[sconnie892]

I need to vent this and get it out of my head. Sorry this is a bit long. Suggestions are welcome.

I don't like going to the doctor, but I go for the female exam once a year. I had been seeing the same person for about 10 years and suddenly...she quit. No notification until I made an appointment. To avoid the whole transferring records thing, I opted for an appointment with the nurse practioner at this clinic (all the remaining docs are men and I wanted a woman for this). I was nervous about having to see someone new. What happened at the exam did not help at all.

So when I got there, in came someone completely different - the STUDENT nurse practioner. I was nervous and assumed she would do some of the preliminary stuff but that the real NP would be in to do the majority of the exam. I was so nervous it never occured to me that I had the right to ask for the regular NP to do the exam. The NP finally came in at the very end for the final "internal" stuff. But the student still did the actual examination. Well apparently I have a tilted uterus and the student did a poor job and had to try three times to get the most delicate portion of the exam correct. The first time was downright painful and I told her so. I have never had pain with this exam before.

She also found a hard area in one breast and they wanted an ultrasound. I told them I probably couldn't afford that. I have horrible insurance. Apparently it wasn't too concerning because they agreed to a watch and see approach.

It wasn't until I got to work and talked to the women in my office I realized what really happened. One of them asked "Did they ask if it was okay to have a student do the exam?" I don't think they ever did. She just kind of went ahead and did it. Now I am questioning the quality of the exam. I paid to see the NP - not a trainee. She did catch the breast thing, but she is still just a student. I only go once a year and this was the first time seeing this person. I am really disappointed.

Should I complain to the clinic? Write a letter? I don't even know who I should talk to there. They are a small clinic that is part of a pratice wtih multiple offices and affiliated with a big hospital system.

I just feel emotionally paralyzed right now - clamped up with fear, sadness, and anger.

[carrie_ann]

i would definitely write a letter of complaint to the clinic. here the medical centre i am registered with is a teaching practice, so lots of medical students, but we are always asked at the point of booking if we mind being treated by a student or having one sit in. we have the right to say no. here out healthcare system if free (in that it's funded via taxes etc but if you aren't a taxpayer, you still get treated) and even we have the right to be asked in advance. as you pay hard cash, i'd say you have even more right to have treatment you're happy with and to complain if not. after all, it's not JUST your money, it's your health!

I personally would minimally call up there and complain, and I believe you would complain to the Doctor who over sees the NP.

[sconnie892]

So I've been doing a lot of thinking about why this whole appointment has me so upset. I was thinking about how I would write a letter to the clinic. The thing is the student was more thorough than the NP. The NP came in, touched my breast for 20 or 30 seconds and wanted an ultrasound. (Which when I researched the average cost in my area was $350-$650). She never asked about other symptoms. Never asked if I get sore breasts as part of my cycle. She had only met me minutes earlier - although I could hear her flipping through my chart in the hallway. It was only when I started asking questions about the cost of an ultrasound and explained my insurance that she back pedaled.

If they had looked at the records from my old doctor, they would have seen things like testing for possible thyroid issues, which can be linked to iodine deficiencies....and iodine deficiency can be linked to fibrous breast tissue. (I've been doing a lot of research tonight). My old doctor used to ask about it every time - was it bothersome, what did I do to alleviate symptoms (exercise and drink water).

Instead of explaining the situation to me, I was left shocked with the finding and feeling hopeless and scared. I felt no reassurance. They basically told me to call my insurance company and find out what it covered (because I questioned the cost). Told me to watch it and if it got worse come back. It's never even bothered me - until they pointed it out. Now I feel like I have ticking bomb in my boob!

I was going to send a letter to the NP, but I think the letter should go to the doctor whose name is on the clinic. He has one dissatisfied patient right now. I've been in this clinic system since I was born. This is the first time I have been completely disappointed in them.

I think I will write the letter and take it with my to my next t appointment on Thursday...she has a good way of telling me if I am completely off my rocker with things like this.

[sunrise]

I am an NP student and my supervisor must ask a patient if it is OK if I either sit in the room to observe or to do the exam. (In my case it is a psychiatric evaluation or med management.) Some patients say no and that is perfectly OK and within their rights. That is why the patient is asked--so they have a chance to decline. The NP at this clinic blew it by not asking your permission for the student to participate. The NP student was working on the clinic NP's license when she saw you, not the clinic doctor's, so it is the NP who made the error. Definitely complain to the NP and also the clinic manager/chief administrator.

I'm sorry you had such a bad experience. They really blew it.

Originally Posted by sconnie892

I think I will write the letter and take it with my to my next t appointment on Thursday...she has a good way of telling me if I am completely off my rocker with things like this.

Good idea. My advice on the letter: be concise. Hope you will check back and let us know how this turns out.

[sconnie892]

Originally Posted by sunrise

I am an NP student and my supervisor must ask a patient if it is OK if I either sit in the room to observe or to do the exam. (In my case it is a psychiatric evaluation or med management.) Some patients say no and that is perfectly OK and within their rights. That is why the patient is asked--so they have a chance to decline. The NP at this clinic blew it by not asking your permission for the student to participate. The NP student was working on the clinic NP's license when she saw you, not the clinic doctor's, so it is the NP who made the error. Definitely complain to the NP and also the clinic manager/chief administrator.

I'm sorry you had such a bad experience. They really blew it.

Good idea. My advice on the letter: be concise. Hope you will check back and let us know how this turns out.

Thanks. I am sending a three page letter to the two doctors at the clinic and a copy to the NP. Not really concise, but I felt the need to document everything. If they don't want to take the time to read it, it only confirms my feelings that the patient care at this clinic has gone down hill the last year.

I don't think they have a manager onsite as it is part of much bigger system of clinics and hospitals. Rather than complain to someone at the headquarters 50 miles away, I am going to give the clinic to address this and talk to me about it. I would rather have them improve their patient care than have my complaint get tied up in the Customer Care Office of some other place. But if I don't get a reply I will definitely take it to the next level. Unfortunatley this NP was the only female provider left at this clinic, so I will likely have to go somewhere else from now on.

[oceancries]

Okay I read this whole thread and I have to say that was very wrong of the NP not to ask you if it was okay for the Student NP to do the exam.

[hamster-bamster]

I routinely get blood drawn by student lab technicians and they always, always first give me the right to refuse their services. I always agree because one way or another, they need to learn.

[hamster-bamster]

I see that you ended up with the student because you did not want an appointment with an established male doctor. That is something I could never understand about women who have preference for female gynecological practictioners. Sure, a very hands-on midwife or doula who literally holds you and breathes through every contraction with you - that person should be a down-to-earth, emphathetic female. But just for the exam, who cares about the gender? I have had PAP smears done by men and women, IUD's placed and removed by men and women - there is absolutely no difference. The bedside manner, quality of care, professionalism, and attention are all the same. If you start accepting males as your gynecologic providers, your pool of available providers will increase more than twofold - it is worth it.

[Yoda]

Everyone is entitled to their feelings and preferences but when I was working at the hospital some patients would confuse me because they would have a male doctor but would ask to be treated only by female nurses.

[hamster-bamster]

Originally Posted by Yoda

Everyone is entitled to their feelings and preferences but when I was working at the hospital some patients would confuse me because they would have a male doctor but would ask to be treated only by female nurses.

What a weird set of preferences.

[Yoda]

Originally Posted by hamster-bamster

What a weird set of preferences.

Welcome to West Virginia.

[hamster-bamster]

Originally Posted by Yoda

Welcome to West Virginia.

Oh, I see. Have never been there, coal-mining, right? Have been to VA, but not W.VA.

[sconnie892]

I had actually requested the regular NP for my exam. She chose to send in the student instead of coming in herself for the whole exam.

I've had male and female providers. I like that when I say "I get cramps" the female may understand that feeling because she's had them. A guy might get it or not. However since I am once again in the market for a new doctor, I've revised my list of preferences. While I still prefer a female, I will take a male if he is better qualified to meet my list:
1) Must have good communication skills with the patient
2) Cannot take offense at an educated patient asking questions
3) Open to alternative treatments/doesn't push excessive testing

Interestingly enough when I met with a surgeon Thursday he had a student PA with him. Again, no asking if it was okay. She stood there, said nothing and looked like a deer in the headlights. This time I was okay with it since he was doing the exam.

[RomanSunburn]

I understand preferring women over men doctors... Or maybe it's a actually a preference of nurses over doctors.... When I had a UTI, the female nurse who did the intake told me I clearly had a raging UTI and could understand the pain I was going through. The male doctor didn't really say much, but when he called me with the results of the test basically said "Oh wow, you DO have a UTI. I didn't think you did, but the results say you do!" Seriously?

I've also had a student do my pap smear before... She didn't do a very good job, and I had to go back for another exam. It turned out that she simply didn't get enough to test, but I got a phone call that I had abnormal results... Talk about nerve wracking until I finally found out what really happened...

Good luck with your doctor search. I hope they get in touch with you to deal with your complaint... They could really get in a lot of trouble if they don't fix the issue.

[hamster-bamster]

Originally Posted by RomanSunburn

I understand preferring women over men doctors... Or maybe it's a actually a preference of nurses over doctors....

That IS a valid prefence! Nurses are closer to the trenches and really understand what is going on. That is also one reason why nurse-midwives (CNMs) are, in my view, better than doctors for obstetric and gynecologic care. Not because they are women but because they provide better care.

[feralkittymom]

Originally Posted by hamster-bamster

I see that you ended up with the student because you did not want an appointment with an established male doctor. That is something I could never understand about women who have preference for female gynecological practictioners. Sure, a very hands-on midwife or doula who literally holds you and breathes through every contraction with you - that person should be a down-to-earth, emphathetic female. But just for the exam, who cares about the gender? I have had PAP smears done by men and women, IUD's placed and removed by men and women - there is absolutely no difference. The bedside manner, quality of care, professionalism, and attention are all the same. If you start accepting males as your gynecologic providers, your pool of available providers will increase more than twofold - it is worth it.

Rather dismissive and invalidating, I think.

Practitioners and patients are not robots, and many factors come into play when making a choice. Gender is a valid choice, whether or not it is for you, personally.

[hamster-bamster]

Originally Posted by feralkittymom

Rather dismissive and invalidating, I think.

Practitioners and patients are not robots, and many factors come into play when making a choice. Gender is a valid choice, whether or not it is for you, personally.

No, for me it is not, and I have lots of experience, having had three children etc.

[hamster-bamster]

Originally Posted by hamster-bamster

No, for me it is not, and I have lots of experience, having had three children etc.

+ one abortion + post-abortion care including cervical cryotherapy
+ three IUDs put in
+ two IUDs taken out
+ countless PAP smears

So all in all, I have received a lot of OB-GYN care and can say with confidence that men and women are equally good care providers. CNMs are better not because of their gender but because they practice a different model of care. For instance, they spend more time with you. That is an objective difference.

[sconnie892]

Originally Posted by RomanSunburn

I've also had a student do my pap smear before... She didn't do a very good job, and I had to go back for another exam. It turned out that she simply didn't get enough to test, but I got a phone call that I had abnormal results... Talk about nerve wracking until I finally found out what really happened...

Good luck with your doctor search. I hope they get in touch with you to deal with your complaint... They could really get in a lot of trouble if they don't fix the issue.

The student did my pap too and I was terrified she messed up. Thankfully that all came back normal.

I did get a phone call back from the clinic and the doctor who called apologized and actually thanked me for my letter. He said "sometimes doctors need a wake-up call." The NP had to coordinate my follow-up visits for a breast ultrasound and was very polite. I doubt I will schedule any more appointments with her, but I don't feel it is necessary to pursue the issue any farther.

[feralkittymom]

Originally Posted by hamster-bamster

+ one abortion + post-abortion care including cervical cryotherapy
+ three IUDs put in
+ two IUDs taken out
+ countless PAP smears

So all in all, I have received a lot of OB-GYN care and can say with confidence that men and women are equally good care providers. CNMs are better not because of their gender but because they practice a different model of care. For instance, they spend more time with you. That is an objective difference.

Of course, men and women can be equally good care providers. But personal choice is just that: personal. And many factors beyond the "objective" come into play and are valid.

Sconnie, I'm glad it worked out for you.

[RomanSunburn]

Sconnie, that's absolutely wonderful that the doctor handled it the way he did! I'd say we need more doctors like him around... Owning up to mistakes is a good characteristic to have!

I'm glad this worked out so well for you. Now in the future, you can look back on this event and remember how empowered you felt after all was said and done!

[Vibe]

Ah, I've got the same issue with the tilted uterus. So far I've only seen doctors (primarily female) and all the exams have been painful. No students yet, but I'd prefer to have one so long as the doctor or nurse was supervising. It's a great learning experience, and I find they're often more thorough because they're really thinking about what's going on.

As for male versus female, I've had this discussion with female family members. Most agree that men are gentler - like they don't have the equipment and aren't sure exactly what would be painful so they err on the side of caution. Women often assume other women are just like them, when we may be more sensitive. However, it's really going to come down to the individual practitioner. Not gender.

I always felt really bad for the male nursing students doing obstetrics, labor & delivery, and gynecology rotations. I feel that their education was often limited by their gender. It's definitely opened my eyes to the fact that that some of it's not just preference and comfort but also stigma. If I ever have a kid, I'll make sure to ask if any male students around who want to be part of the experience. Gotta fight the good fight!

Anyways, I'm glad you wrote the note and that your voice was heard. That's always important. I hope if there's ever a next time that you (and everyone reading this) will think to speak up before things go that far. You have a right to accept or refuse any care.

[jennifersullivan]

I always facilitate learning of students however, they did not approach the situation correctly or even notify you that the student will administer the exam. I think you should bring up the situation

[googley]

Originally Posted by hamster-bamster

+ one abortion + post-abortion care including cervical cryotherapy
+ three IUDs put in
+ two IUDs taken out
+ countless PAP smears

So all in all, I have received a lot of OB-GYN care and can say with confidence that men and women are equally good care providers. CNMs are better not because of their gender but because they practice a different model of care. For instance, they spend more time with you. That is an objective difference.

While it may not be important for you whether you have a male or female provider, it is important for some people. And saying it is not important devalues others experiences and needs. Just because you do not have a preference, does not mean that others needs are not valid.

For me, who experienced sexual assault, having a specific gender for ob/gyn is important. I have enough problems going to the doctor, having to face a man for my papsmear would make sure i never went.