"best" and "worst" programs for ED pelvic exams

[Pathmonster]

As we all know, a pelvic exam is essential for any woman with abdominal pain, especially of acute onset.

It is essential, but let's face it, some exams will be more pleasant/tolerable than others just as some patient's personalities are more pleasant and more enjoyable than others.

What programs have the worst (least pleasant)? I imagine it would be at a poor county hospital. Charity Hospital New Orleans, Bellevue NYC, LAC, etc..

What programs have the "best" (most pleasant)? I am guessing programs with lots of younger affluent populations. My guess would be Cornell (though there are hoards of poor people within striking distance of Cornell), UCLA (near Brentwood, Bev Hills, Santa Monica), any programs near Pacific Heights SF? How about South Beach?

Any people with first hand experience?

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[AlienHand]

You're kidding, right?

 

[JackBauERfan]

As we all know, a pelvic exam is essential for any woman with abdominal pain, especially of acute onset.

It is essential, but let's face it, some exams will be more pleasant/tolerable than others just as some patient's personalities are more pleasant and more enjoyable than others.

What programs have the worst (least pleasant)? I imagine it would be at a poor county hospital. Charity Hospital New Orleans, Bellevue NYC, LAC, etc..

What programs have the "best" (most pleasant)? I am guessing programs with lots of younger affluent populations. My guess would be Cornell (though there are hoards of poor people within striking distance of Cornell), UCLA (near Brentwood, Bev Hills, Santa Monica), any programs near Pacific Heights SF? How about South Beach?

Any people with first hand experience?

Do you think there is any difference if the school in question has a OB/GYN residency program available to help with the pelvic exams. This is a concern I have had while applying to schools and interviewing also, and would appreciate it if we got some good feedback... I will most likely be using this information, and solely this information, to make up my rank list, so please advise to the fullest extent possible.

Also, I have used geographical epidemiology studies showing the rate of STD's in certain segments of the country as a basis to places I would like to go. I think Maryland had a surprisingly high rate.

(this is of course sarcasm, and another attempt to increase my total number of posts)

 

[southerndoc]

Is there such a thing as a pleasant pelvic exam? I hate doing them. To me, there is no such thing as a pleasant pelvic exam. I dread doing every one of them and do them only of necessity.

Having said that, I heard that the infamous In-and-Out Residency doesn't require their residents to do pelvic exams. They have nurse practitioners on call 24 hours daily to do their pelvic exams for them. How nice!

 

[EctopicFetus]

southern.. in addition... I hear the PD Dr. McFattypants will come in during all hours of the day or night to do them for you.. well as long as the women are hot (per pathmonster), of course at the In n out Residency they have some triage nurse who sends all the not so hot chicks across the street to you know where.....

 

[mustangsally65]

Is there such a thing as a pleasant pelvic exam? I hate doing them. To me, there is no such thing as a pleasant pelvic exam. I dread doing every one of them and do them only of necessity.

Us "wimmens" don't really enjoy them very much either. Especially if we're in pain and they're being done by someone in an ED who hates doing them.

Just remember that the female on the other end hates them even more than you do. Maybe that will help get ya through them.

 

[EctopicFetus]

sally are you volunteering for pathmonster?

 

[southerndoc]

Us "wimmens" don't really enjoy them very much either. Especially if we're in pain and they're being done by someone in an ED who hates doing them.

Just remember that the female on the other end hates them even more than you do. Maybe that will help get ya through them.

Sally, in the EM forums? What gives? Are you thinking EM?

 

[EctopicFetus]

I believe she is still Pre-med.. Best of luck getting in sally..

 

[mikecwru]

Us "wimmens" don't really enjoy them very much either. Especially if we're in pain and they're being done by someone in an ED who hates doing them.

Just remember that the female on the other end hates them even more than you do. Maybe that will help get ya through them.

Would you rather the doc really, really enjoy them?

mike

 

[southerndoc]

Would you rather the doc really, really enjoy them?

mike

Hi, I'm Dr. McFaddypants. I'll be doing your pelvic today, mmmkay?

 

[DropkickMurphy]

Best- The Hugh Hefner Women's Hospital Emergency Medicine Residency
Worst- The SEATAC Strip Streetwalkers Memorial Medical Center EM Residency (you've heard of the In and Out EM residency- this is the "B-tches and Ho's" residency)

 

[waterski232002]

Is there such a thing as a pleasant pelvic exam? I hate doing them. To me, there is no such thing as a pleasant pelvic exam. I dread doing every one of them and do them only of necessity.

It's not as bad as draining a perianal abscess.... anerobes = FOUL!!!

 

[leviathan]

Best- The Hugh Hefner Women's Hospital Emergency Medicine Residency
Worst- The SEATAC Strip Streetwalkers Memorial Medical Center EM Residency (you've heard of the In and Out EM residency- this is the "Bitches and Ho's" residency)

I agree with Praetorian's assessment.

 

[BKN]

As the recent traffic on "Things my patients" indicates, EM is the most public forum.

This thread has real potential for unprofessionalism. Suggest we keep it clean.

just my 0.002

 

[SoCuteMD]

Only 2 hundredths of a cent? I think it's worth more than that BKN!

 

[napoleanna]

mmmm....how about 2 tenths of a cent?

 

[colforbinMD]

As the recent traffic on "Things my patients" indicates, EM is the most public forum.

This thread has real potential for unprofessionalism. Suggest we keep it clean.

just my 0.002

BKN while I agree with your premise here. I have to say it angers me that it's true. Whoever posted those links grrrrrrrrrrrrrrr This site exists BY us FOR us. And I HATE that we have to censor ourselves.

 

[southerndoc]

As the recent traffic on "Things my patients" indicates, EM is the most public forum.

This thread has real potential for unprofessionalism. Suggest we keep it clean.

just my 0.002

Yea, we should actually delete this thread.

 

[tigress]

lol, okay I have an actual question (sorry for my naivete)

Do you do a pelvic if it seems obvious that the abdominal pain is due to appendicitis, or something else non-gyn related? Just curious (mostly because when I had appendicits -- I was 17 -- they did not do a pelvic; my presentation was textbook, though)

okay, one more question
does it bug y'all when pre-meds or 1st or 2nd year med students who are interested in EM come post in here? lol
How about when people with no connection to medicine post on the popular threads? That influx has certainly been interesting.

sorry if it does bother you. I EM, though, and I love this forum.

edit: I just saw the above post that indicates that the answer to my above question is emphatically yes. At least re: the non-med people.

 

[colforbinMD]

lol, okay I have an actual question (sorry for my naivete)

Do you do a pelvic if it seems obvious that the abdominal pain is due to appendicitis, or something else non-gyn related? Just curious (mostly because when I had appendicits -- I was 17 -- they did not do a pelvic; my presentation was textbook, though)

okay, one more question
does it bug y'all when pre-meds or 1st or 2nd year med students who are interested in EM come post in here? lol
How about when people with no connection to medicine post on the popular threads? That influx has certainly been interesting.

sorry if it does bother you. I EM, though, and I love this forum.

edit: I just saw the above post that indicates that the answer to my above question is emphatically yes. At least re: the non-med people.

Med students interested in EM are MORE then welcome. (you know since basically I am one) It's just the need to self censure so the public doesn't see our dark side and lose faith in their local ED that has my panties in a bunch. There is a time and a place for professionalism but this forum didn't use to be one of em. If you ask me though, if a person has a problem they are planning on going to the ED for and they decide not to because of something they read on SDN well then they probably shouldn't have gone to the ED for it to begin with.

 

[BKN]

lol, okay I have an actual question (sorry for my naivete)

Do you do a pelvic if it seems obvious that the abdominal pain is due to appendicitis, or something else non-gyn related? Just curious (mostly because when I had appendicits -- I was 17 -- they did not do a pelvic; my presentation was textbook, though)

IMHO pain in a woman south of the xiphoid and north of the pubis requires a pelvic. One thing that easy CT scanning and sono has taught us is that frequently classic appy=ovarian cyst or other things. Actually we knew that long before, the patient learned it the hard way when we cut her open. Even RUQ pain that seems obviously liver or biliary can be Fitz-Hguh-Curtis (perihepatitis due to pelvic infection). You never know if you don't look.

okay, one more question
does it bug y'all when pre-meds or 1st or 2nd year med students who are interested in EM come post in here? lol
How about when people with no connection to medicine post on the popular threads? That influx has certainly been interesting.

sorry if it does bother you. I EM, though, and I love this forum.

edit: I just saw the above post that indicates that the answer to my above question is emphatically yes. At least re: the non-med people.

It doesn't bother me much, I like it. I see this as a developmental site, from the premeds on up to the faculty. For the premeds and preclinicals, you need to make the mental adjustments to prepare to do invasive exams, hear private thoughts and keep silent.

As for nonmedical folks viewing and posting, well that's the way it's set up. To make it a secured site, while allowing students in health sciences and Docs from all over the world to participate, sounds like a logistical nightmare to me.

 

[Pathmonster]

I'm just saying that ED pelvic exams are a fact of life and mandatory for any woman with abodminal pain. Obviously if the suspected etiology is determined to be pelvic than the OB/Gyn team is consulted.

And just like some patient's have more pleasant personalities to deal with some people have more pleasant pelvic exams to deal with.

I was just thinking that a program like UCLA, where all the woman who live in the area have the grooming and body habitus of Cameron Diaz, or say UCSD in La Jolla would be a lot better than performing them on women at County Hospital in Atlanta or New Orleans or NYC.

 

[BKN]

I'm just saying that ED pelvic exams are a fact of life and mandatory for any woman with abodminal pain. Obviously if the suspected etiology is determined to be pelvic than the OB/Gyn team is consulted.

And just like some patient's have more pleasant personalities to deal with some people have more pleasant pelvic exams to deal with.

I was just thinking that a program like UCLA, where all the woman who live in the area have the grooming and body habitus of Cameron Diaz, or say UCSD in La Jolla would be a lot better than performing them on women at County Hospital in Atlanta or New Orleans or NYC.

And I'm saying that I find speculation on the relative pleasantness of pelvic exams by the grooming and body habitus of the patient remarkably unprofessional.

Part of becoming a physician is to develop a neutral attitude to doing things like pelvics, rectals, male genital exams, sigmoidoscopies, etc that would never be done by anyone else, at least professionally. If this is going to be a public forum, let's act like doctors.

IT'S TIME TO CLOSE THIS THREAD.

I hate being the SDN nanny.

 

[SoCuteMD]

a program like UCLA, where all the woman who live in the area have the grooming and body habitus of Cameron Diaz

Yeah, sure. 'cause goodness knows there are no people who don't shower daily in LA.

 

[southerndoc]

I'm just saying that ED pelvic exams are a fact of life and mandatory for any woman with abodminal pain. Obviously if the suspected etiology is determined to be pelvic than the OB/Gyn team is consulted.

At my institution, we only consult OB/gyn if someone needs to go to the OR or they need admission. I suspect it's the same situation at most places. Not every gyn problem deserves a gyn consult.

With regard to a previous poster making the comment about the classical appendicitis presentation, I remember getting signout from a medicine intern rotating through the ED for a girl waiting on CT scan for her appendicitis. He told me he didn't do a pelvic because of her "classic" presentation. When I did her pelvic, she had this huge ovarian mass. I canceled the CT, sent her for a transvaginal ultrasound, which showed an ovarian torsion. Turns out she had ovarian CA (at 20!) that predisposed her to the torsion. She was quickly taken to the OR.

 

[BKN]

With regard to a previous poster making the comment about the classical appendicitis presentation, I remember getting signout from a medicine intern rotating through the ED for a girl waiting on CT scan for her appendicitis. He told me he didn't do a pelvic because of her "classic" presentation. When I did her pelvic, she had this huge ovarian mass. I canceled the CT, sent her for a transvaginal ultrasound, which showed an ovarian torsion. Turns out she had ovarian CA (at 20!) that predisposed her to the torsion. She was quickly taken to the OR.

Strong work!

 

[EctopicFetus]

I have to agree with BKN on closing this thread. The reality on the Pelvic situation is this.. It is no different (in grossness) than anything else. I have seen (and smelled) the feet of clean people and of those who are not quite as clean. I think the pelvic thing draws some strange interest because of the uniquely personal nature of this. I assume the initial poster meant this as a joke or a misguided attempt at humor.

I have rotated at county hospitals in Chicago and Orlando as well as community (both wealthy and poor) in Chicago and I can assure the amount of $$$ a person has has little to do with their level of cleanliness.

 

[DrQuinn]

I have hesitated to close this thread... mainly because unless it turned into a huge flame war or it was completely inappropriate (I think it leans on borderline), I let the threads take care of themselves. It will die down, I am sure, shortly.

Q

 

[colforbinMD]

I have hesitated to close this thread... mainly because unless it turned into a huge flame war or it was completely inappropriate (I think it leans on borderline), I let the threads take care of themselves. It will die down, I am sure, shortly.

Q

Strong work!

 

[The White Coat Investor]

Hey Quinn, Did you make a video for Gar LaSalle about breaking bad news?

Regarding Pelvics, I have learned to dread them ever since I had to do one on a relatively young, nice appearing lady, whose entire vaginal vault was wall to wall warts. I think she had prostituted herself out for drugs. Maybe somebody liked the extra texture? At any rate, pelvics have gone from being interesting (never enjoyable, I must say) to dreaded.

I frequently skip a pelvic BTW, for straight forward GB pathology or gastritis. But if there is anything weird at all...pelvic time.

 

[DrQuinn]

Yes, I did do that video!

Gar La Salle came by last year, and needed someone to be an actor. Me, being an aspiring Keanue Reeves look alike, as well as never shying away from the spotlight, eagerly signed up. Did you see the one of my PD, Kelly O'Keefe, get "pissed off" at the angry brother? Wow, so funny.

They gave me a $100 GC to Borders for doing that video. Saweet!

Where did you see it.

Q

 

[colforbinMD]

Yes, I did do that video!

Gar La Salle came by last year, and needed someone to be an actor. Me, being an aspiring Keanue Reeves look alike, as well as never shying away from the spotlight, eagerly signed up. Did you see the one of my PD, Kelly O'Keefe, get "pissed off" at the angry brother? Wow, so funny.

They gave me a $100 GC to Borders for doing that video. Saweet!

Where did you see it.

Q

Because when I just lost a loved one there is noone else I would rather hear if from then Ted Theodore Logan.
I know, I know your going for more of a Thomas Anderson look. Either way I am dying to see this video.

 

[The White Coat Investor]

I saw it in a conference for our residency didactics. I put two and two together and now I know what Quinn really looks like!!!!!!

Yes, I did do that video!

Gar La Salle came by last year, and needed someone to be an actor. Me, being an aspiring Keanue Reeves look alike, as well as never shying away from the spotlight, eagerly signed up. Did you see the one of my PD, Kelly O'Keefe, get "pissed off" at the angry brother? Wow, so funny.

They gave me a $100 GC to Borders for doing that video. Saweet!

Where did you see it.

Q

 

[The White Coat Investor]

Yes, I did do that video!

Gar La Salle came by last year, and needed someone to be an actor. Me, being an aspiring Keanue Reeves look alike, as well as never shying away from the spotlight, eagerly signed up. Did you see the one of my PD, Kelly O'Keefe, get "pissed off" at the angry brother? Wow, so funny.

They gave me a $100 GC to Borders for doing that video. Saweet!

Where did you see it.

Q

Yeah, pissed off brother was good.

 

[mustangsally65]

sally are you volunteering for pathmonster?

No, thanks.

But thanks for the admissions encouragement. If it doesn't happen this year then next year is my year!

 

[mustangsally65]

Sally, in the EM forums? What gives? Are you thinking EM?

I lurk a lot, actually, but don't post a lot. I'm thinking family medicine, but in a rural area. Rural family med docs often work in EDs.

Then again, i haven't made any concrete decisions yet, I still have to get in first!

 

[EctopicFetus]

Best of luck getting in!!

 

[Pathmonster]

Yeah, sure. 'cause goodness knows there are no people who don't shower daily in LA.

You obviously have never been to Beverly Hills and Brentwood (which is where UCLA patients would come from). All the women there are immacuately groomed from head to toes(and thin)

 

[EctopicFetus]

Let me guess that you are from there. Ive been to LA and the women are nice.. but beneath their clothes I think you are just guessing about their grooming..

 

[Pathmonster]

Let me guess that you are from there. Ive been to LA and the women are nice.. but beneath their clothes I think you are just guessing about their grooming..

Not from LA, just visited, and the women in Brentwood are all cameron diaz, lucy liu wannabees. I'm sure they are fully groomed like in Brazil if you know what I mean. Bev Hills is of course an older crowd on average (but they probably go to Cedars Sianai over UCLA)

 

[Pathmonster]

At my institution, we only consult OB/gyn if someone needs to go to the OR or they need admission. I suspect it's the same situation at most places. Not every gyn problem deserves a gyn consult.

With regard to a previous poster making the comment about the classical appendicitis presentation, I remember getting signout from a medicine intern rotating through the ED for a girl waiting on CT scan for her appendicitis. He told me he didn't do a pelvic because of her "classic" presentation. When I did her pelvic, she had this huge ovarian mass. I canceled the CT, sent her for a transvaginal ultrasound, which showed an ovarian torsion. Turns out she had ovarian CA (at 20!) that predisposed her to the torsion. She was quickly taken to the OR.

There's an article in the recent NEJM about how physical exam has gone out the window in favor of technology. This is a good example about the importance of exam.