Everyone's a Ken Doll

You'd think that at this point in our lives, as med students, that everyone would be comfortable with penises and vaginas. We are not. I remember as a first year in Anatomy lab there being seveal students that never laid a scalpel on the body and remained on the margins, their scrubs smelling just as bad as everyone else's but missing the flecks of flesh. This would be laughable if it weren't encouraged. Pick up a medical textbook and more often than not, instead of an anatomically correct drawing you get a Ken Doll, complete with nondescript genitalia and breasts that ride the border between overweight guy and underdeveloped girl.

So I was surprised today when I walked into Clinical Skills to see a video of a very curt Irish physician giving a full pelvic exam to a very hairy Jewish girl. I was more surprised than anyone, having heard so many stories about giving pelvic exams to manequins instead of prosititutes like the other medical schools get to do. I don't know where I heard that, but I did.

So after a perfectly graphic demonstration of a female pelvic/anal/breast exam was an equally graphic male example. Checking for an inguinal hernia does not look fun.

"With your right index finger grab a section of free scrotal tissue and feed it up and into the inguinal ring, following the spermatic cord, where you may appreciate the internal inguinal ring."

Now I applaud the folks that put the video together and the phsicians and patients that volunteered, but everything was still a little off. Hospital work, though repetitive and disgusting, does have a pot of gold at the end: you get comfortable. It took my around 11 months to get really comfortable to the point where I could talk to patients about their dying and regrets and family. Being able to speak frankly and honestly with a person that near death is special and should be mandatory. Imagine you're dying slowly, having the chemo-book thrown at you, and everyone's too busy being motivating and positive to say that, "Yeah, you're dying. How do you feel about that? What are your biggest concerns and what do you want accomplished in the next few months?" Sure you throw a chaplain or two at them, but they aren't part of the day to day care. That job should instead fall to the day-to-day staff: your oncologist and nurses and hell, even your techs.

My point about all this is that those physicians and patients were really off. The patients were too happy and compliant about their anuses and urethras and the physicians weren't distracted enough. Your proctologist is bored with your anus. He's seen thousands of them. Same goes for your OBGYN. The patients are not happy about your finger in their rectums. That hasn't happened to them thousands of times and they want it to be over. They certainly don't hop off the bed and shake your hand afterwards.

I'm not asking for much, just a doctor who'd prefer to do a quick exam and say your fine and a patient who can't wait to hear it so that she can leave. They were all just too happy and it reminded me of the embarassed students in anatomy lab that didn't want to see what a body really looked like, just like the video wasn't showing us what a rectal exam is really like. I don't blame the actors; I blame the director.

Soon, I hope, medical school will stop presenting the "Ken Doll" version of things and let Barbie know what she's really in for.