The “Oh, It’s A Guy” Look
I’m sure my male classmates will back me up on this one: I swear, every time I knock on a door, open it and say hello, I get a little look of awkwardness and discomfort from my patients. It’s a mix of surprise, disappointment and disapproval. Only once has a patient said, “Wow, great, a male in the field, you don’t really see that very often anymore!” Maybe I’m over calling it, and some of it is just made up in my head, a product of my own insecurity with the exam–but I swear it’s there at least half of the time.
In some ways, it makes me try harder, which I guess is a good thing. I try to be even more respectful and caring; I try to make even more outward shows of compassion than I do already. Empathize, use normalizing statements (“I ask all my patients about their reproductive and sexual health,” “This is an incredibly common problem among women, even if it’s not discussed very often in public,” etc.). I realize the exam puts a person in an incredibly vulnerable situation, and it probably doesn’t help that I’m a young man and that many of my patients are my age or younger. I also realize this may be the first time a male physician has seen their genitalia since before puberty (or any male unless they’ve been in a relationship with one), but I feel like the look still exists in many of my older patients as well.
I realize all of this, but still. It’s discouraging and frustrating. I’m not present to make my patients feel uncomfortable. If I could somehow learn everything I need to learn without making anyone uneasy I would, but I can’t. Unlike many other fields of medicine where you’ll never do another pelvic exam in your life, I actually need to know how to perform them adequately as a future Emergency Medicine physician.
For the most part, I’ve actually been enjoying my rotation thus far, but it’s been the first and only where I’ve felt so actively discouraged by patients. Usually my upbeat attitude and smile engender (no pun intended) some points from the patient, but during the past three weeks most of what I detect is disappointment. The nurses and attendings have been absolutely positive, enthusiastic, and encouraging, which has been immensely helpful, but I think I’ve discovered another reason why OB-Gyn is such a woman-dominated field.
(This is not a boo-hoo, woe is me post, just an observation I’ve made. I wouldn’t be surprised if it’s just as awkward–if not worse–for my female colleagues when examining men. It’s not the end of the world, and is a minor annoyance at best: I’m professional, get the job done, ask the questions that need to be asked, and do my best. This is what defines medicine as a profession: we put our patients’ needs and concerns ahead of our own. This does not, of course, mean that we as professionals are not affected by these situations, just that we work past them.)
Maybe it’s because they’re simply not expecting to see a male physician or are not prepared for the fact they might be seeing a male physician in this setting?
I mean, it’s one thing for a female to actively choose a guy as her primary care doctor. It’s another thing to be… well, surprised.
I really don’t think all female patients would give you such a discouraging reception. I think it’s probably the specific setting you’re in, and the specific population as well.
FWIW, I have a guy physician as my primary care doc. And I picked him because of his skills and caring. At the end of the day your patients need to judge you as an individual, not just on the basis of your gender.
I can tell you as a woman in a male-dominated field, I have gotten that “Oh it’s a girl.” look/sneer, too. Fortunately though, I’m working with professionals, not the general public, so it’s been extremely rare over my career. That would be tough getting that look on a regular basis!
I’m not a big fan of seeing fields dominated by one gender or another. I am ecstatic every time I see a woman pilot. I didn’t realize OB-Gyn was female-dominated. It makes sense since I do hear lots of women say they prefer being seen my another woman.
FWIW, I see a male. I think I originally picked a woman thinking I was supporting women doctors (as they generally seem to be male), but apparently I was wrong, supporting a female in a female-dominated role, anyway! One year, a male physician was available but not my regular one, so I went to him. Then he just scheduled me for the next year. I almost switched back because it seemed like he didn’t care about my womanly pain and other side-effects. However I gave him one more shot, and I’m glad I did. This last time, he asked me how my grad school was going and what I was studying, etc. I know he didn’t remember that info over a year, and I know he probably didn’t actually care how school was going. But I was so impressed with the fact that he cared enough about customer service to write that fact down and then review it before seeing me, that I’ll be sticking with him for awhile.
I will never go to a male gyno. Ever. I am not comfortable with discussing any issues with someone who doesn’t have the hardware. I had to have a pelvic once in a hospital and it was a male doctor and that was fine – emergencies don’t let you pick and choose.
[...] course right after I post about patients not wanting to see a male student, Virginia was incredibly warm and welcoming, totally open to talking about [...]
I’m sorry that you’re not being warmly received by all of your patients. Have you considered that perhaps it’s not the fact that you’re a guy, but just that you’re not the physician that the woman normally sees and knows already? If you’re expecting to see a physician that you know well and trust already, and then someone that you’ve never seen before walks into the exam room, I can imagine why they might be feeling a bit dismayed.
That being said, while I try to be impartial when choosing a doctor and pick one purely based on skill and rapport rather than on gender, it is a bit more awkward to talk to a man about that kind of stuff.
I have a male family doc, a male OB/GYN and work at the university and teaching hospital where I receive my care. Awkward is giving a student a poor mark on her assignment, then handing her your urine specimin 15 min later.
The most important skill is your ability to communicate. This is especially true as an OB/GYN.
Here’s a study that patients report feeling more vulnerable http and more discomfort with STIRRUPS than without stirrups: Maybe you could consider doing pelvic exams without stirrups- the study said it works just as well
://healthgate.partners.org/browsing/Content.asp?fileName=167642.xml&title=Women%20Reported%20Less%20Discomfort%20When%20Pelvic%20Exams%20Were%20Done%20Without%20Stirrups
Being a girl who has done a urology rotation, I can say that I occasionally got a funny look or comment, and was asked to leave one cystoscopy, but otherwise didn’t really have much of a problem. I’m sorry that women have given you trouble about being on OB.
I’m sure the discomfort of your patients is nothing personal. I would never and have never used a male gynecologist. It just seems more “natural” to me to have a female gynecologist. In fact I only use female doctors period. You are so young and so used to having female colleagues and female professors you may not realize how inappropriately some of us female patients have been treated by our male physicians. Almost every woman I know in my age group (52) has a story about a male doctor doing or saying something unprofessional to us–of a sexual nature. I had an unprofessional pelvic exam by a male urologist in my much younger days and only recently can I see a male doctor wearing a white lab coat without shaking. I know the vast majority of male doctors are not like that today but I do think this problem was not unusual in the past. When my daughters were of an age to start having pelvic exams (by a female doctor), I purchased a gynecology text and had them read about the exam so that they would know what was legitimate and what was not. Having said (written) all this I do know women who are completely comfortable with their male doctors. But surely there is no more personal choice than the choice of a gynecologist and as such emotions as well as logic plays a role in this choice.
That’s terrible, anon. So sorry you ever had to deal with that.
I’d had bad experiences in the past with male GYN/OB and largely avoided any exam for years. Or I would force my GP to do it if he absolutely insisted. I had the opinion another poster mentioned of if you don’t have the equipment, how could you possibly be effective?
My daughter made me promise when it was time for her first pelvic that we would find a female GYN. I did and we both disliked her intensely, she was very judgmental and would ignore our questions if she didn’t feel they were “appropriate” for a minor. Unfortunately she was highly recommended for adolescent medicine, specifically GYN/OB issues so the association was less than happy with my request to see another physician.
Upon several recommendations from friends we switched to a male GYN/OB who specializes in young women (ages 15-21) and WE love him. He answers all questions honestly and has developed a great rapport with me and my daughter. She actually dreads the day she will “age out” of his practice.
I currently have a female primary care doctor, and a male rheumatologist. I prefer both female dentists and females to do my pelvics because I prefer someone with much smaller hands poking around in both orifices. My female doctor also remembers to warm the speculum, and to insert it gently. Not all doctors I have had pelvics from have done so.
But that being said, I’ve had bad doctor experiences from both men and women.
Blame the patriarchy, dude.
I’m surprised no one else mentioned what I’m about to say. You do realize that 1 in 4 women are victims of rape or attempted rape, don’t you?
I work in a med school and I sometimes get annoyed when I’ve debated this topic with my friends (doctors and med students) because they seem to think it just magically goes away after the rape kit is finished so no one can use that reason for not wanting them to do their exams later in life. Nope! Or they think the female patient would tell them that part of her history or at least tell them that’s the reason she doesn’t want to see them. Nope!
I didn’t tell my female doctor for awhile after I started going to her because I wasn’t ready. I told her when I was ready. And it’s always there. Every time I go in for my pap I have panic attacks beforehand and it’s hard emotionally even with a doctor I like and trust. Like hell I’d let a man do it!
Yup, I sure do realize that.
In addition to what Anne mentioned about sexual assault, there’s another thing. Most of my friends with vaginas have been to male gynecologists that were total jerks and treated them terribly in some way or another. There are also plenty of asshole women gynecologists out there, but there seems to be a higher frequency among the male gyne population.
Dismissing their questions, treating them like they are stupid, not explaining what they are doing or touching even when asked, and yelling at them for expressing concern or emotion are just a few of the things my friends and family members have experienced as patients. 2 in particular, both of whom are well-educated about and had very appropriate questions about their health were treated very disrespectfully and yelled at when they began to cry. (Also – both of these 2 friends are straight, well-off white women with health insurance, I can only shudder to imagine how these doctors might have treated someone else even less like them that might make them more uncomfortable or activate more of their jerky tendencies).
I think for many women it is about how they are worried they will be treated (and likely have been treated in the past) more than specific worry about being naked in front of a man. At least for me, the reason I will always choose a female doctor for a pelvic exam (and anything else I can) if possible is about increasing my chances for respect and not being treated like a stupid object. I don’t really care who sees my naked body, it’s about how they treat me when they are seeing it.
Also – even if the new field of up and coming OB/GYN are mostly women, that has not been the case in the past, and the field itself has a history of not treating women (especially women of color) right, and seeing women as dumb/hysterical, etc.
Hmm, interesting debate. Its funny that you say most ob/gyn’s are women, because I think that here in the British Isles its still mostly men. its probably changing though, as more women go into medicine. I’ve never had to have a pelvic exam, so I can’t say, but I do know a lot of women who said men were very rough and insensitive, and also dismissive of their worries. I guess I’ll have to wait and see!
I suspect that, if you were to survey your patients, older women are comfortable with male gynos because, when they were young women, there were almost no female gynos.
When women gynos first popped on my scene (I’m 51), I thought it would be great because so many of the male docs I saw were a-holes, but these days I don’t found much difference generally (fewer obvious a-holes though). There are huge individual differences between physicians, however, and I look for a good doc, not gender.
I’m sorry I’m not in your area because I’d love to have a doctor like you.
As a woman, I sympathize with women who are uncomfortable with male gynecologists. Personally I’ve been lucky enough never to have any experiences that would make it difficult for me, and I’ve had excellent doctors, both male and female. (The best two were actually internists, one of each gender, who were willing to handle my yearly well-woman care as well; make of that what you will.)
As a med student, I haven’t done a urology rotation but have had occasion to examine males for sores, hernias, etc. So far I have never had a male patient seem uncomfortable at all, except for rectal exams in which case presumably the discomfort was related to the procedure and not to anything about me. (In fact one patient was iffy on the whole thing but agreed once he saw the small size of my hands.)
If I went to the Gyn and saw a young man such as yourself come in to do a pelvic exam, I would probably unintentionally give you a surprised/awkward/disappointed look, more because of your age than anything else. And I don’t mean doubts about your abilities either.
As a young woman, I would feel embarrassed by having such an intimate exam performed by someone I consider a peer. I think there’s a perceived professional distance when being treated by an older male, as compared to a younger one. And for things like a pelvic, a little distance can be more comforting than attempts to be buddy-buddy.
But I imagine that as I get older, the age and sex of my Gyn will become irrelevant.
You shouldn’t be offended by the looks that some patients have given you. The insecurities the patient brings reflect on her own situation, not on you. And it sounds like you’re doing a good job of being comforting yet professional, so you may be changing their minds, one by one.
Having been in this position before I can tell you that the following 2 thoughts cross my mind when I see a male OB-GYN:
1.why would a male choose to do this? It’s creepy.
2. He can’t relate to what’s happening with my body…hello, have you ever had menstrual cramps? or a baby kicking you from the inside?
Perhaps your patients share these sentiments?
As a young, woman and rape survivor the entire process of a pelvic causes me incredibly anxiety regardless of the gender of the person performing it. Even more anxiety should I need a longer procedure like a colposcopy.
That being said I have had some vicious female Gyn’s. The typical male one I use lacks some tact and personality but I won’t be walking out of there without all my questions answered. Compared to the worst female gyn I had he was infinately better in use of the tools and comfort.
My usual pap smear person now is a nurse practitioner who is younger. I was uncomfortable with her at first because of age. I know she went to school but worry about how much she has actually seen on the job. I learned she was very competent and became comfortable with her.
I guess the best piece of advice I can give you is to be open to listening to concerns. And when ladies start talking about what can be painfully embarrassing problems be open to listening and learning from them about what they’re feeling.
I understand many of the concerns expressed on this page, but how can it be suddenly OK to practice outright gender discrimination when choosing a doctor? Patients have an ethical obligation to judge individual doctors based on their individual performance, not based on their gender identity.
Hippie: I completely disagree. Patients have an ethical obligation to choose whatever doctor they want for whatever reason they want him/her. If you don’t feel comfortable with your doctor, you will not get the most out of your visit, plain and simple. Choosing your physician is not the place to exercise political correctness.
To that end, my mom only goes to male doctors. She thinks all women are silly (except me of course) and has no interest in being poked and prodded by silly people. I think she’s ridiculous, but who am I to judge. She has had excellent care over the years despite her bizarre preferences. This is why it’s important that there are male and female doctors in every field.
What I *do* think is amusing is this tendency to think that men who go into Ob/Gyn are perverted. Have you ever SEEN some of the problems women come in with? They’re not sexy problems, that’s for sure.
I just want to second the comments about trying to find someone who won’t dismiss your fears and worries, particularly when dealing with that area of the body. I have had many male and female providers and I have only ever had male providers belittle, demean or patronize me. I don’t want to be in the position of needing to assert my equality when my feet are in stirrups. I also don’t want to be even a little inhibited about expressing my concerns or complaints and I know I would be with a male provider. I would also not be comfortable having a student of either gender doing a pelvic on me. I know you need to practice, but it’s not going to be on me if I can help it.
The one exam I have had done without stirrups actually was more comfortable and I felt less vulnerable.
I wouldn’t say the look at you is because you’re a male – if it were me, at least, it would be because you are a student. I have a number of health issues and unless the exam has to do with my eyes, I generally don’t want to be learned on. I, too, know you need to practice, but I have too many friends in med school who make fun of their patients when they leave for the day and I minimize the risk of being THAT person by limiting who is around when someone is examining me!
I am by far more comfortable seeing a female than a male OB/GYN, but it wasn’t until I read this post that I analyzed those feelings. I have an overall preference for female doctors because I find it easier to develop a rapport with them and feel at ease. While this isn’t strictly necessary for a simple physical, it is essential for an embarrassing and uncomfortable procedure like a pelvic exam. While I have no doubts regarding a male OB/GYN’s skills (after all, not all surgeons have had appendectomies either), the increased barrier to communication makes the procedure much more unpleasant.
lala,
About 70% of OB/GYN residents are women now, as are about 50% of medical students, but it will take a while (decades, probably) for the current, male-majority cohort of physicians to retire and be replaced by them.
Thank you, Anne, for mentioning how many women have been raped and for acknowledging the long-term effects it can have.
I’ve been raped, and now see female doctors as exclusively as I can. It’s not fault of male doctors, nor is it mine, it’s the fault of the man who raped me.
Because I have PTSD, I’ve finally given in and take Xanax before every single doctor’s appointment to avoid any incidents.
Even though I explain that I have PTSD (and why) to all of my doctors immediately, my reactions to being physically examined can be very unpredictable. Sometimes I’m fine, but sometimes I’m definitely not. I think I’m unusual that I even bring it up: most women do not.
The average ob-gyn patient in a large urban area waits a couple of months for an appointment, arrives on time, and waits for at least 45 minutes to be summoned.
After her name is called, she is ordered to “follow me” by someone who walks ahead of her (not beside her). She is placed in an examining room and told to take all her clothes off and gown up.
She is then left alone there for about 20 or 30 minutes with nothing to do but look at the looming stirrups or–if she’s remembered to bring it with her–leaf through an outdated magazine and try not to look at anything.
Her doctor finally arrives, offers the standard and unhelpful apology for being late. A little small talk may take place, or some medical questions may be posed. The woman is undressed, placed in insufficient and generic clothing and therefore stripped of dignity and identity; the doctor is not.
And then she climbs awkwardly onto the examining table, places her feet in the stirrups, is told to reposition herself for the doctor’s convienience, and someone–male or female, it doesn’t matter–inserts something into her vagina. That person will likely not think to ask permission to begin, and will often not explain in advance what they’re going to do, or even what they’re doing as they’re doing it.
Imagine what that’s like if you’ve been raped.
So try this: sit around a waiting room for 45 minutes, have yourself led into an exam room, close the door, take all your clothes off and put on the paper gown, and have a friend call you at an arbitrary time, somewhere between 20 and 30 minutes later. Then climb onto the exam table, “scoot down,” put your feet in the stirrups, and spread your legs wide. Just to FEEL what it’s like.
My hope is that if you can physically understand that a women–or anyone–might find it distasteful and humiliating experience, it might take some of the hurt from your experience as a doctor-in-training.
You sound like a committed and compassionate person, and I hope you’ll find comfort in knowing that “the look” isn’t necessarily about you as a man, a younger person, or a student. It’s about our reality, not yours.
Your efforts to reassure patients are well-intentioned, welcome and probably very helpful, even if you’re not rewarded with the smile or thanks that you deserve.
Try to realize that some of us just aren’t able to respond to your kindness in that particular situation. Think of it as a kind of trauma-induced brain damage, and keep up the good work anyway.
And best of luck to you.
Well, Personally I guess I have never given it any thought being a guy, all I am concerned with is that they can do their job well. But then again I have never been easily embarrassed especially when it comes to the human body and what I consider normal activities of the body. My wife however absolutely can not stand having women doctors treat her regardless of what it is for or about, she prefers and is much more comfortable with a male.
As for those women at the age listed above 50+ I would assume “I know its not a good idea lol” that the large majority of them only feel comfortable with women, because in the days gone by most men would go to their grave not having even a basic understanding of the female body. Thankfully now such things are taught in school and allows us to consider it “normal” and thus not be so embarrassed that we actually risk our health because of the lack of understanding. One small note “having the same hardware, does not mean that the driver is automatically going to win the race :D