was mortifying. I sat on the exam table with my eyes closed while the doctor asked my mom some questions. He never addressed me except to tell me to slip off my “panties” and lie back on the table. I hated the word panties, it sounded both juvenile and dirty. I wanted the exam table to swallow me up. Barring that, I wanted his Cat In The Hat tie to come to life and strangle him.
He put on a blue nitrile glove and poked his big fingers around at my labia. It was so embarrassing and humiliating I thought my heart would stop.
Before my mom dragged me in here I had not realized that my body was doing anything unusual, but now I felt alien, defective, contaminated. The doctor made some “hmmm,” sounds and then had me sit up. My “panties” were still around my ankles and fell to the floor. He continued with a lymph node exam, without removing the glove.
Here I was at the doctor for having this weird stuff coming out of me…down there… and now here he was getting that stuff on my neck and in my hair. I just wanted to go home and shower with hot bleach.
He concluded his exam by mashing idly at my stomach, and then told my mom that this “probably a normal part of early puberty,” and asked her to step out and talk with him while I put my clothes back on. Then he came back in without my mom and asked me if my friends were using drugs or if I was “sexually active.” I mumbled “no,” to both questions. He assured me that if I ever wanted to talk about “that stuff,” that I could talk with him about it.
As if. I never wanted to see him or his stupid ties again. I never wanted to see another doctor, either. Even though I was very confused about what “early puberty” entailed and what actually caused this vaginal discharge, I did not feel like he was even remotely a person I could ask about these things.
And that is when I decided to become a doctor. I decided to become a doctor who would never make anyone feel as miserable and ashamed and dehumanized as I did that day.
I’ve learned a lot of things since my experience with the insensitive pediatrician. I understand why he acted the way he did. (Except for not removing the glove before doing the lymph node exam. That still seems sketchy.)
But for the most part, he did things by the book. I was under eighteen, and so addressing the questions to my mom made sense. Moreover, it is the medical-legal tradition in pediatrics. He probably even thought he was letting me off the hook by not forcing an obviously embarrassed tween to talk. Since I was not the medical decision-maker in the room, and because it is usual to assume consent for the physical exam, I can understand how he did not ask my permission before touching my genitals.
That whole awkward song and dance about drug use and sexual activity is also totally by the book, even though at the time it felt forced, formal, and invasive. And because physicians don’t want to overwhelm their patients with too much information, it is not unreasonable that he didn’t tell me anything about puberty. After all, I didn’t ask for any information.
Overall, the way he handled the visit was exactly the way we were taught to handle it in medical school. And this approach might have been fine for a different kid. But it was not really fine for me, his patient.
Because what they don’t teach in medical school is how to connect with people, how to know people, how to read their reactions and gauge how you’re doing. They don’t teach you how to be a human being. In a lot of ways, they specifically teach you to abandon your humanity, to replace your own interpersonal judgment with the “by the book” approach. And whatever book they are using is terrible.