Observations of a Pelvic Exam

During one of my scribing shifts at a free clinic, a patient came in with concerns about her menstrual cycle. Further discussion with my provider soon showed that she needed a pelvic exam immediately. However, compared to my observations of patients during standard pelvic exams and pap smears, this situation was different.

The patient was visibly distraught over her current condition, and my presence during her discussion only worsened her discomfort. Normally, patients demonstrate two patterns in the presence of scribes- actively interacting with them or paying no mind to them. This trend of neutral or enthusiastic coincides with the responses of scribes surveyed about their motivations for scribing. The majority of scribes answered that they both wanted clinical experience for medical school and to make a positive impact for their patients. Therefore, the patients’ normal behavior toward the scribes emphasizes the latter. However, in this case, it seemed as though my presence was only serving to make my patient’s visit more difficult.

During the exam itself, the patient was constantly apologizing to the provider about her condition. She felt personally responsible because it was her own body that was not functioning properly. And when the provider asked her questions during the exam, it was evident that the patient was having a difficult time answering due to her emotions. It is standard practice for a scribe to sit in on these exams. The idea is that the provider is able to talk aloud about pertinent observations during the exam in order to save them time as well as to ensure accuracy by immediately recording the information as opposed to potentially waiting a few hours. However, as I watched my patient struggle to answer questions, I began to doubt this concept. She may have felt more at ease if I had simply waited outside, but at the same time, I am also motivated by personal interests- gaining quality clinical experience. Scribing is unique to other clinical volunteer positions because it is akin to a form of intensive shadowing. Therefore, as a scribe, I also had an agenda for being in that examination room because, through my observation, I was able to watch the provider’s mannerisms and see how she managed an extremely personal procedure while comforting the patient. These moments are truly substantive for potential medical school applicants to see what they need to be capable of as future physicians.

I have repeated mentioned the patient’s discomfort throughout this blog post, and although some procedures are, by their nature, extremely unnerving, this situation highlights an important issue involving free clinic scribing. The patient population at free clinics is already considered an at-risk population. These are patients who do not regularly visit their providers, are generally not focused on preventative care, and mainly visit because a serious medical problem has emerged. As a result, my patient’s discomfort plays a large role in whether or not she chooses to return to the clinic and continue her care.

Comments

  1. Hi Linh,
    Your research is fascinating. Your outlining of the two patterns of patient behavior in the presence of scribes is indeed an accurate psychological observation, especially with so-called “at risk populations”. Does your research involve finding solutions or rather ways to reconcile these two behaviors and find a middle ground?