Tuesday, October 18, 2016

Why I don't do doctors...

Yesterday, I read a very interesting account of a woman's experience visiting a gynecologist in Iran.  Bahar Anooshahr, the woman who wrote the piece, is herself an oral surgeon.  She had given up that career for one in writing.  She wrote about the culture shock she experienced when she visited a doctor in Iran.  Anooshahr is originally from Iran, but had not lived there in many years.  She knew it would be much cheaper to see a doctor there than in a more western country.  Since she was no longer practicing oral surgery, money was an object for her.  She got a very cheap gyno exam, as well as a reminder that sometimes you get what you pay for.

I cringed as I read about Anooshahr's experiences in Iran.  The doctor had told her to strip and stood by while Anooshahr got naked.  She got up on the table and the Iranian doctor delivered what sounded to me like a very unkind and embarrassing exam.  Then, to add insult to injury, the doctor gave Anooshahr the samples she'd provided and told her she had to deliver them to the lab herself.

I have read other accounts of healthcare written by Americans abroad.  A lot of women who have babies or even have routine gyno care in Germany are shocked by some of the differences.  I was talking to a German friend the other day and she said that here in Deutschland, women typically see their OB-GYNs twice a year!  This conversation came about after I visited my dentist last week, who gave me a sound lecture about getting to the doctor for a checkup.

My last visit with an actual OB-GYN was in 1995, when I had my first "female" exam... the one that has left me traumatized over two decades later.  I did have an exam in 2007, before we moved to Germany the first time.  It was delivered by a very kind physician's assistant, though, who had to comfort me while I had a total meltdown in her exam room.  That led to several weeks of my having to come back for blood pressure checks because she was certain I had hypertension.  I didn't, at least not at that time.  But I had to spend 24 hours hooked up to a blood pressure monitor to prove that what I actually have is white coat hypertension.  Not good.

I am fascinated by healthcare, especially as it's delivered in other countries.  I went to school to study public health and, had I not turned into "knotty, The Overeducated Housewife", I might have actually had a real career in healthcare.  But when it comes to my own healthcare, I'm negligent.  I think I have a phobia of doctors.  When I visit them, my blood pressure typically shoots up and I get panicky.  The offical name for "doctor phobia" is iatrophobia.  Sometimes people mess up the word and think it's "Latrophobia", which is wrong.  I think they must be mistaking the "I" for a lower case "l".  To remember the word "iatrophobia", all you have to do is realize that it derives from Greek.

Iatrophobia is a word that comes from the Greek word iatros, meaning "healer".  I know this because I also know the word "iatrogenic", which is one that comes up in public health.  A medical problem that is iatrogenic is caused by medical treatment.  Here's an example of an iatrogenic medical problem.  Say you need a heart transplant.  You get the transplant, but then have to take anti rejection drugs for the rest of your life.  Because you are taking powerful drugs that lower your resistance to germs, you end up suffering from chronic sinus infections.  You never had problems with your sinuses before your transplant.  The sinus infections would be an iatrogenic condition.  You would not have had that specific issue had you not sought medical treatment. People who get transplants are also at an increased risk of developing cancer, which could also be considered iatrogenic.  Basically, what it means is that you have a condition that was brought on by your visit with a healer.  The issue may or may not be worse than the original problem for which you sought treatment.  For instance, a scar that results after surgery is iatrogenic, but it's not usually medically harmful.

I suppose my own issues with iatrophobia were actually caused by iatrogenesis.  I have never enjoyed visiting doctors much, but I didn't have a full on phobia of them until one fateful day in April 1995.  I was 22 years old and had applied to the Peace Corps.  A condition of Peace Corps service was that I had to have a very thorough physical.  Most of the physical, as delivered by my local military treatment facilities, was bullshit.  I had blood and urine drawn, got my hearing and vision checked, got tested for AIDS, weighed, and all the rest.  The last part of the physical was the gynecological exam, which the Peace Corps insisted that I needed even though I was a virgin at the time.  The doctors I saw were reluctant to examine me because of my virginity.  I told them I had to have it done.

I remember that April afternoon, sitting in the dingy waiting room, looking at the pictures of all the babies on the walls.  I was alone and very nervous as I filled out the paperwork.  It was a very primitive setup; I recall the form had actually been typed on a typewriter rather than printed from a computer.  I had my blood pressure taken by a kind medical assistant who reassured me that the doctor I was about to see was "gentle".  Unfortunately, she was wrong.

The Air Force physician, a major who was wearing her uniform, had a nurse in the room as she performed the exam.  She was very rough and physically hurt me.  I was lying naked under a paper sheet while the nurse stood by silently and the doctor proceeded to use a cold metal speculum that was much too large.  When I shrieked in pain, she told me I had to "calm down" or we couldn't do the exam.  Since I needed to have the exam done and she'd already assaulted me with her instruments, I bit my lip as she removed the first overly large speculum and inserted another one.  It hurt only marginally less.  I almost fainted from the pain and shock.  She chastised me for my reaction as she roughly examined my breasts, my ovaries, and my rectum.

When the very thorough exam was over, I was invited into the doctor's office.  She said "Everything looks okay, although I didn't get the 'world's greatest exam' because you weren't very relaxed."  She told me I'd gain weight in Armenia and advised me to go on a diet.  Then she asked me if I wanted birth control pills.  I remember looking at my medical records and the impersonal notes she'd written.  I felt utterly worthless and humiliated.  I left that office feeling thoroughly violated.  I don't want to use the word "rape", because I don't know that the exam was necessarily like a rape.  But that exam definitely had a horrifying effect on me.  I felt like that doctor saw me as a big slab of meat and had treated me accordingly.  It was a terrible experience that still makes me cry when I think too hard about it.  While I don't regret my Peace Corps service, I can't deny that it helped lead to the situation I'm in now.

Still, I realized the importance of medical exams even after that awful experience at Langley Air Force Base.  As I was leaving the Peace Corps in 1997, I tried to have another exam done by the Peace Corps Medical Officer.  The physician's assistant was a nice lady that I had gotten to know.  She assured me she'd be gentle.  She told me to get undressed, but failed to mention the paper gown I was supposed to put on.  When she entered the room, I was completely naked and should not have been.  She was shocked and did nothing to hide it.  So that was horribly awkward for both of us.  In the end, I couldn't let her do the exam.

I fainted my last day of being a Peace Corps Volunteer.  The physician's assistant tried to draw blood, missed my vein, and instead of trying again, simply tried to dig for the vein in my arm.  I remember it hurting, telling her I didn't feel well, and then waking up confused.  She told me to get a blood test in the States.  I didn't bother.

The funny thing is, from what I've read, here in Germany it would have been perfectly appropriate for me to be standing there naked, waiting for an intimate exam.  They don't even leave the room while you disrobe.  That's apparently how it's done here because nudity is not a big deal.  No thanks.

It took another ten years after my aborted pelvic exam before I could bring myself to have another exam.  That time, the pelvic exam was pretty much painless.  The PA who did it was extremely gentle and understanding.  I still cried; but she gave me a hug and listened.  I was really relieved that the exam was painless and delivered by an empathetic person.  On the other hand, the painless exam also pissed me off.  Because now I know that my first exam didn't have to hurt so much that I'd almost pass out on the table.  Now I know that there was no reason for that first doctor to traumatize me, other than her own convenience and insensitivity.  I was too young and scared to do something about her abusive treatment of me.  And now I know that, while I could end up with a very kind and understanding healthcare professional, I could also end up with someone who might make my issues even worse.

In the late 1990s, there was a time when I did willingly seek medical care.  In that situation, I truly needed to see a doctor because I had developed dangerous skin infections that made me legitimately sick.  I'm pretty sure the germs responsible for those repeated infections (I got my first one on a trip to Turkey in 1996) came from my time abroad.  It took a good three years before I finally stopped having problems with random bouts of cellulitis.  I had to take powerful antibiotics and, at one point, almost ended up in the hospital.  I fought going to the hospital and turned out to be right, but it wasn't without a lot of arguing with authoritative doctors about it.  I did find a doctor I would trust if I still lived in Virginia.  The guy was a saint.  But so many of them talk to you like you're stupid and/or unwittingly cause harm by being bad communicators.

That time post Peace Corps assignment was very stressful for me because, besides being sick, I was also broke and suffering from clinical depression and anxiety.  The positive side of that experience was that, for the first time in my life, I was getting medical care from civilian providers.  They were a lot better than the military docs I had seen throughout my childhood and adolescence.  My mom was never one to take me to the doctor unless I was sick, so even my experiences with military docs were somewhat limited.  But then I married Bill and ended up back in the military healthcare system.  I fought using it for two years before I finally gave in and gave up my civilian health insurance.  Here in Germany, I could go on the American installation if I needed to, but most medical care would involve seeing a German doctor.

So now, here I am in my 40s, when I'm supposed to be diligent about check ups.  I even have advanced education in healthcare.  I realize that I'm probably being stupid and I may end up paying for neglecting my health.  Still, the idea of seeing a doctor terrifies me.  So many people, Bill included, have asked me to get a check up.  I know in my head that I should do it, but I can't bring myself to it.  Aside from that, I have a bit of a death wish anyway.  It comes from the low grade depression that has dogged me my whole life.  I guess I'm somewhat lucky in that I've always been very healthy.  I have a sister who hates seeing doctors and went through many years when she would actually faint every time she was in a medical setting.  She told me some time ago that after many years of repeated fainting, she finally stopped.

I know I have written about iatrophobia before, but the subject is coming up again.  Apologies to those who think it's too personal.  I really am writing it because I think this is a problem that many people face.  I want to tell my friends that I appreciate their concern when they ask me to see a doctor.  But I also want them to understand that I have a phobia and it's not so simple as making an appointment because someone says I should.  Also, while I understand why people engage in scare tactics, I want to tell my friends that trying to scare me into seeing a doctor won't work.  If anything, it simply makes the anxiety worse.  Why would I want to make an appointment to see a doctor if I know that he or she will simply give me bad news that may mean I'd need to come back for more?

Reasoning is also a natural thing to do when someone is being "stubborn" about visiting a doctor.  What I think people should understand is that phobias are irrational fears.  While reasoning makes sense if you're rational, a phobia is by definition irrational and ridiculous.  So telling me about all the things that could be wrong or explaining that it's not so bad does little to cut through the anxiety.  What is helpful is kind reassurance, active listening, and, frankly, a little firm insistence.  The last time I saw a doctor was in 2010.  Bill made the appointment for me, drove me there, and escorted me into the medical facility.  When I needed an ultrasound, he did the same.

I'm sure this post will resonate with some people.  Look up "doctor phobia" online and you'll find that a whole lot of people don't do doctors.  I suppose there will come a day when I'll have a crisis of some sort and end up seeing one because someone called an ambulance.  I realize that's a ridiculous way of getting over a phobia.  It's not fair to Bill, who genuinely cares about me and shouldn't be stuck with a big bill due to my negligence.

I do mostly feel fine.  Ignorance is bliss.  I know it's stupid and ridiculous.  Believe me, I know.  I know I could have cancer or diabetes and die a painful death at a young age.  Knowing those things doesn't make me want to go to the doctor, though.  I'm not sure what the future holds.  I may die younger than I have to.  The good news is, that when I do finally kick the bucket, I doubt that many will care.  Some may actually cheer.  And ultimately, life is 100% fatal anyway.

13 comments:

  1. Hi there. Just a word about German gynecology. Having lived here for the better part of the past 8 years, I've visited German gynos regularly. I've also had German pre-natal care and given birth in this country and not once have I been asked to disrobe in front of the doctor or hospital staff. A sheet has always been provided and honestly my American gyno experiences have been far worse.
    I wish you all the best. Your phobia is an unfortunate one.

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    1. Thanks very much for the reassuring comment. I figure if we stay here much longer, I will eventually have personal experience one way or another.

      Hopefully, if I do, I will have a chance to blog about how great German docs are.

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  2. I don't think I'd ever have a gyno exam anywhere other than in the U.S., Canada, Australia, New Zealand, or in of the western European countries. Good luck if you're contemplating one soon.

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  3. Your experiences with gynecological care are a bit nightmarish. The physician's assistant you described was especially unprofessional, but the Air Force physician was no cupcake, either. Sometimes it's assumed automatically that women will be gentler or otherwise better, but such is not always the case. Sometimes we ARE (I said "we" because I have performed a pelvic exam during surgery rotation though not on a conscious patient. They let us practice on anesthetized patients first, which is better for everyone. I'll have to do the first "real" one, as in on a conscious patient, in January. I want to be good at it because I'll do a lot of them in 4th year and in my internship, and it's important to learn to perform them thoroughly but in a way that causes the least possible physical and psychological pain to the patient. the same can be said of prostate exams. I did a couple of those during my surgical rotation as well. Those I especially dread because i understand that it will be tough for a man to undergo such an exam froma woman my age, but I have to do it. I just feel sorry for the poor guys.

    I haven't undergone a pap smear yet. i suppose it's a bit ironic that I've practically performed one before having undergone the procedure. (We don't go through the motions of doing the scrapings if it isn't a procedure the patient needs to be done. At some point you have to draw the line at the importance of physician training and the overall good of the patient.) After the attack incident, when I was not raped but was kicked in the general area, I was given a pelvic exam but I was sedated to the point that I was out, as in not technically under general anesthesia because I was still breathing on my own but with no consciousness. The doctor had wanted to do it without any sedation whatsoever, but I screamed when the nurse tried to insert a catheter because it was so painful, and my Uncle Steve told the OBGYN no one could proceed without anything in that area without heavy sedation. My mother passed out when I screamed. I don't think the doctor cared one way or another. Your friend is right that there are American gynos who will give you bad experiences.

    It will be time soon for me to bite the bullet and undergo the exam, but

    I haven't been at especially high risk for anything, so I haven't rushed it, but it will be time soon for me to bite the bullet and undergo the exam. I can't put it off forever, and millions before me have survived it. Just the same, I'm very happy not to have my initial exam be in Iran after what you've shared.

    I remember Sonia Johnson, in "From housewife to Heretic," telling of having her last baby somewhere in Africa. All the women in the maternity ward of the hospital were laboring on separated tables in one communal room with a large viewing window for the families (or probably for anyone who wanted a view). The only women who had so much as a sheet or blanket were ones who had been through the experience there or knew someone who had and had the insight to bring a sheet or blanket from home. Basically no one did anything for the women until it was time for the babies to pop out or be pried out. it took almost an act of God to bring about a c-section. How barbaric!

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    1. The second PA-- the one who did my last exam, was excellent. If all medical folks were like her, I'd probably be more willing to see them.

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  4. You might want to look into purchasing your own sphygmomanometer - actually, I don't even know if they call them that when it's an automatic cuff and machine, but you know what I mean. Omron is a good brand and is available from Amazon, or here you can get it from a local pharmacy. I don't know about the electrical outlets and converters, and if you'd need something compatible with German electrical outlets, or if you would already possess converters that would work for basic small appliances. If you get one, you should know that the ones with wrist cuffs aren't necessarily accurate. The Omron brand ones with upper-arm cuffs almost always calibrate plus or minus a standard deviation evenly with those in doctors' offices. If you get one and it doesn't, you can send it back. It's just that it might be good if you could tell your doctor what your pressure has been every day for the past week, particularly if your pressure is normal except when the white-coat hypertension rears its ugly head, if he or she is concerned about hypertension.

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    1. We actually have a sphygmomanometer because Bill has HTN. I used to use it sometimes, but don't now. I'm getting less and less cooperative about such things.

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    2. As is your right. You are an adult. Unless Lt. Col. goes all Pat Boone on you or something like that.

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    3. Ha ha! He might do that at some point. Most of the time, he's pretty mild mannered.

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  5. P.S. i'm working night shifts for a couple of weeks because the nausea is at its mildest then. I am allowed three barf sessions. If I exceed three, it's time to call it a night. Last tnight and this night I've only tossed cookies once each night, which is workable. For liability purposes, I'm not touching anyone. I'm taking symptoms and medical histories. In a couple of weeks when the test comes back negative it will be business as usual. I'll still need to test at three and six months, but it's a formality. I'm really not worried about this. there would be nothing accomplished by worrying about it anyway, but I'm REALLY not worried. My only concern is that the prophylaxis regime has me so wiped out that my immunity is low enough that I'm concerned about picking up every bug, particularly bacterial or fungal, that comes through the E.R. I wear a mask, which helps, but it can't catch everything. This, too, shall pass.

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    1. Ugh... it just sounds horrible. I hope you never have to go through this again.

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  6. A lot of medical professionals make it through their entire careers without going through it once, so my chances of not having it happen twice are good.

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