How to navigate your way through an appointment with the gynecologist, and health providers in general.
Informed Consent
Informed consent is generally divided into three parts
A patient agrees to a health intervention based on an understanding of it
The patient has multiple choices and is not compelled to choose a particular one
The consent includes giving permission to have the procedure or take the medication
Other aspects of informed consent include that it should be
freely given
reversible
informed
enthusiastic
and specific
What is medical gaslighting?
Medical gaslighting refers to cases in which a healthcare practitioner imposes a pattern of questions, testing or diagnosis that runs counter or tangential to the history or symptoms the patient is describing or experiencing.
Examples include:
A distrust and dismissal of anecdotal, first person experience
Having your symptoms brushed off as the result of stress, anxiety, or another nebulous mental health problem
Being dismissed on the basis of having the fluctuations of a normal menstrual cycle aka a hormonal problem
A practitioner who ignores what you are asking for, such as requesting testing, inquiring about symptoms that you have, or if you are unhappy with the medication that you are on and want to switch
Shaming of your body or lifestyle, such as fat shaming or slut shaming
Coercion, such as requiring a pelvic exam to access the medication you need
Being told to “wait it out” if you develop new symptoms or side effects from medication
Gaslighting always occurs in the matrix of oppression, so poor women and particularly, poor Black women are dismissed as not being able to feel the pain they describe, or stereotyped as addicts looking for drugs
Gender nonconforming people are often ridiculed for their choices or denied care and compassion for their symptoms
Underlying all of this is the same root which is that medicine does not consider women or people who menstruate as an accurate judge of when something is bothering them about their body
A Guide To Talking With Your Gynecologist
Prepare
Pre-write out your notes including a goal for the visit. It helps to have clear objectives for your visit, especially if something in particular is happening to you. This also helps you take control over the appointment from the provider, who may have a pre-made script of their own for the appointment. This forces them to slow down and actually think about the discussion with you.
Be Firm
Frame your questions as questions, but frame demands as demands. If you need guidance because you don’t understand something, it’s appropriate to ask. If you need a certain kind of medication or treatment, framing your needs as a demand shows urgency and that you are confident, allowing you to get your needs met.
Self Advocate
Your lived experience is valuable and valid, even if a doctor presents evidence to the contrary. There is not a one size fits all solution to anything in life and gynecology is no exception. Advocating for individualized care that takes into account your unique factors helps you get care faster.
Free To Leave
Remember you can always SAY NO. You can always LEAVE. You can always bring a friend/doula/advocate. No is a complete sentence. You only have to visit the gynecologist out of your own choice and free will to do so. If you feel uncomfortable in an appointment you never have to stay there to appease other people around you. You never have to agree to medication or procedures in exchange for the treatment you are seeking. You always have the option to walk out.
Your doctor works for you, not the other way around. You can fire your doctor if you are being dismissed, full stop. You have a right to compassionate care that actually helps you get better, and if your practitioner is getting in the way of that, it’s time to move on.
A New Paradigm for Reproductive Health Consent
Doctors Must Ask For Consent
Doctors should ask for your consent before touching you or performing an exam. Doctors should be fully trained in dealing with victims of sexual violence and abuse. Proper training could hel address the lack of compassionate bedside manner which is disturbing and creates ripples of harm. This change would also encourage better utilization of equitable healthcare systems instead of avoiding it altogether due to past medical trauma, which is a huge under discussed problem.
Menstrual Education
We need widespread education about the endocrine system and how hormones affect the body. This needs to come from inside doctors offices but also from general sex education. Patients who are informed before they go to the doctor are more likely to take a critical approach to being prescribed medication, and are more likely to ask questions before taking something new.
Screening
Being properly screened and tested before taking medication to reduce serious adverse events is preventative healthcare. For example, people with inherited blood clotting disorders that use oral contraceptives may be at increased risk of ischemic stroke. Though not yet recommended, in the future it may be advisable to screen patients for the genetic variants – factor V Leiden and methylenetetrahydrofolate reductase (MTHFR) 677T – before prescribing the birth control pill. Genotyping is relatively inexpensive, easy to perform, and could be a part of preventative care.
Midwifery Foundation
Midwifery, full spectrum doulas, and menstrual health educators should be more legitimized. They serve an integral role in our reproductive healthcare system. Midwives can and do provide a variety of health services that mirror gynecology such as pelvic exams, pap smears, and STI/D testing. A competent midwife can replace the need to visit the gynecologist for regular check ups. Doulas can provide a variety of different types of counseling about the best choices for your particular healthcare needs.They also can be useful advocates inside gynecology offices and other healthcare clinics.
Using Charting to Help you Make informed Decisions
Charting can help you make informed healthcare decisions.
One of the problems with the modern state of gynecology and obstetrics is that we are largely outsourcing our decision making. We are reliant upon the doctors tests to know whats going on with our hormones, we don’t know when we ovulate, we don’t have a way to read how our hormones are doing generally.
With an understanding of fertility awareness you can read your hormonal profile over the course of several cycles which gives you stable data on how estrogen and progesterone are cycling.
It can also enlighten you to how other chronic health conditions interact with your hormones or other potential triggers.
It’s a specific bio-profile that is unique to you each time you make a chart. This data is useful for you because you can make decisions outside the healthcare system that improve your health, and it also helps you make decisions with your doctor, as they can use the information to provide you with the most appropriate treatment or medication.
A compassionate provider will take time to look with you at your charts, and actually treat charts as important data to consider. If your doctor laughs at you or refuses to look at the information, that says a lot about who they are as a practitioner.