Contents
Perhaps there is no woman who would not know about the need to undergo scheduled examinations by a gynecologist. Just as there is no one who, at least from time to time, would not postpone such visits. Why do we do this to the detriment of our own health? We deal with a specialist.
1.Şerm
One of the main feelings that most often prevents women from reaching the doctor’s office is shame. I am ashamed to discuss my sexual life: its presence or absence, early or late start, number of partners. I am ashamed and embarrassed by the examination procedure itself, I am ashamed of my appearance (extra weight, lack of epilation), of the features of the anatomical structure (asymmetric, hypertrophied, pigmented labia minora or major, unpleasant smell).
It is important to understand that not a single gynecologist will pay attention to the lack of hair removal or other factors that disturb a woman. The doctor focuses exclusively on the diagnosis of pathological conditions and general health assessment, but not on the aesthetic components.
2. Tirs
Someone is being examined for the first time and is afraid of the unknown, someone is afraid of pain due to a previous bad experience, someone is worried that they will hear an unpleasant diagnosis … Let’s add here the fear of moral and physical humiliation. Many patients complain that the joy of pregnancy and childbirth is overshadowed by a rude attitude from the medical staff.
All these fears often lead to the fact that women go to doctors with advanced cases and at the same time are afraid to hear something like “where have you been before”, “how could you bring yourself to such a state”. That is, at first the patient puts off going to the doctor for fear of hearing the diagnosis, and then — for fear of condemnation.
3. Distrust
It often happens that women do not want to go to a state clinic with long queues and sometimes boorish attitude of the staff, and there is no trust in doctors from private medical institutions — it seems that the doctor will definitely force you to take unnecessary, but paid tests, prescribe examinations that are not necessary, will make the wrong diagnosis and will treat for non-existent diseases.
4. Nexwendewarî
“Why should I go to the doctors? Nothing hurts me”, “I don’t live a sexual life — that means I don’t need to see a gynecologist”, “20 years already without a husband, what is there to see”, “I have one sexual partner, I trust him, why go to the doctor ”,“ I heard that ultrasound can harm the child, so I don’t do an ultrasound ”,“ While I’m feeding, I can’t get pregnant — so why am I late? do not get there yourself; I’m still waiting for it to pass” … Here are just a few of the misconceptions that patients are guided by, postponing a planned visit to the gynecologist.
Ideally, it is important to educate people — both women and men — from school, it is necessary to form a culture of dispensary observation of patients. It is necessary to go to the gynecologist in a planned manner, without complaints, once a year, with the same frequency to do ultrasound of the pelvic organs and mammary glands, cytological smears from the cervix (screening for cervical cancer) in the absence of human papillomavirus, it is important to take at least once every three years up to 30 years and at least once every five years up to 69 years. Regardless of whether a woman is sexually active and menstruating, a routine examination is shown to everyone.
5. Doctor’s indifference
According to the League of Patient Defenders, «90% of conflicts arise due to the inability or unwillingness of the doctor to explain information about the state of health to the patient or his relatives.» That is, we are not talking about poor-quality medical care, not about an incorrect diagnosis and prescribed treatment, but about the time not given to the patient, as a result of which he incorrectly or does not fully understand what is happening to him.
In 79%, doctors do not explain the meaning of the terms they use, and patients do not say whether they understood what they heard correctly (the doctor clarifies this only in 2% of cases).
Peculiarities of doctor-patient interaction in Russia
To understand why this happens, let’s look at history. In the XNUMXth century, the main way to make a diagnosis was a thorough history taking, and the main method of treatment was the word of a doctor, a conversation. In the XX-XXI centuries, medicine made a grand breakthrough: instrumental, laboratory methods of examination came to the fore, pharmaceuticals developed, a lot of medicines, vaccines appeared, and surgery developed. But as a result, there was less and less time for communication with the patient.
Over many years of work, doctors cease to perceive the medical institution as a place that provokes stress, and do not think that this is exactly the case for the patient. In addition, a paternalistic model of relationships between a patient and a doctor has historically developed in Russia: these figures are not equal a priori, the specialist communicates like a senior with a junior, and does not always condescend to explain what he is doing. The transition to partnership, equal relations is taking place slowly and reluctantly.
Medical ethics seems to be taught in Russian universities, but this discipline is more often of a formal nature and lectures on this subject are not popular with students. In general, in our country, ethics and deontology are more about relationships within the medical community, rather than outside it.
In Europe, today they use the algorithm of clinical communication — the Calgary-Cambridge model of medical consultation, according to which the doctor is obliged to master the skills of communicating with patients — a total of 72. The model is based on building partnerships, trusting relationships with the patient, the ability to listen to him, facilitation ( non-verbal encouragement or verbal support), the formulation of questions that involve open, detailed answers, empathy.
A woman brings her deepest fears, worries, secrets and hopes to a gynecologist appointment.
At the same time, the doctor does not waste time, but structures the conversation, builds the logic of the conversation, correctly places emphasis, controlling time and adhering to the given topic. A specialist who has mastered the necessary skills must be tactful in relation to sensitive topics, respect the patient’s fear of physical pain during the examination, and accept his views and feelings without judgment. The doctor must dispense information, assess whether the patient has understood him correctly, and must not overdo it with medical terminology.
Face-to-face positioning, eye contact, open postures — all this is perceived by the patient as manifestations of empathy and involvement of the doctor in solving his problem. Experts identify three components of success: patient satisfaction with the assistance provided, doctor satisfaction with the work done, and the relationship between the doctor and the patient, when the first explains, and the second understands and remembers the recommendations given to him, which means that he fulfills them in the future.
Obstetrics and gynecology is one of the most intimate medical specialties, which means that contact in this profession is more important than in any other. A woman brings her innermost fears, worries, secrets and hopes to the gynecologist’s appointment. Even the process of examining a woman by a gynecologist suggests incredible trust between them. Young and inexperienced, mature and self-confident, everyone behaves the same in the chair, embarrassed, worried and as if apologizing for their such defenseless appearance.
The issues that are discussed in the gynecologist’s office are deeply intimate and require the patient’s trust in the doctor. Intrauterine loss of a child, the failure of a long-awaited pregnancy (or, on the contrary, the onset of an unwanted pregnancy), the detection of malignant tumors, the severe course of the menopause, conditions that require the removal of the organs of the reproductive system — an incomplete list of problems that come to the gynecologist. Separately, there are “shameful”, uncomfortable questions related to intimate life (dryness in the vagina, the inability to achieve orgasm, and many others).
The health of each of us is, first of all, our responsibility, our discipline, lifestyle, adherence to recommendations, and only then everything else. A reliable and permanent gynecologist is just as important as a reliable partner. Don’t be afraid to ask, don’t be afraid to tell. If in doubt, seek a second opinion. The first bad experience of visiting a gynecologist is not a reason to stop visiting doctors, but a reason to change a specialist and find someone you can trust.