I was 12 years old when I found out about Poison Oak. It wasn’t pleasant. A weekend stop in Huntsville, AL, on the way to Florida, left my face unbearably itchy. While my family enjoyed the sunny, uncrowded beaches of Destin in the fall my scrawny, unhappy frame sulked underneath a beach umbrella. The last straw came when I woke up on our second morning with my left eye swollen completely shut; my right not too far behind. I had to go see a doctor.
I’m not sure who I actually saw; I only remember one person from the Urgent Care that day: the nurse. The unmemorable doctor (or perhaps PA or NP) had correctly diagnosed me with “a rip roaring case of poison something” and left the room with instructions for in-office IM steroids to be followed by an oral prednisone taper. Subsequently, a young, female nurse entered the room with a needle that is usually reserved for reaching the deepest recesses of one’s spine and merrily informed me that “IM” meant I was to have a shot. She then asked if I would like to have the shot in my arm or my butt remarking that the rear end is a big muscle and would hurt less. After a quick assessment I realized almost no difference in pain would surmount the loss of my adolescent, male pride that I would surely experience if I had to pull down my pants. I got the shot in the arm, my dad and I went to Wal-Mart next door, and while he picked up the prednisone prescription I consoled myself by playing the newly released Goldeneye on an in-store demo N64.
What made me do that? It was a small choice that really didn’t matter too much but the same pressure that led me to choose the deltoid over the glut plays out every day in clinic, and it’s something that male providers can be very familiar with. A young 20-something woman comes into clinic for an acute problem and a quick review of the medical record shows only a handful of acute visits over the last couple of years. It’s a rare opportunity. I will address the acute issue and make sure that there’s a few minutes at the end of the visit to talk about the things that can really make a difference in a patient’s lifelong health. But as I start talking about Pap smears and in-office IUDs the patient, very subtly, backs out of the conversation and any commitment that might lead her to see a male provider for such issues.
Women’s Health is important stuff. For better or worse women are currently, largely in control of contraception for the entire human race, and when effective options, with a low level of side effects, at the right price are presented to females, amazing things happen for everyone. In developing countries birth rates decline sharply along with in-home abortions. Women become educated, start businesses, and use that money to improve their family and community. The statistics can be mind boggling even in the U.S. One of my favorite studies, the CHOICE project, was created to see what would happen if the upfront cost associated with long-acting reversible contraception (LARCs) didn’t exist and these (and other forms of contraception) were available to lower income/high risk populations. The study authors themselves were blown away at the results: “The teen pregnancy rate was 34.0 per 1,000 teens compared to the national average of 158.5 per 1,000 teens AND the abortion rate for teens in the CHOICE project was 9.7 per 1,000 teens compared to the national average of 41.5 per 1,000 teens.” WHAT?!?! Where else do you see those sorts of numbers?
Last month a fellow, female resident remarked that she was “drowning in IUDs”. While the XX gender does often get the short end of the stick when it comes to their professional life in medicine (lower pay, difference in expectations, breaking into a male dominant field) this definitely is not one of them. I know that I will be more than competent to place IUDs or other forms of LARCs when I graduate, but I still sometimes have the frustration of looking ahead at my schedule and seeing the message asking to change providers for their procedure in 3 days; they would prefer a female.
I can’t blame anyone or say that it’s dumb to have this gender-bias and hesitation. After all, I did it myself over nothing more than pulling the back of my shorts down 4 inches for a needle stick, and it’s great that women can see female providers. I just don’t want to miss out on being the one making that big a difference in people’s lives. But if I ever need consolation I just go back to what I know works: a little bit of Goldeneye.
Brad Schleenbaker, MD is a second year family medicine resident at the University of Utah.