Tips for Your GYN Visit

A genius listener asked us how to advocate for themselves during a gynecology visit - we have thoughts! 

Episode Transcript

Sara (00:10):
hello, hello.

Supraja (00:14):
Oh, there it is.
Sara made me a drink,encouraging me to drink earlier
in the day than we'll say, And Iwas like do we really want to
drink right now?
And then we're like it's calledGyn and Tonic.
We're with you guys.

Sara (00:27):
We actually like to drink a lot.
We're sacrificing for theaudience.

Supraja (00:32):
Yes, sacrifice.
This is really hard for us.
You're welcome, but I made itsome Aperol Spritzes.
That's Sara, it's like yourgo-to drink.

Sara (00:41):
Yeah, it's like I feel like I specialize in Spritzers.
I think, Sara specializes ineverything.

Supraja (00:47):
Sara should be a bartender.
It's actually my lifelong dream, is it?

Sara (00:52):
No, i want to be a travel Instagram influencer.

Supraja (00:54):
I saw that you wrote that You posted it on your
Instagram And I was like don'twe all?
I think literally anyone whohas a dream and confesses to it
online, it's to be a travelInstagrammer.
I'm with you.
I have no shame about it.
I think we should all do that.
Yeah, You first.
You called it first You lookreally nice.

Sara (01:14):
by the way, I know I have a date today.

Supraja (01:17):
You have a date, i have a third date.
I have a third date.
Ooh, the third date curse aboutto be broken.

Sara (01:22):
I don't know, i'll see.
I have a third date curse.

Supraja (01:24):
I can't get past the third date.
That used to be my thing too.
I would feel like people weresuper obsessed with me until the
third date, And this is like Idon't know.

Sara (01:34):
It's because I think I lose inhibition on the third day
.

Supraja (01:38):
I'm like, well, let me just show you all my cards,
these are all of the things I'vebeen through.
These are all of the reasonsI'm problematic.

Sara (01:47):
No, you're lovely.

Supraja (01:49):
I think honestly.
I think it's just becausepeople realize you're the real
deal On a third date.
It feels like a turning point.
I'm like, okay, am I reallygoing to commit to this person
and show up for them?

Sara (01:59):
I feel like you hype me up so much, I'm like okay.

Supraja (02:03):
Well, look at her, Stop Or listen.
If you're listening, you couldalso watch it.
Everybody get a super jet inyour life.

Sara (02:09):
A super jet or a Maria McKinney, because Maria McKinney
thinks I walk on water.

Supraja (02:13):
So yes, she should.
She's like I birthed you.
You have my genes.

Sara (02:18):
She kills me.
Anyways, yep, I have a thirddate?

Supraja (02:21):
I'm just curious about it.

Sara (02:23):
I'm starting to go into the mindset of like when I go on
dates, like you're just gettingto know somebody.
Don't put pressure on anything,because before I'd be like, oh
my God, this is date number.
And now I'm like, who cares?
Just like, do like this person,do not Like, just figure it out
.

Supraja (02:37):
Yeah, i wish that we could just be excited about the
experience without being tooforward thinking, like a little
bit, in that you're honestlyevaluating if this person is a
good person.
You like spending time around,but not that you have to imagine
five years in the future whenyour kids are four and a half
100%.

(02:57):
Not that you have to beimagining conceiving in three
months.

Sara (03:03):
But we're going to go to this Mexican Speak Easy that
I've been really willing to goto Which one.
It's called Porachito.

Supraja (03:10):
Oh, I haven't even heard of that.
Where is it?

Sara (03:12):
Katie Clark told about it one of my other besties.
It's in Seaport and I like,love Mexican food.
I'm Peruvian but I wish I wasMexican.
I don't know.
don't tell my mother, MariaElena is going to come for you.

Supraja (03:28):
Scratch everything that you just said, but her being
your high-poor wife is going tobe like sada.

Sara (03:33):
It's because I love Mexican food, i love Mexican
culture, me too.
And it's kind of funny too,because people are like oh,
mckinney, have you?

Supraja (03:39):
let people know this.

Sara (03:41):
You should have this Mexican food and fast and like.
don't ever try to tell mewhat's your Mexican food.
You're from San Diego, I'm from.
Chula Vista.
Okay, i'm from Chula Vista.
You can go to Mexico for myhigh school, so I know Mexican
food.
Okay, i know.
I'm not Mexican, but I know.

Supraja (03:55):
Mexican food.
Yeah, I will say I was verypleasantly shocked when I went
to San Diego by how freakinggood the food there was It's so
good, like nothing out herecompares.

Sara (04:04):
Yeah, it's true, i mean.

Supraja (04:06):
Boston, boston.
I'm learning to really love thefood four years into living
here, but it's not all the same.

Sara (04:13):
You have to find the places you love Well.
So, worst case scenario, I havea good Michelada Oh exciting.

Supraja (04:19):
You know That's nice.
Are you still going on a bikeride?
Did you tell me you were doingthat?

Sara (04:24):
Yeah, we're going on a bike ride because I want to do
something active.

Supraja (04:26):
now I get tired of like sitting at a restaurant because
then you're like let's do someactivities And you've already
had your first drink, so youkind of got to slow it down And
then you kind of like,immediately get another one.
Exactly, that's so fun.
I love biking as a date.

Sara (04:41):
I think it's fun.
It's really fun.
A few weeks ago I went on a hotyoga date and I was like don't
ever do that again.

Supraja (04:48):
Oh my God, I was like this is a bad date idea.

Sara (04:50):
I was like I don't want to squat in front of this person,
i don't know.
I'm like bending over.
I was just like no, i don'teven sweat very much.
I was like I feel uncomfortable.

Supraja (04:59):
I feel like going to a hot yoga date is the equivalent
of letting someone know you'renot interested, like after that
you both understand youshouldn't speak again.

Sara (05:08):
We never made it to a third date.
So there you go.
He was such a nice guy.
Yeah, that's fun, sarah.

Supraja (05:15):
I'm excited that you're putting yourself out there and
going on lots of dates.
We'll see.
Well, tell me about yourwedding planning.
Oh God, that's a real buzzkill.
I want to know.
Don't put pressure just enjoy.
Okay, tell me about the thingthat is so much pressure and
difficult to enjoy.
I wish I was one of thosepeople who just loved the
process, and maybe I willeventually get there.

Sara (05:36):
It's so funny because my friends are planning and like
I'll go see a venue with you,I'll go to the wedding.

Supraja (05:42):
I like love, like, like all those things.
Okay, do you mean it?
Because literally yesterday,when we were at that party
together, someone came up to meand was like why don't you ask
Sarah to plan your wedding,because I care about her?

Sara (05:53):
But I just told her I had checked out wedding venues in
New England by myself for amonth.

Supraja (05:58):
Yeah, I mean, I'm down for you to help me do this, do
it for me.
I don't know, I feel like if Ireally had your interest at
heart, i wouldn't make you dothat, i just like love.

Sara (06:07):
I love all things planning and organizing.
They make me excited.
So that's, why like planning,even if it's not my wedding, I
think it's so excited.
Yeah, that's true.

Supraja (06:16):
Yeah, i think I just wanted to have a wedding that
felt different, like meaningful,because it's such a big expense
.
I know it's meaningful foreverybody, obviously, and
different things are meaningfulfor different people.
But I was like, if I'm going tojustify spending so much money,
i want to do it in a way that'sintentional, like I want to
give my money to venues that Ibelieve in or feel really

(06:38):
special in, like their missionetc.
Etc.
But it's really hard,especially when you're having an
Indian wedding where you justneed to have a bunch of
different spaces for all theseevents, like, really, i just
have to get married in like areally basic hotel.
You're so thoughtful though.
There's nothing wrong with hotel, which I'm also realizing.
I've been to a lot of weddingsat hotels that are so beautiful

(07:01):
that I've loved, So I need toget over myself a little bit.
But I'm struggling with that ofjust wanting it to be
intentional and wanting it tofeel like this money I'm
spending is benefiting more thanjust us.

Sara (07:14):
Well, my goal for you in this wedding process is to be
selfish.
Oh, because you're alwaysthinking about other people.
I want you to think aboutyourself for once.

Supraja (07:22):
Super Joanne.
Well, you know what's so funnyMy mom and my sister I was like
yesterday being like I need youguys to explain to me because my
sister is married and my mom isIndian Also got had a wedding
too obviously but also she likeknows all the details of an
Indian wedding And I was like Ineed you guys to explain to me
every single thing that happens.
Like you wake up three daysbefore what happens, what's

(07:45):
involved?
who all is there then?
what happens, what?

Sara (07:48):
does the ceremony mean?
And they were like man.

Supraja (07:49):
You were so chill that you get engaged and you're a
completely different person I'mlike I don't know.
It's very confusing.
I'm like actually I changed thesecond I thought I was getting
engaged, where before that I waslike I don't need a ring, i
could just a loop whatever.
And then the second I knew Iwas getting engaged.
I was like I want a beautifulring.
I want everyone to be excited.

(08:11):
It's kind of a mind conundrum,Like you just don't know who you
are.

Sara (08:21):
It's the one time you could be super selfish and do
whatever you want.
My goal for you is to beselfish and more think about
yourself and Adam and what'simportant to you.
unless so, what's going to makeyour guests happy?
We're going to be happy ifyou're happy.

Supraja (08:34):
Aw, thanks.
It is really nice to have Adambecause he just really wants to
be part of everything, which Idon't know why I'm saying it
like that.
Obviously it's his wedding too,but I feel like often in like
hektra relationships, the personwho's identified as a woman is
more in charge of it, and thenthe stereotype is the man is

(08:54):
just like hanging out in thebackground, but Adam like wants
to be at all the meetings.
He like wants to.
He was like taking notes as myfamily was talking and wanted to
review them with me.
I was like it's really cute thatyou really want this to be
50-50.
Although I was also like you'rejust not Indian.
It's just not going to be that50-50 because you don't know.

Sara (09:13):
Well, adam's the best, so I'm not surprised He's so great.

Supraja (09:16):
Okay, well, what are we talking about today?
Well, we were going to do aquestion episode, which is still
upcoming, but one of thequestions was so good that we
decided it really deserved afull episode And one of our
lovely friends wrote in, whichwas really cute that friends
wrote in, you know they werereally good questions, but one

(09:37):
of our friends wrote in and justasked how to advocate for
yourself in a GYN visit and howto even know if the information
you're being presented are allof your options, how to give
feedback if you've had negativeencounters in the past or, if
that experience is negative, howto make sure that doesn't
happen again, and I think that'sso important.

(09:58):
I feel like so many people arehaving an experience for the
first time or have had reallyterrible experiences before, and
, as someone doing the exam, inever want to re-traumatize
someone or cause trauma, but itis really sensitive.
So I love that we're going totalk about this And I also feel
like we should Make it clearthat I don't think it's on the

(10:22):
person coming in for the exam tomake sure that they're not
traumatized.
Yeah, you know, obviouslythat's on us, but there are some
tips that help everyone justfeel more in control of what's
happening.

Sara (10:33):
Yeah, i feel like You know I have my own goals during a
visit, but I you know, so that Icover everything that's
important to the patient.
But when the patient isfacilitating that, i think we
both win.
We both like at the end of theday, you're the most important
person and I'm gonna be betterable to take care of you if you
let, if, if you're vocal aboutthose things That you want to

(10:55):
dress during the visit.
So I always welcome that.
That's literally how I start avisit.
I, oh, i walk in.
I'm like, hi, i'm Dr Sarah.

Supraja (11:01):
McKinney.

Sara (11:02):
My staff always laughs at me because I say hi.
The same way every single timeI go hello.

Supraja (11:08):
I'm Dr And they're always like hello.

Sara (11:13):
My Mickey Mouse voice and then I walk in.
I'm like my understanding isthis is an annual exam, but I
just wanted to know if there'sany questions or concerns you
wanted us to address today.
And most of the time people sayno, nothing.
I'm just here for my past year.
But when somebody does have alike a list or like a few things
they want to address, i lovethat, because then we I know
exactly what you want to get outof this visit and helps me

(11:34):
Organize the visit so we canprioritize those topics.

Supraja (11:37):
Yeah and as much as I think the burden really should
be more on me, i really trulybelieve that it's just a fact
that the system is not set upfor anybody to have a good
experience.
I love days when I have a bunchof cancellations and I can
spend a good 30 40 minutes witha patient because I feel like I
Really understood, they feltunderstood and we both left

(11:59):
feeling like, wow, that was agood experience that changed the
course of my day because youaffected me and were vulnerable
with me and hopefully reallyhelped you too, But sometimes,
like I have to see anotherpatient, another patient,
another patient, another patient, and I hate that.
So I really love when peoplealso come in with a clear idea
of what they want to accomplish,so that we can Use the, the

(12:23):
time we have together, which isjust never enough, to come to
some good progress, and I do.
I try to ask everybody that atthe beginning of a visit I try
to say what are your goals fortoday?

Sara (12:34):
What were you hoping to leave today with I love that
because then I'm like Respectingyour goals, your boundaries,
and I want to be the bestversion of myself for you.
Yeah, cuz you're the mostimportant person in the room You
really are yeah.

Supraja (12:47):
So I think that's probably tip number one, like
have an agenda, come in withthings you want addressed and
Know that you might not be ableto go through your whole agenda,
but you definitely can havemultiple visits to talk about
that.
And it's like a businessmeeting.
Honestly.
You start up up at front sayingthese are the things I want to
talk about.

(13:08):
Then you come to a shareddecision like okay, we'll do
this and this today, we'll maybedo this in this later, or maybe
we can do all of that today, ormaybe we can do half of one
today if with the conversationwe realize it's gonna be a
bigger feat.
Yeah.

Sara (13:20):
I'll have sometimes patients list off like five, six
things and I'll say, let's pickthe two to three most important
things to you and then we'llfigure out a time to address the
rest, yeah.
Or I'll say, hmm, we can spendthe majority of the visit
talking about all these things,but we might not have time for
an actual physical exam.
And oftentimes the physicalexam is not what's actually
important during that visit.

(13:41):
It's actually the counselingregarding the topic They're
coming in with.
And great, we skip the exam.
Let's spend the full 30 minutestalking about contraception,
your abnormal bleeding, freezingyour eggs.
We can do all those topics.
When we set the agenda togetherat the start of the visit,
we're both gonna leave feelinglike, okay, i did something good
for this patient.
The patient feels like I gotall the things I had on my to-do

(14:03):
list done and there's a planfor You know, topic five, six
and seven?

Supraja (14:07):
Yeah, exactly.
So I think, yeah, that's agreat thing.
And then realizing that youdon't have to have the same exam
at every GYN visit.
Sometimes, like you said, youdon't even need an exam.
Sometimes the exam is just avulgar exam where you don't have
a speculum placed on the insideAnd that can be affected by so

(14:28):
many things.
Like I have a patientpopulation that has really high
incidence of prior trauma.
I take care of a lot of LGBTQflow, a lot of Transpoke, a lot
of gender diverse individuals,and I just think that trauma is
unfortunately way more prevalentamong Everyone than then we're
aware of.

(14:48):
So I always ask people have youhad this exam before?
How does it normally go for you?
Is it particularly triggeringor uncomfortable for you?
Is there anything that I can doto make it easier?
Do you feel comfortable havingthis exam today?
So I try to ask all thosequestions up front and knowing
that your answer to any of thosethings can be yes, no, i don't

(15:09):
know.

Sara (15:10):
Yeah, if there's certain clues about a patient like this
is their first GYN exam, thenI'll incorporate that into the
conversation.
Before we even jump to gettinginto the exam, you know, outfit
or even getting in position forthe exam, you know I'll say this
is what a speculum is, this is,and then I'll say, like this is
what you know, what the vaginais, what the purpose of the

(15:31):
speculum, and I'll literally goover each step so that they can
anticipate.
Or, you know, if the There's abig component to trauma or poor
prior experiences beforehand,we'll spend the majority of the
visit just talking about thatand deciding if there's even
value in doing an exam today.
And sometimes we'll say whydon't we save the exam for

(15:51):
another visit?
And so really tailoring Theexam and the, the conversation,
the counseling, based on likewhat the patient's goals are,
what their prior experienceshave been like.
There's so much Flexibility.

Supraja (16:04):
Yeah, there's not one, one way for every patient right
And I think people sometimesfeel panic like I waited so long
for this appointment and now Ihave to come back.
Who knows when that will be.
But one little hack is, onceyou're in, getting your next
appointment was way easier.
Especially if you and yourprovider have a conversation and
it feels like you didn't getthrough everything that you and

(16:25):
the provider decided You wantedto do, they're much more likely
to figure out a place to see yousooner to finish it.
So don't be afraid of that.
And you can ask the questionlike can I see the speculum?
I'm not sure if I want to dothat today.
Like what are our options here?

Sara (16:39):
Agreed.
I run a vulva clinic once aweek and a lot of my patients
have pain with intercourse, painwith intimacy, prior history of
trauma and you know they'relong visits They're 60 minutes
with for a reason, becausethey're tough conversations and
we want to be, you know,sensitive about it and there's
many times when the patient youknow I can tell we'll get ready

(17:00):
for the exam and I realize,right, right now is not the
money.
Yeah, that's totally fine, likeI know there's no reason to rush
anything.
We have established arelationship like I'm and super
just so right.
Sometimes It takes forever toget in my specialty clinic that
I run, but once I know you andwe have spent a time getting to
know one another, i can squeezeyou in for an exam first, like

(17:24):
because we've already done youknow a lot of the The getting to
know part.
Yeah, and I'm so happy toaccommodate patients who I
really know and I know like Iknow exactly what I'm gonna do
in this next visit.

Supraja (17:35):
Yeah, easy for me to do , i agree.
Okay, let's go over whatexactly you should expect from a
routine GYN visit.
So the first is the historydressing, those specific
questions and concerns.
I try to do that up front andthen we always ask other history
, you know, to try to justunderstand a full picture of a

(17:55):
person, because all of thosethings can relate to why You're
coming in.
Whatever the problem is, evenif it seems irrelevant, our body
is a whole system that workstogether, so things that might
not feel that relevant can endup being relevant.
So I try to be really completein that, especially the first
time I'm meeting someone, theytry to really ask all the
questions.

Sara (18:15):
I say the same thing.
I will get the agenda rightwhen we get going and then I'll
say let me just review the restof your medical history So I can
best appropriately answer thisfor you.
Yeah, and sometimes we spendfive minutes going over medical
history and sometimes we spendlonger because I realize
actually This is gonna be quiterelevant when I provide you
options and counseling.
Yeah, but some of the othersubtopics will go into or like

(18:36):
your obstetrical history, andsometimes that's quick.
I've never been pregnant.
Okay, great, that took 10seconds.

Supraja (18:42):
Yeah, and then GYN history, which is like talking
about your bleeding every month,talking about pain you've had
with that.
Your sexual practices I try toreally not make any assumptions
about that, because people doall sorts of things.
So I try to ask how manypartners you have, how many
partners your partners have?
how do they identify in termsof gender, what?

(19:04):
what do your sexual practicesentail?
and I kind of sometimes do givea disclaimer, like I know this
is a lot of personal informationFor someone you just met where
I'm like where do you put it?
Do you put it anywhere?
But that's like literally whatI asked like what are you
putting?
is it a finger?
Is it a toy?
Is it a penis?
Is it something else?
How did that penis come to be?

(19:25):
Was it created?
Did it?
like I said, i work with a lotof transgender, diverse folks,
so I it has really beautifullytaught me that with anyone you
can't make assumptions.

Sara (19:36):
I've learned some terms from our patients are like fluid
, open or fluid like I don't.

Supraja (19:41):
I'm like forgetting some of these terms, but yeah,
you have to not just be liketeach me, what does that mean?

Sara (19:46):
I know okay, and do the work yourself, but I will
sometimes tell people like, ifI'm using the wrong term, let me
know, like we're all learningand we all owe each other that
you know Respect and courtesyand like some of us have not,
like you know super, just alwaysteaching me.
Like I'm trying to be moremindful about using Sis.
Yeah, our neutral turn.
Yeah, i don't.

(20:06):
I have not historically usedthose terms as frequently, but
I'm realizing it is importantand I am so lucky to have people
in my life who do moreregularly use them And I'm being
mindful of it because they canmake the world of a difference
to.

Supraja (20:18):
Yeah, i mean, i think I learned that for my patients.
I feel really lucky thatthey've had patients with me in
that growing process Not thatthey should have to, but I'm
really grateful for it.
Yeah, and I've had people tellme, like you know, my last
provider just assumed because Ihad a partner, that's all who
all I was having sex with.
Yeah, just wasn't true.

Sara (20:36):
So I feel really lucky to be around people who feel
comfortable sharing that with meand and to be able to grow Just
interacting with other humanbeings and I would like I will
have patients giggle at me whenI say like Do you have sex with
you know, are you intimate withmen, women or both?
and then people will giggle andbe like and then I'll say like,
oh well, you know, that's nottrue of all my patients, and

(20:57):
then people realize, huh, that'sa good It's kind of nice when
we're both learning in themoment or something.
You see a light bulb goingsomebody's head.
Yeah, i try to be very like,standardized and normalize
things and hopefully that pagethe patient realizes like I'm
open to having any kind ofConversation you want to have,
like I don't have any, like Ijust want to understand you so I

(21:18):
can best understand your, yourquestions and concerns.

Supraja (21:22):
Okay.
And then I say I feel like yourmic could be a little farther
away, just because I can't seeall of your beautiful face.
So if just now I messed Sarahup and now she's way quieter,
this is my way to get my voiceto be loud and yours quiet.
No, really, only because Inoticed I couldn't see all your

(21:42):
face and I want to, okay.
But so after the a history,then it's the portion of the
exam and we kind of touch onthis before.
But exams can be as abbreviatedor as comprehensive as it makes
sense for the person, theproblem and getting to a
solution.
But just for acomprehensiveness I guess let's

(22:03):
talk about if you were coming infor an annual, for a full exam.

Sara (22:07):
So I'll generally start with like I'll feel your lymph
nodes, your thigh, roi.
I don't listen to people'shearts and lungs.
I see neither.
I did initially realize, like Idon't know what I'm listening
to.

Supraja (22:18):
I'm a gynecologist, like that's primary care doctor.

Sara (22:20):
Yeah, and I remember one time one of my chief residents
did she's like I went to her fora check for a GYN visit and she
didn't listen to my heart and Iwas a little surprised.
And then you were like I can dothis too, I was like I can do
this too, i don't have to listento people's hearts because I
wouldn't realize I was like, ohmy God, i've been using my
stethoscope in eight years.
But also because, like I'mgiving some, i realize I'm
giving somebody falsereassurance by saying everything

(22:42):
sounds nice.

Supraja (22:43):
I don't know, is that what you say?
nice, what That?
was music to my ears, yourheart, everything sounds really
nice Yeah.

Sara (22:51):
Who knows, you could have like a huge, like systolic
murmur and all this crazy.

Supraja (22:55):
I'm not the person to pick that up.

Sara (22:57):
I'm just gonna be like no, no, no, Yeah, Anyways so.

Supraja (23:00):
So your gynecologist might have different levels of
comfort with that.
I agree, i'm not someone whodoes that.
Occasionally I'll have apatient ask me to and I feel
really tortured and I'll be like, okay, i'll do it, but just so
you know, this is not myexpertise, yeah.
And then I just have a reallylow threshold to say like you
should see someone where it istheir expertise, yeah.

Sara (23:19):
But so Some people may incorporate into their exams.
Wonderful, but it's not a badthing if they don't.
It just means that's notsomething I'm particularly
comfortable with or confident in.

Supraja (23:29):
And then another part of the body that is definitely
within our realm but has had alot of changing recommendations
is the breast exam.
IACOG, which is AmericanCollege of Obstructurists and
Gynecology, says somethingdifferent than some of the
primary care societies, so it isdefinitely an evolution.
how often you need that, if youneed it at?

Sara (23:49):
all.

Supraja (23:51):
I think I still do it every one to two years and most
people and Sarah follow some ofthe other guidelines and doesn't
do it quite as systematically,unless there's a reason to, i'll
bring it up with a patient andsay you know, some of the
evidence suggests we don't needto routinely do this anymore.

Sara (24:07):
It might result in testing and biopsies that weren't
necessary.
And I'll ask the patient wouldyou like me to do a breast exam?
Do you have a specific concernthat you wanted me to examine
today?
So I kind of leave it moreopen-ended.
Now My cousin, who's a nursepractitioner in primary care,
told me that she's like we don'thave to do those anymore.

Supraja (24:24):
I was like I know I'm like AGog.
tell me I don't have to do it.

Sara (24:30):
So I just bring it up to the patient and we talked about
it.
And then we decide and they'relike, no, I have no concerns.
I'm like, okay, let's skip itand let's spend more time on
your public exam.

Supraja (24:37):
But if you're having one done, if you have
sensitivities around thosethings, let the person know.
A lot of times a good place toadvocate for yourself is before
you get undressed, becauseyou're just going to feel way
more in control of what'shappening, less vulnerable, so
that's a good time.
But you can also do it afteryou've gotten undressed, if you
didn't do it beforehand.
And the part of the exam peoplewill look at both to assess the

(25:02):
symmetry and assess anydifferences and then help it one
at a time.
So usually I have the patientlift one arm above their head
and then kind of go up and downon the breast with two fingers,
like I'm about to do it on mybreast.
This is why you should watchthis on YouTube.

Sara (25:20):
It's like the lawn mower technique.

Supraja (25:22):
And there are some other techniques too, the
circular technique Yeah.
And the reason we have you liftyour arm above your head is
because we all have some breasttissue in our armpit.
And then I do express thenipple too, because you want to
check for nipple discharge.
So why are you looking?

Sara (25:38):
at me like that Am.

Supraja (25:39):
I supposed to do that?
Yeah, i don't know.
Well, then again we also say,like it doesn't matter, maybe
you don't need to do it at all,so have a conversation about
that But always learning.

Sara (25:50):
Always learning.

Supraja (25:52):
When you express the nipple.
what I do people do itdifferently is just take two
fingers and literally like pullon the nipple to see if anything
comes out, and then I do thaton the other side.

Sara (26:00):
I've never had somebody do that to me Really Well, I don't
know.

Supraja (26:05):
I mean, my fusions are like why did she just do that?

Sara (26:07):
Okay, we're going to get into this when we get a
direct-to-exams, because I'mliterally here taking notes.
Should I take notes?

Supraja (26:14):
Well, sometimes people have milky discharge or other
things that you have to work on.

Sara (26:19):
I don't know.
Can we talk about my breastafter?
Yeah, okay, sarah's about totake your shirt off.

Supraja (26:23):
Just kidding, in private, not on this video-flash
audio podcast.
Wait, really, no one has everexpressed your nipple.

Sara (26:31):
No, oh, interesting, except for like a partner,
that's kidding Too much, oh toomuch, keep going, keep going.

Supraja (26:41):
Well, your doctor should not express it with their
mouth, Sarah.
It is not like a partner.
This is why I warn people thatthis podcast is a little spicier
than you might think.
Okay, so that's the breast exam, And then usually people do
some kind of abdominal exam,sometimes just palpation,
sometimes certain other thingslike percussion or listening.

(27:05):
I feel like gynecologist.
We just don't carry around aspeculum We give it up Or a
stethoscope, a speculum yeah,i'm gonna take the speculum,
shove it in your abdomen.

Sara (27:16):
I'm just kidding.
I'm listening to bell soundswith my speculum.

Supraja (27:19):
Yes, i'm gonna take the stethoscope.
We do not often have astethoscope in every visit, so
usually I just palpate And thenwe move on to the pelvic portion
, which is what?
Woo Yes, that's how we feelabout it Woo, cheers, pelvic.
Okay, yeah, sarah, go off.

(27:40):
Sarah's our bulbar specialist.
So this is where I feel likeyou shine, sarah.
Tell us all about it.

Sara (27:47):
Well, it's so funny because I remember being a
resident and attending physiciantelling me, you know, she was
watching my exam during a visit.
She's like Dr McKinney talks alot But and I was like okay.

Supraja (27:57):
I was like I'm a patient.
feedback emailed to me like DrRoger Gopalan was really
thorough, but I didn't need allthat information.

Sara (28:06):
But I do tell my patients.
I say I'm gonna, i'll be.
I talk out loud during my exams.
I'm gonna be naming youranatomy.
Let me know if you have aquestion or if I'm talking too
much.
I give the caveat, but most ofmy patients say no.
I love that you tell me what'sgoing on.

Supraja (28:20):
But if you don't, let me know I'm receptive to the
feedback.

Sara (28:23):
Anyways, i always start with the well.
First I make sure I figure outis this the first pelvic exam my
patients ever had?
Because if it has, even beforeyou place your heels into the
holders, i will show you what aspeculum is so you can have an
idea of what to anticipate.
But if you've had pelvic exams,then well, the first thing I do
is just a vulva exam, and a lotof people skip the vulva exam.

(28:43):
But I'm like a diehard vulvaadvocate And I, you know, like
it's not a people skip the vulvaexam.

Supraja (28:49):
Like the vulva if you didn't hear our last episode,
which you should is the outsidepart of that.
So the vagina is the canal, theinside portion.
The vulva is pretty much all ofthe outside, like everything
else, all the all the reallygood stuff, like I feel like you
would have to close your eyesbefore you put a speculum in not
to do a vulva exam.

Sara (29:07):
You're just like driving into the garage and you're not
looking at the house.
You're just like look at thehouse, look at the house, look
at the features, the shutters,the door, the grass.

Supraja (29:16):
I think Sarah's vulva exam is so beautiful.
I've literally just copied herexam template and put it in all
of my notes.

Sara (29:25):
Well, anyways, i do tell my patients I'm going to, i'm
looking at your and I'll saythis because I want my patients
to know their term, the term, sothat they can be aware of their
body, have ownership of it Andso, should something come up in
the future, they know how toadvocate for themselves.
That's like my big thing in allmy visits is like I want you to
know how to advocate foryourself, whether I'm your
doctor in 10 years or somebodyelse.
And I'm going to bring this upbecause I think you guys should

(29:47):
follow Rachel Rubin.
She's a Eurogynecologist in.

Supraja (29:50):
DC.
Oh, that's great job.
Yes, she did an article in theNew York Times.
Does Rachel have a podcast?
Does she want to be on ours?
I know we should.

Sara (29:56):
She's fabulous, She's part of the Ishwish Society And
essentially it was an article inthe New York Times about we
should be addressing theclitoris.
There's just many parts of thevulva that people kind of ignore
and they can be big factors inpain and discomfort and itching
And as gynecologists we shouldbe taking ownership of it and
recognizing it in our exams,because sometimes people have a

(30:20):
condition that is only diagnosedby looking at the vulva, But
we're forgetting this part ofthe exam.
And so you look up RachelRubin's article in the New York
Times.

Supraja (30:30):
It's really good And anyways a fan girling right here
, yeah, but So your vulva exam?
you said you look at theoutside.
you look at the labia majora,the clitoris, the clitoral hood,
see if it's retractable.
you look at the lymph nodes,the mons.

Sara (30:43):
And I look at the perineum and I'll look at the anus as
well, like you know.
Especially if somebody'scomplaining of itching or
constipation, do they havehemorrhoids?
Hemorrhoids yeah, exactly So.
I always take a moment just tolook at the vulva.

Supraja (30:53):
It literally takes like 15 seconds Right, but then, for
you all to know, the first partof the pelvic exam is just
people.
You probably will feel touchhands of spreading to see this
parts on the outside, but it'snot anything going inside, it's
just looking and feeling theoutside And I always get the
patient heads up.

Sara (31:12):
This is my hand on your thigh.
I am now separating your labiaminora so people know exactly
what I'm doing.
I'm not placing into anythingin the vagina, i'm just looking.
And so that the patient knowsexactly what I'm doing and
what's the purpose, i'm lookingat the texture of the skin, the
color.
Are there any growths that lookabnormal or benign?
And I'll mention it.

(31:33):
Oh, did you know?
you have a mole along yourperineum or in this area, like
oh yeah, i didn't know that Mydermatologist keeps an eye on it
, or they'll say oh, i had noidea.

Supraja (31:41):
I was like oh well, there's dermatologists does a
Volver exam?

Sara (31:44):
Some dermatologists do Impressive, so I know those are
my people, But yeah so somebodyand I just bring it up so that
the patient knows, becausesometimes they're like, oh I
didn't know about that, and thenI'll bring out a handheld
mirror and we'll look at ittogether.
I love the mirror.
Yeah, use a mirror a lot moreYeah because people then bring
up like oh, I have these bumps,I'm really worried about them.
Is this so and so?

(32:05):
And I'm like, no, actually,let's look at it.
I just love going over anatomybecause I just want people to
feel confident and likereassured about their bodies And
if there is something that weshould be worried about, then
let's chat about it and addressit, yeah, so that's the external
portion, and then, if you'rehaving a full exam, it's the
internal portion, which is wherewe use the speculum.

Supraja (32:24):
Now, that's the device that kind of looks like a duck
bill.

Sara (32:28):
Oh, that's a good.

Supraja (32:29):
Yeah, looks like a duck bill.
It's put inside an opened whichlets you inspect the canal of
the vagina, the cervix, some ofthe area around that.
That's where swabs arecollected in the vagina.
If you're getting STD testing,for example, or if you have
discharge, that's being tested.
And then that's how we do a papsmear, which is where two swabs

(32:51):
that are rubbed against thecervix, which is at the very top
of the vagina, which is kind ofthe entryway of the uterus.
That's where cervical cancergrows, and pap smears are
testing cells on the surface tosee if there is changes that
could eventually become cervicalcancer.
The screening test.
So it's telling you if you needmore testing.
But there are actually a lot ofdifferent ways.

(33:12):
even that part of the exam canhappen.

Sara (33:15):
Yeah, so you know, one of the interesting components to
the question that this friendsubmitted was you know how can I
advocate for a speculum that'smore comfortable?
or are there options, or is itjust one for everybody?
And there are many optionsactually.

Supraja (33:30):
Yeah.

Sara (33:31):
Thinner speculums, larger speculums And oftentimes the way
we decide is like has thispatient had a vaginal delivery
before?
Is she post menopause?
Is she an adolescent, ateenager, and maybe needs a
smaller speculum?
Does she have a history withpain with intercourse?
Is she asking for a smallerspeculum?
There are speculums smallerthan my pinky and speculums that

(33:51):
are three, four centimeters inwidth.

Supraja (33:54):
So there's, a variety in sizes, yeah, And I mean and
just to clarify one thing thatyou said, which I think all that
is exactly correct If you're ateenager, most likely you don't
need an exam.
Yeah, but sometimes if you havean issue, you do, and that
should be a long conversation,not something that just
automatically happens, correct?
But one of the tips I would sayis to ask to see it, and I try

(34:15):
to just show people.
I'm like this is the speculum,are you comfortable with?
this And then you can say ifthey show it to you and you
think it's too big, or whateveryou can say, is there a smaller
one?
Can we start with somethingelse?
So hopefully people are showingyou, but I know there are many
times where I wish that I hadtaken the time to do that and

(34:35):
you don't.
So know that your provider isnot going to be perfect, even
though we want to be, and it'stotally acceptable for you to
ask to see it.

Sara (34:43):
Because I think the thing that makes my heart hurt the
most during a visit is when apatient we finished the exam
just like, Oh, that wasn't sobad, The last one was so painful
I was dreading this visit.

Supraja (34:54):
And I'm like what, What , Yeah it makes my heart hurt
because like the moment I try toplace a speculum.

Sara (34:59):
If I see the patient even wins with any discomfort right
away like Oh, let's pause.

Supraja (35:05):
Let me grab a cake, are you?

Sara (35:06):
okay, let me grab a different speculum, let me warm
it, like there's so many thingswe can do throughout the process
to make it more comfortable.
And if somebody's not doingthat for you, like that's not
okay, you can say stop, this isactually uncomfortable.
Or can you switch this, likethere's so many things that can
be done beforehand And even whenI'm doing my exams.
This is the speculum at theopening of the vagina.

(35:27):
I'm now going to advance itinto the vagina again.
I use many words.
I talk too much.

Supraja (35:31):
But I love it Very good mind And it was like it was
great.

Sara (35:34):
And even when I'm advancing, I'm trying to get her
to do it again.
Even when I'm advancing it intothe vagina.
I'm like please let me know,you know, if I need to adjust my
technique, because I can.

Supraja (35:45):
Yeah, I really can I try to clarify for people.
This can be is uncomfortable,not even can be.
It is uncomfortable.
There's a lot of pressure, butit really shouldn't be painful.
It should never be So, if you'refeeling pain, tell me and I
will adjust, because pain is notnormal, So you don't need to
just grit and bear through that.
That's not what you should befeeling.

(36:05):
Yeah, it doesn't mean peopledon't feel it, because people
have a lot of reasons to feelpain, but it means feel
comfortable speaking up and knowthat something can be altered.
If what you're feeling is pain,yeah.
And then the other thing is weuse lubricant or water, you know
, and some people are reallysensitive to one or the other.
So you can also ask, like doyou use lubricant or water?
I've had better experienceswith this one.

Sara (36:27):
Yeah, you can also warm the speculant, like my
gynecologist warms my speculantfor me.
How with under?

Supraja (36:32):
hot water.
Oh, with water, or she and heor she, or they use lubricant or
no, they still use lubricant.

Sara (36:39):
Oh, i don't do that I should.
I need all the things I shoulddo that I don't.
I don't warm it unless thepatient specifically asks or if
I know it's going to beuncomfortable.
But also when I'm on in adifferent office they have
drawers that warm the speculantsfor you?

Supraja (36:55):
Oh okay, Find yourself a fancy gynecologist.

Sara (36:59):
And so those are little things you can do, and giving
heads up about different partsof the exam, like.
so it sounds like Supergine, ido exams very similar.

Supraja (37:07):
This is my hand.

Sara (37:08):
I'm now doing this.

Supraja (37:09):
I try to warn people about every single feeling
they're going to have.
When you're going to feel myhand, you're going to feel the
speculum, you're going to feelmore pressure, you're going to
feel it open and you can askyour provider to do that Like I.

Sara (37:20):
I on occasion will have a patient say I prefer if you
didn't tell me what you're doing.
But people are like be quiet.

Supraja (37:25):
Yeah just associate And that's totally fine too.
Then I'm like, okay, like I'lljust tell you the big things,
like something's going in, i'mnot going to talk as much, i'm
going to just hurry through itbecause that's what you're
asking of me, and I love whenpeople feel comfortable to share
that with me and comfortable totell me, like, actually, the
standard way you do this is notwhat I want.

Sara (37:43):
Yeah 100%, like it's just so easy for us to adjust and
anything I can do to make youmore comfortable that I want to
do that.
Yeah, one of the things we cando if an exam is to is not
something you can do like a way,we can also do them under
conscious sedation.

Supraja (37:58):
Actually, some places have a facility that's done in
sometimes it's done in the OR,just depending and you get
medicine through an IV.
You're put to sleep withmedication, so you're still
breathing for yourself.
You don't have a tube down yourthroat, but you are asleep,
basically.
Yeah.

Sara (38:16):
So yeah.

Supraja (38:17):
I definitely offer that to people and people.
I think more and more peopleare feeling empowered to ask
about it, which is totally fair.
You know there's no right wayto do this, and someone who
makes you feel like you'reasking for something
unreasonable by suggesting this,it's probably not the person
for you to go to, because it'syour body.
Nothing is unreasonable to makeyou feel comfortable.

Sara (38:38):
Yeah, So yeah, I definitely had patients say like
can you actually do my papsmear in the operating room
under light sedation?
Absolutely.
That's a fun case.
For me It's so easy, it's sostraightforward.
Like it's more inconvenient forthe patient because they
probably they have to take a dayand a half day off to like
coordinate, be a part of thesurgery.

Supraja (38:55):
But, like for the provider, it's so easy and like
it's more expensive generallybecause you have to pay for the
facility fee and the anesthesiainsurance covers that
differently than an officeprocedure, which is unfortunate.
So there are realities to it,but your provider should never
make you feel bad about it.
Yeah, like I love those surgery,like it's not a surgery but I
love those, or cases You're like, yeah, you have time to get a

(39:18):
drink with me, and so yeah.
And then there's the rectalexam.
Okay, i've had so many peopletell me, like friends and things
to be like my provider did arectal exam.
Is that normal?
And I'm like, actually it canbe, but they should have talked
to you about it.

Sara (39:37):
So I think this is an interesting topic because I feel
like when I was a resident, alot of my older attending
physicians would say did you doa rectal exam?
And I'm like no.
And I'm like did you do arectal exam?
I'm like I've actually neverhad a rectal exam during my well
, i guess a lot of things aren'thappening during my G-wagging
exams.

Supraja (39:57):
All the surgery is sexual and contractual.

Sara (39:59):
Okay, anyway, marie is not watching this episode, but okay
, what are reasons?
SuperJet, what is the reasonyou would do a rectal exam?

Supraja (40:08):
I would do a rectal exam if someone had rectal
specific complaints likebleeding, bleeding with their
bowel movements, extremeconstipation sometimes although
honestly that would not thatoften concern for fistula,
concern for rectal prolapse,endometriosis sometimes again

(40:29):
not that common, but you cansometimes feel like the implant
nodularity in the rectum.
But to be honest, let's meracking my brain, yeah.

Sara (40:38):
Most of the time I don't do one.
I don't routinely do them either.
I do them in my vulva clinicfor patients who have a history
of HPV and high-grade dysplasiaor abnormal cells on the cervix
or somewhere else on the vulva,because then that increases your
risk of having HPV or dysplasia, abnormal cells in the anus.
So I, for me, personally, ihave to have a specific reason

(41:01):
to do a rectal exam.
Yeah, and same reasons you justmentioned.
I do know some providersroutinely do them and I think
that's fine, as long as you'reexplaining to the patient.
this is part of my routine exam.
These are the things I'mlooking for, but somebody should
be explaining to you whythey're incorporating that into
their exam and you can alwaysask, like, why are we doing this

(41:23):
part of the exam?

Supraja (41:24):
If you have any reservations like, bring them up
And you can say I would prefernot to have a rectal exam.
Or you can say can you tell methe components of a pelvic exam?
Does it include a rectal examAnd what are you hoping to learn
from that?
And if their answer doesn'tmake you feel comfortable, say I
don't want that, totally fine,yeah, 100%.
So, along with the rectal exam,people normally do that in

(41:46):
combination with a bimanual exam, which I would say is more
standard, and that is when you,we put two fingers into the
vagina and then a hand on theabdomen And that allows us to
feel the cervix, the uterus, theadnexa, which are, i mean,
really what we're feeling isovaries, although the adnexa
comprises of both your tubes andyour ovaries feeling for any

(42:09):
masses, any tenderness, feelingfor normal sizes of those things
I feel for lymph nodes when I'mdoing that too.

Sara (42:20):
I'm not a.
I do a bimanual exam but I alsowill flip my hand over and feel
pelvic floor muscles for a lotof my patients, because that's
the specific population that Itend to see.
So you know, like anold-telepation, i'm going to be
feeling your pelvic floormuscles, i'm pushing on this
pelvic floor and I'll explain.
But, like, don't ever hesitateto.

Supraja (42:40):
Somebody should be explaining to you What's
happening, why it's happening,what's?

Sara (42:44):
the purpose of it.
What's the benefit Like whatare they interpreting from this
information?

Supraja (42:47):
they're gathering And then they should pause to be
like do you feel comfortablewith that?
Yeah, um yeah.
And even with the bimanualsometimes the bimanual is a lot
less uncomfortable than aspeculum because, at least for
me, i have very small fingers,so it's a lot less just mass
that's going into that space.
So sometimes for people who arenot comfortable with the

(43:08):
speculum, i'll say how about abimanual, are you comfortable
with that?
And then I'll say how about onefinger instead of two fingers,
would you be comfortable withthat?
And there are people where I'mlike let's talk about this and
you can decide if the risk toyou personally, whatever this
causes for you, is worth thehaving this exam and what we

(43:29):
could learn from it.
So, yeah, i think again.
I feel like the theme is youdon't have to do anything You
don't want to do and you deserveto understand why certain
things are being recommended toyou and to make a decision Like
yes, no, i don't know.

Sara (43:45):
Yeah, and as a healthcare provider, we shouldn't be
offended in explaining that.
Like that, you know we're hereto serve you and we should be
able to explain, like, what'sthe purpose and benefit of this
specific component of my history, my question, my exam.

Supraja (44:00):
Yeah, and so Okay.
Oh, i have a controversialquestion I'm interested in your
take on How often do you have tosee a gynecologist?
Okay, are we obsolete?

Sara (44:10):
I think this is a great question.
No, i see my gynecologist everythree years.

Supraja (44:15):
You do Yeah.

Sara (44:16):
Oh, wow, i see my primary care doctor every year.
Oh, interesting, Because I andthat varies for people, but I
generally don't have manygynecological concerns or
complaints.
I have an IUD.
I don't need to birth controlprescriptions.

Supraja (44:31):
And you have a very thorough primary care doctor.

Sara (44:33):
I love my primary care doctor.
She takes care of all the otherthings and you know, most
medical problems like asthma,diabetes, high blood pressure,
any like those things Agynecologist does not want to
manage, that's, you know, like aprimary care thing.
And I like my primary caredoctor because she tells me when
I need to get screened forthyroid conditions, high
cholesterol, and so I know she'sgoing to be probably maybe more

(44:57):
on top of that or, you know,more enthusiastic about those
topics, whereas when it comes tomy pap smear or talking about
birth control, i want my GYN todo that.
So I literally just go to myGYN for my pap smear.
Some PCPs love that, aretotally happy doing a pap smear,
so then you might not need tosee a GYN.

Supraja (45:11):
But if I have a specific GYN complaint, like
when I needed my IUD exchange, iwent to my gynecologist to do
that Yeah, whereas I think I'mthe opposite, although I do not
encourage my way of thinking, iwas telling Sarah earlier the
last primary care doctor I sawwas my pediatrician.
I am in my mid 30s, not good,i'm trying to get it figured out

(45:32):
, but I will say that a lot ofmy gynecologists in the past
have been like good friends ofmine also.
Probably not ideal but, theyhave been very kind to like take
on some primary careresponsibilities.
So and I am someone with notthat complicated of a medical
histories So it depends on yourprovider, like how thorough I
shouldn't even say thorough buthow comfortable they are dealing

(45:54):
with all of your health careneeds versus a specific need.
And that can be true for thegynecologist or the primary care
.
But for patients who see me, iusually say you should see me
every one to two years.
but it's different fordifferent people.
Like if you've had surgerieswhere your anatomy down there is
different you don't have allthe same parts that you were
born with, for example maybe youdon't need to be seen that

(46:16):
often.
Or if you're someone with anissue that we're following up on
a lot, or you're on amedication that we need to
adjust, maybe you need to beseen more often.
But the key, i think, is torealize everybody's a little bit
different and it's okay to havea conversation with your
provider like how often do Ineed to see you?
What can I expect at the nextvisit?

(46:37):
Is it necessary to do it in ayear?
Do we want to wait two years?
Do we want to only wait sixmonths?
So having comfortability tohave that conversation and know
that it's not a one size fitsall situation is really
important.

Sara (46:52):
Yeah, because I'll have patients come for an annual exam
and I'll ask like any questionsor concerns will you want to
address today?
And they'll say no.
And then I realized, as we gointo the visit, they don't need
to pass me for two or threeyears.

Supraja (47:03):
I know I'm sometimes like you don't really need an
exam.
Like do you want me to do that?
Yeah, like what were you hopingfor?
Like I don't mind the visit.

Sara (47:10):
But I also, like I want you to know, like you know, you
can come see me again next year,always happy to see you.
It's a very straightforwardvisit, but like you don't have
to, You don't have to, andsometimes it's more beneficial
for you to see your PCP than itis for me every single year.
But, yeah, some of my patientswho have like PCOS, polycystic
ovarian syndrome.
let me figure out thecontraception protect your

(47:31):
endometrial lining But I wantyou to go to your PCP to take
care of, like some of themetabolic stuff or other things
that I'm not as comfortabletaking care of.

Supraja (47:38):
So let's have a conversation about it, yeah,
okay.
And then, if all of us hashappened and you didn't have a
good experience, which, as muchas we want to pretend we're
perfect, i know I've gottenfeedback that was not
necessarily all positive andwe're all human, you know we all
have room to grow and do better.
So I want to talk to peopleabout, like, how they can give

(47:59):
feedback if they want to.
I think, also okay.
If you don't want to spend theemotional energy on providing
feedback, because that alsotakes effort, you just want to
find a new provider, totallyfine.
But if it's a situation whereyou do want to invest in this
provider you do feel like it's,or you want to, you want to
stand up for yourself, forsomething that has happened and

(48:19):
you want to provide feedback.
There are ways to do that.

Sara (48:22):
Yeah, and I've had patients write like a letter
that my MA gave me beforewalking into the room, saying
like these are things that cameup at the last visit that I'd
like to be addressed a littlebit differently today.

Supraja (48:36):
And.

Sara (48:36):
I, you know, read the letter And then when I walked in
I was like, oh okay, let'saddress this.
I want to understand what yourconcerns are, and so I knew
right away there's ways we cantweak our visits so that you're
a little bit more comfortable,or things that are being
addressed in a way that's thatyou would like to be addressed,
and that was I reallyappreciated that.
That gave me direction.
It was, you know, it helpedbuild, helped us build rapport.

(48:59):
I could tell the patient was sograteful after.
And, and you know, at the endof the day, like we can also
pick up when we've donesomething where I'm like, why
did?

Supraja (49:07):
I use, I'll get it go into my office.

Sara (49:08):
right then I'm like why did I use that word?
Oh, i like hate myself forhaving said that I don't hate
yourself.

Supraja (49:14):
But I'm like, so I'm so hard on myself Like, like.

Sara (49:17):
Sometimes I'll be like, oh , i can't wait to like visit
with this patient again so I cando better, or like you know,
you know.

Supraja (49:21):
Yeah, or I just I feel grateful when people are
vulnerable enough with me to belike Hey, can you use a
different word that bothers me,like can you do this slower?
Can you actually explain to mewhy you did that or why you want
to do that?
I love, i mean it, of course.
Whenever anyone is telling youlike I wish you had done this
differently, you're like, oh God, do I?

(49:42):
am I terrible?
As an instinct, but I actuallyhaving two steps of thought
outside of that, i'm like I'mactually so grateful that you
told me that and I really wantto be better And if that's not
the reaction you get again, youdon't have to see that doctor.
But I would say I like what yousaid both in terms of you can do
it in writing and you can do itto another person in the system

(50:07):
If you don't feel comfortablesaying it to your doctor to look
face to face.
I've definitely had people sayit to me face to face too, which
is great.
Most, i think all, all likegood clinics have an official
mechanism to provide feedback,whether that's like making a
patient complaint or just givingthe feedback less linked to you

(50:28):
in the complaint to you can doit both ways, and a lot of
people have that on theirwebsite.
Or, if you can't find it easilyor it's not on the website, you
could call and ask Hey, isthere a hotline or an email or
some form I can fill out to givefeedback?
and that should exist prettymuch everywhere We get weekly
feedback emails summarizingpeople's comments and usually

(50:48):
they're like nice comments, butsometimes they're like people
only tell me that I'm her.

Sara (50:53):
No, but sometimes there are comments where, like I was
you know the pay the providerwas running 30 minutes behind
and I sat in a gown or undressedin the room for 20 minutes and
I didn't like that.
And now, like ever since I sawthose, like that's really
reasonable.
And now when the medicalassistant asked me, like I know
you're running 20 minutes behind, you want me to room the
patient, I'll say room thepatient, do not have her get

(51:15):
undressed.

Supraja (51:16):
Because I took that feedback.

Sara (51:17):
so seriously I was like I wouldn't want to sit naked in a
room for 30 minutes.

Supraja (51:21):
I've had that feedback before too, like I was waiting
with my clothes off for a longtime.

Sara (51:24):
Yeah, and so now.
so I appreciated that feedback.
It came.
you know, it was like it wasanonymous, but I was like now
I'm going to treat all mypatients that way And some
patients will tell the medicalassistant like I don't care, i'm
going to get undressed rightnow.

Supraja (51:36):
And that's great.

Sara (51:38):
But I appreciate it And we do take it seriously.
And if somebody's you know notreceptive to your feedback, you
don't need to go to them, Don'tgo back to them, You know, like
just don't go back to them Andit's probably not personal, but
it's not about you and maybethere it's not about them.

Supraja (51:56):
Either way They're just having a bad day or they don't
understand.
But you want to feel supportedin your interaction, like when
you go to the doctor.
It should be about you.
So if it's not, if it doesn'tfeel that way, it doesn't mean
that your doctor is a terribleperson, but maybe you just need
a different relationship, likeSarah and Matt.
Not every man is for you, butthere's some good ones.

Sara (52:16):
None of them have been for me.
Where is he?

Supraja (52:19):
damn it, sarah it's just, you're just too good.
Sarah's like the cream of thecrop, that's hard to live up.

Sara (52:25):
I'm like Charlotte from Sex on the City.
I've been dating since I was 15.

Supraja (52:29):
Where is he?
And she found Harry.
She's so happy.

Sara (52:32):
We're still together.

Supraja (52:33):
Okay.
So okay to summarize our tips.
Tip one agenda.
Have an agenda, be clear aboutit when you go in.

Sara (52:43):
Tip two, don't be afraid to ask questions or convey what
you need from the visit, becauseit can be tailored to however
you need it to be.
Whether it includes an exam, orthat's reserved for another day
, or you need an explanationabout what's going to be
included in the exam.
It can be adjusted in a millionways.

Supraja (53:01):
Tip three if you know things bother you or you want to
have it done a certain way,bring that up in a time where
you feel safe.
So that could be an emailbeforehand to the MA.
It could be before you'reundressed, or if you're
undressed already, it could bebefore you're in position.

Sara (53:19):
And tip four it's okay to give feedback.
It feedback can sometimes be alittle painful to receive, but
ideally it's constructive and ithelps you become a better
person, a better provider.
You can give feedback.
It sometimes is just about howyou do it.

Supraja (53:33):
And tip five final tip if you didn't like that, don't
go back, get a differentprovider.

Sara (53:41):
Go to SuperJet.
There are other providers.
Go to Sarah.

Supraja (53:45):
There are other providers where it's going to be
better, and sometimes you needa better connection with someone
.
Sometimes you just need a freshstart.
There's no guilt involved withthat.
It's supposed to be about you.

Sara (53:55):
I always tell my patients like you're the boss.
My job is to give you theinformation you need to make the
best decision for yourself andyour family.
You run the show And I reallydo believe that You have control
.
You have more control than yourealize.

Supraja (54:16):
And I know it can be daunting to find providers.
So ask the people in your lifedo you see someone you like?
even if they're not taking newpeople, sometimes they'll have.
I tell everyone to go see Sarahbecause I trust her.
I trust that she's going to bean empathetic person and that
she is lovely and going to bereceptive to feedback and try to
cater to the person she'sseeing.

(54:37):
And I have other people I wouldsend people to And some people
I think would be a better matchfor someone who doesn't have a
lot of trauma.
So we all know, even if we can'taccommodate someone, people in
the community who would be goodfor different types of people.
So ask your friends who theysee.
Ask if there is someone whospecializes in a specific type

(55:02):
of an exam.
People are more of a resourceto you than you might think.
So don't feel so overwhelmedabout like Because we know it's
hard to get into the doctor,it's hard to find a provider and
then you feel like you have tostart over.
Can be really challenging, butyou're worth it.
It's worth finding someone youfeel comfortable with.

Sara (55:20):
Yeah, so you're the boss, own it.

Supraja (55:24):
Love it, celebrate it, and we're here for you.
Okay, i'm going to go expressSara's nipples, because no one
ever has.
Oh God, bye, ciao, bye, ciao,ciao, ciao, ciao, ciao, ciao,
ciao, ciao, ciao, ciao, ciao,ciao, ciao, ciao, ciao, ciao,
ciao, ciao.