Sunday, July 3, 2016

And just where do you think you're going to put THAT?

This post has a gyn flavor, so if you're the squeamish type, you may want to skip reading this one. ;)

To the VERY few people I regularly talk about finishing medical school with (no one close to me except my kid these days), I always get asked why a medical school goal at such an older age. And the answer is pretty extensive based on the medical experience I've had over my entire lifetime. But it also comes down to 3 personal and career reaffirming gyn appointments.

The first occurred when I was a married graduate student studying Chemistry at one of the best Chemistry departments in the US. I went in for my yearly pap a year after the birth of my daughter, and was asked the standard questions at these types of appointments. But there's one question which to this day. seems to absolutely leave my health care providers surprised and flabbergasted. Actually let me correct that, it leaves my non Black healthcare givers surprised and flabbergasted and the typical exchange goes a little something like this:

Provider: "How many children do you have?"
Me: "One".
Provider: How many pregnancies have you had?"
Me" "One".
Provider: "That includes pregnancy terminations?"
Me: Deep sigh, followed by a LONG pause..................................................................."One".

Now my providers typically know I'm educated because it often comes up in conversation during that awkward chit-chat that occurs when you have your legs spread wide open during the pelvic exam. So this idea that I don't know that abortions count toward the number of pregnancies is complete racially tinged bunk IMHO.

And so this has gone on since 1996 up until a few weeks ago except after 20 years, the exchange went like this:

Provider: "How many children do you have?"
Me: "One".
Provider: How many pregnancies have you had?"
Me: "One".
Provider: "That includes pregnancy terminations?"
Me: Deep sigh, followed by "no shit, the answer is still one".
Provider: "Ma'am, I just needed to make sure you knew what I meant".
Me: "Thank you I appreciate that, but truly you don't think I'm almost 50 years old and didn't know that".

For the record, I'm not making ANY judgments about people who made the decision to terminate a pregnancy because I realize that it's probably the most difficult decision a woman can make.

Here's another experience that helps solidify why we need more Black physicians or at the very least, culturally astute ones. This also occurred when I was a Chemistry graduate student:

Provider: "Your test results have come back showing dysplasia?"
Me: "Really?".
Provider: "It's due to the presence of HPV" (a sexually transmitted virus that can cause cervical changes including cervical cancer).
Me: "I don't recall you mentioning that I was being tested for that, so how do you know that's the cause? ".
Provider: "I didn't test you for that, I just know from experience that most cervical changes are caused by HPV".
Me: " You can't assume that's the cause without proper testing". And there's nothing in my medical history what would cause you to draw that conclusion without laboratory confirmation. Thank you for you time, I'm going to follow up with another Gyn".

Now I'm not saying you can't be a married graduate student, with only one pregnancy/birth, and not get diagnosed with HPV. And having spent time in a rural health clinic in a college town and having basic common sense, I know that anyone sexually active is at risk for an STD, married people too. But I also know that this Physician "diagnosed" me with HPV because I was a Black female. She also never asked if I was a "DES daughter" which given my age, is a common sense question  to me (I had a first cousin that died from cervical cancer at 15 who was a DES daughter).

My final "bad gyn to medical school experience" occurred more recently and this one may not be as racially obvious as my other 2, but suffice it to say that if teed me off (and hurt like hell) too!!
The image of this post shows a variety of different sized speculums, which for the uninformed, are instruments used during gyn exams. Now I usually don't have "issues" with this exam but I did this time because the FP trained in Gyn decided to use the largest speculum on the tray. Now if I had birthed an baby Elephant, that would make since to me. Or if I had had 15 kids, that might make sense to me. Or if I was a prostitute, that might make sense to me. Maybe being 400 pounds and 8 feet tall, might make sense to me! But assuming I needed the largest speculum on the tray is like assuming that because I'm a Black woman, I also have a very large ass. And if I had a large ass, would that necessarily mean I require a large speculum? Needless to say two things will never happen again. One, I will NEVER see another FP trained in Gyn and two, I will ALWAYS check the size of the speculum the Doc is going to use BEFORE they do the freakin' exam!!!!

Edit: Now that I'm doing research again in infectious diseases (ID) especially HIV, I know all to well what "the numbers" show are far as the rates of ID in the Black community. But I also know that if I go to a rehab clinic and take a sample of the number of injection drug users (IDUs) in the group, that rate/number will probably be pretty high. So as a person becoming an expert in stats, I can say that sampling is everything when it comes to drawing medical conclusions. And when I look at the data (which I have access to given my current position/educational endeavors), the ONE commonality that is pretty glaring to me when it comes to IDs/STDs are the rates of infections when the data are (And yes, "are" is the right word, data is plural ;)) stratified by education and most especially, income. OTOH, I also know having lived in one of the richest counties in America (in the Metro DC), that a LOT of what should get reported in a medical record, never does..

So for numerous reasons including those I just mentioned above, I just don't trust stats derived from populations I know for a fact, aren't truly normalized. Put another way, I can't trust it!

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