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Feeling comfortable during appointments is important for both patients and physicians, March 21, 2017.

Disclaimer: Some topics discussed relate to graphic health issues, mental illness and suicide.

Dr. Laurence Batmazian is one of the family physicians at Student Health Services.

Note: This article represents my personal opinion and should not be interpreted in any way to represent the views of Western University. All stories occurred prior to my employment at Western — there are absolutely zero students (past or present) referenced to in this article.

In a time of increasing sensitivity around one’s genitals, I thought it important to explain why your student health physician may ask very personal questions and want to see very personal areas.

1. We ask only because we want to provide good care

I once saw a young man who complained of some uncommon urinary symptoms. I asked if everything was “OK” in his genital region, to which he responded, “Yup!” It was not until the third visit that I caved and asked if I could take a quick look. Unfortunately, I had to inform him that the green ooze emanating from his urethra was not a normal part of growing up. One cotton swab later and I was writing him an apology note for not diagnosing his chlamydia two weeks earlier.

I was lucky — other doctors have missed cervical cancer, infected tampons and strangled testicles.

Honestly, we do not want to look at genitals. Our job, however, is to provide good care and if that requires us to offer to take a look, you should expect us to.

2. You have the right to decline an examination

We respect that you may have any number of reasons to decline to be examined. Those of us with trauma histories can sometimes feel triggered for reasons that we can’t explain. Other times, you just don’t feel like showing off your thrombosed hemorrhoid to your doctor (do not Google this). You don’t have to give a “valid” reason: if you say no, I respect that. Now, of course, you assume the risk of whatever it is we didn’t see — but the privilege of adulthood includes choosing what risks to take.

I have never left a room feeling bad that a patient did not want me to examine them. However, for many doctors, one of our biggest concerns is inadvertently making you feel uncomfortable and finding out after the fact.

If there is anything we can do to make the visit more comfortable — whether that is setting you up with a provider of a certain gender, warming up the stethoscope, or doing a better job of explaining the steps of what is going to happen, then please tell us. We genuinely want to know.  

Now is also a good time to remind you that you always have the right to request a chaperone during your visit, particularly for any sensitive examinations.

3. You have the right to ask why

Sometimes we ask questions that might seem offensive or request physical examinations that do not at first make sense — feel free to ask us to justify why. Medicine is not a secret; as the patient, you have the right to ask me why I do what I do.

I hope, however, that you also trust me. The media has greatly publicized the < 0.01% of physicians who are nefarious. I urge you to not let bad apples ruin your faith in our profession. Instead, I hope this article makes you feel empowered to do what bad doctors fear and good doctors want: ask questions in the moment. That way we can clear the air right away.

Why might I use the back of my hand to move your breast when listening to your heart? Because one of the heart valves is located right underneath. Why might I use a flashlight to illuminate your scrotum? Because I can quickly eliminate cancer as the most likely diagnosis. Why do I ask about your sex life when you have a sore throat? Because gonorrhea in the throat is a thing. Why do I want to know if your vaginal discharge smells different than usual? Because that might be a sign of something worth treating. Just ask us — we’ll gladly explain.

The same goes for asking questions around suicidality. An estimated one quarter of people who die by suicide see their primary care practitioner within their last month. I ask, bluntly and frequently, whether patients have any suicidal thoughts because every morning I fear waking up to an e-mail from the university saying that we are one Mustang short.

4. There is nothing you are going to say or show that will surprise me

In the last five years, I have been (among other things) bitten, pinched, punched, robbed and violently threatened by various patients.

I promise you: there is nothing you can say or show me that will surprise, impress or scare me.

And look, we can all relate to being uncomfortable showing our genitals or sharing personal details about our lives with our health care providers. That’s human. But the reality is, we actually do not think about your body after you leave the room. Like most people, I actually spend a significant amount of time each day thinking about myself, my own life problems and food. And trust me, the last thing I want to think about while peeling a banana or crunching on a cucumber for lunch? Your genitals.

5. We care

Everyone at Student Health Services does this because we are genuinely here to help. It may surprise you to know that we make less than our non-student-health counterparts. (Please write your MPP and tell them.) We have made sacrifices to work at Western because working with students is what we love doing.

So let it all hang loose. Spill out your metaphorical (and only if truly necessary, your literal) guts, and feel free to tell us how to make your visit and experience more comfortable. We’re here to help.

— Dr. Laurence Batmazian


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