talking to your doctor about stuff like anal pap smears

Does your doctor understand you? It seems like an easy question. Does your doctor/NP/PA/primary care provider really, intimately get you? Can you talk to them about what's going on in your life? Do you even feel comfortable with them?

Since I'm in primary care, it's my job to try to break down barriers to communication so that I can help patients stay healthy. Some of my best work is done when I'm working with someone to prevent bad things from happening in the future (obviously this doesn't include yesterday's clinic, which was an absolute clusterf*ck after all of my primary prevention patients cancelled).

Now that it's 2016, I feel like more doctors are at least aware of what's going on around them. But there's still a ways to go. Not all doctors prescribe Truvada for PrEP. Many don't think about vaccination against HPV into the 20s (gardasil). Some don't really want to know about sexual history. The list goes on.

The good thing though, is that the vast, vast majority of doctors are bleeding-heart science nerds. We want to be challenged. So if you ask a question about your health and we don't know that answer, we'll look it up in order to stay uptodate and to provide great care. Prevention is both a push and a pull. And sometimes, patients really need to push. So if you think your doctor doesn't understand you, volunteer information. And if you feel uncomfortable, start with one simple question- "what do you think about PrEP?". That question, by itself, opens up avenues to subjects you can only dream of (anal paps anyone? I'll save that for another post).

Has there been a time when you felt you could OR couldn't talk to your doctor? How did you get around it?

 

Lol ok well, it's not that, that weird to not be having sex. Yes, docs should ask about sex-it's supposed to be part of the annual physical. Sex, STD and HIV screening, changes in life, admissions to hospital, changes in family history, safety concerns, immunizations, etc, etc. -these are things I go over! All of this helps nail down health risk and helps both patient and doc plot a course for the future.

I have some suggestions for finding a new PCP. But first, I should say, Charlotte (that is where you are, right?) is a very large city and should have a bunch of pretty cool and maybe even teeth-grindingly liberal doctors (if that's what you need). Think about linking up with a university system primary network or residency program- that way you can meet a few people and settle on a specific resident/attending/NP/PA. I would encourage you to see a family physician since they generally have more outpatient time and the general gestalt of family medicine is happiness and love and... lol.. ok well-rounded, evidence-based continuity medical care. Internal medicine is a good choice too. And finally, in terms of gender- sometimes the right female PCP could work-it could be a liberating experience!

Anyways, do get linked up- if it's been a while, there may be a lot to talk about! Cheers!

 

@mojoreece and @yahoo.com , yep, anal paps are a thing! They help detect anal cancers, which are more common in people living with HIV. In short, the guidelines for anal paps are murky. Anal paps are not routine yet, though in NYS, they are recommended for HIV positive MSM. More on all of this confusion in a bit

 

Lol ok, i got you. So, digital rectal exams ("finger glove method" I assume) is usually used for guys over 50 when someone wants to determine what the prostate feels like- is it nodular, is it smooth, are there a bunch of ridges in it? These, and other questions, are used to determine whether a prostate biopsy is needed. The last rectal exam I did was for a guy with erectile dysfunction. I have no frigging idea what's going on in the military- I would hazard to say that most 20-something year-old guys usually don't have enlarged prostates and don't complain of a weak urine stream, so....yeah....not sure what's going on over there.

Now, the pill/camera is sometimes used to screen for colon cancer. I personally don't like them. We have FIT tests and colonoscopies to ask questions about colon cancer for that reason. They work. Why add the expense?

Anal pap smears are done with a Dacron swab. We don't use lube for it, since it ruins the result. Yes, I'd have to gently immobilize your...bottom...briefly!- so that I don't miss with the swab- but that's it! No finger needed! But just so you know- rectal and pelvic exams are a little uncomfortable for me too. I'll make it seem routine since I have a professional poker face and want I you to feel as comfortable as possible, only so that you don't clench down. And on that note, I'll just end this paragraph.

 

This is not good and definitely not ok. I'm sorry this happened. No doctor should ever act that way, regardless of where they're from.