Life is like a Speculum Exam

For those of you (men) who are unfamiliar, a speculum is a much feared medical device used to visualize a woman's cervix during a pelvic exam. You put it in and then crank it open. Women hate them, and medical students don't really know how to handle them (biggest challenge: finding the cervix!). These devices are actually genius, and save women's lives by allowing us to diagnose cervical cancer (among many other diseases). But having had a few pelvic exams in my life, I have to say that no woman loves a speculum.

During second year, we were taught how to do speculum / pelvic exams on standardized patients. Women who demonstrated how to do the exams on their own bodies. They were able to tell us when we were doing something incorrectly, and if we were making them uncomfortable - verbally, emotionally, or physically. They could kindly inform us when we said something stupid, or worse, something insensitive. I distinctly remember one of my male classmates accidentally saying "I am going to enter you now." (We all laughed, including the standardized patient.) Using a speculum isn't just about placing it correctly, or maneuvering the different pieces of the device. It is also about language, attitude, and respect. A lot like my life right now.

The past two weeks I have done at least 15 pelvic exams with at least ten different supervising doctors / nurses / midwives / medical assistants. And to my frustration, every single supervisor wanted me to use the speculum in a different way. My first preceptor, Dr. Bay, showed me how she used the speculum - the correct placement, sequence of events, etc. With my second preceptor, Dr. State, I followed those same instructions exactly. After the physical exam, despite following every step described by Dr. Bay, Dr. State took me back to his office and informed me that I was "doing it wrong." This happened ten times. Every supervisor that I worked with wanted me to use the speculum in a different way. After all of those exams, I feel like healthcare providers need to conform the pelvic exam based on each patient's personality, anatomy, medical history, and one specific technique won't work on every single woman.

Like the speculum exam, being a third year medical student is all about conforming to the wants and needs of the people around me. The needs of my patients, but also those of the residents, doctors, and other healthcare providers that I encounter. Like a speculum exam, my success depends not only on knowing the facts and the technical aspects of physical exam but also on the way I interact with each team that I work with.

I have definitely learned a lot from each pelvic exam. I am  still somewhat confused by the number of ways a speculum can be placed and which is least unpleasant for my patients (because honestly, there is no way for this exam to be pleasant). A midwife told me I should borrow a speculum and see what feels the best on myself. I am not sure if I am that committed to mastering the speculum exam, or if there is really one superior way to use a speculum. I guess (also similar to my medical school life) I just need more practice to get the hang of it!