VOICE FROM THE FIELD: Feeling Safe in the Exam Room
“I am never doing that again,” thought Megan Rehder after her first pap smear. She was 21 years old, recently graduated from Colorado College, a doctor’s daughter who dutifully scheduled her first well-woman visit after receiving a reminder postcard in the mail.
“I was undressed when the doctor met me, she didn’t take any time to get to know me and all of a sudden I’m in this very vulnerable position,” she said. The doctor, a private practitioner in Seattle, asked Rehder a list of questions without looking up from the computer screen. She never discussed contraception, sexually transmitted infections, or really much of anything. “I felt like it was just not a very safe or healthy experience,” Rehder explained.
Although she has had positive experiences with preventive care since then, even with other providers Rehder didn’t always answer the social and behavioral screening questions truthfully. “I think most people don’t," she said. "Unless it’s brought up in a more safe way.”
Today Rehder is a Nurse Practitioner at SeaMar Community Health Center where she has to coax her own patients to come in for their preventive health visits. “I think it’s important you take a little effort to build rapport,” she said, thinking of her own first experience.
Beyond creating a safe space for patients, Rehder believes that getting to know them makes it more likely patients will take part in their own preventive care. “It’s a little hard to get people on board with routine wellness and checkups. They don’t see the immediate benefit to having to take action,” she explained. “If I can make it about them and about their life, then I have a better chance of getting them to return for preventive visits.”
Most of Rehder’s patients are uninsured or on Medicaid. “I do have a handful of patients that are having coverage for the first time in 10 or 20 years and they are just coming in for a routine check-up. “
One patient, a 30 year old woman on birth control pills, wanted to talk to Rehder about contraception. She was sure she and her fiancée did not want children but she often forgot to take her pill. She knew there were more reliable forms of contraception, like the intrauterine device (IUD), but felt anxious about the idea of a strange object inserted and left inside her body. She told Rehder that she had never had a pelvic exam or breast exam. Embarrassed, she asked Rehder what a pap smear was.
“For this patient,” said Rehder, “I knew that she was 9 years overdue for a cervical cancer screening and that contributing to a safe experience for her first pelvic exam could open the door for more effective contraceptive options.” Rehder took her time with the patient. She explained the reasons for cervical cancer screening, for routine pap smears and well-woman check-ups. The patient returned two weeks later for her first pelvic exam and pap smear. “I’m less nervous,” the patient told Rehder afterward. “I’m ready to talk about the IUD now,”
“People think of the doctor’s office as a place to go if they are sick,” said Rehder. “Hopefully we can change that.”