The Last Word: on intimate exams

April 27, 2013 § Leave a comment

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-intimate-exams

A GP in the UK has been arrested for recording intimate examinations with a spy cam. I hide a contrary secret from patients: I hate examining genitals.  

Once upon a time, I had an obs and gynae job. I didn’t deliver vast numbers of babies but did once race a hospital trolley through a car park with my fingers inside a vagina. Prolapsed cords make odd things happen.  

Most of my time in O&G was, however, spent gazing intensely at a small area between women’s legs. I spent a thousand nightmarish hours suturing vaginal tears and episiotomies.  

When I close my eyes to sleep after a day on the highway, I see the road. And when I close my eyes to sleep after a 57-hour O&G shift, I see girlie bits. And definitely not in a good way. Vaginal examinations now probably trigger PTSD.  

My reaction to naked females is also knotty because I was informally questioned as an intern about a breast examination I did in A&E. A combo of inexperience and diligence meant that, without explanation, I’d checked the breasts of a female patient with back pain. I no longer bother with such stuff. If you’ve already got back pain from the bony secondaries of a breast cancer, then ignorance can be bliss.  

Of course, there are worse things to touch than nipples.  

I once popped behind the curtains in my consulting room to do a Pap smear. I have nothing against beautiful young women, but this one had inexplicably failed to heed my instructions to remove her lower clothing, lie down and cover herself with a sheet. Instead she stood smiling and facing me. Totally starkers. 

Despite this hiccup, a Pap was completed without incident. Back then, doing a digital vaginal examination with Paps was routine. When my gloved fingers made contact, she started to emit disturbingly non-clinical moans. I scampered away like a startled rabbit. Hopefully she had a laugh about it with friends. I didn’t.  

That happened quite early in my career so I wondered if it would be a portent of things to come. It wasn’t. In fact, if anything, female patients who appear to harbour fantasies that would, if acted upon, be a menace to my registration, don’t want me examining their genitals. Which is 110% fine by me. Win win. 

Despite all this, I rarely use chaperones. What’s the point when both doctor and chaperone are sometimes accused of sexual assault?  

I figure patients either aren’t psycho or are psycho. If they aren’t psycho and you’ve done nothing wrong, then misunderstandings should be rectifiable. And if they are psycho, then a chaperone isn’t sufficient — you really need video evidence. Ooh, wait … Maybe not.  

Nowadays, patients often hope their own photos will preclude an examination. My first experience of this was when a well-covered Muslim woman passed me her phone, which showed an odd red lesion protruding from her vagina. It turned out to be an endometrial carcinoma. 

Sometimes you must look to learn. 

I once knelt to examine a patient’s penis while he leant against the examination couch. I failed to sense the lurking danger. No checkup-hastening capacious penile thingy occurred but moments later I was on the floor with a semi-naked man on top. I’d inserted a urethral swab and he fainted. 

I related the event in the staff tearoom. In a disturbingly graphic dramatisation, a receptionist provided solace that it could have been worse. As he fell naked against me, I might in horror have opened my mouth.

It’s a living.

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