where to look at during breast exam?

[batista_123]

hello
Where are you supposed to look when the doctor that you are shadowing is giving a breast exam?
I used to shadow this doctor and I had to quit because i felt very nervous during these encounters with female patients. male patients, i have no problem.
but during female exams, i'd keep thinking "i am not supposed to be looking at those....i hope she doesnt find out whats going on in my head right now...dont look, dont look...but then if I look at the floor, thats even more weird. I am talking breast exams only (cancer doctor), not other female parts.
I just dont want to act suspicious, i want to act normal.
do you look at the patients face and smile?
do you talk to them? but i cant really say anything, because what if i say something inappropriate? i would rather just shut my mouth.
do you look at the breasts?
do you occasionally look and occasionally look away?
do you stare at the wall, pretend there isnt a naked woman there?

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[FlowRate]

If I were in the situation and consent had been given by the patient, I would look at the exam itself, with an interested look on my face. Perhaps ask questions during the exam. Ask they doctor what they think.

 

[synapse lapse]

At the breast! Seriously, I know it's awkward at first but you will get used to it. The first pelvic and breast I had to do I was way nervous, and that was on a standardized patient... but you will get used to it and it will not be awkward at all after your Ob/Gyn rotation one day. Since you are in undergrad I know you might feel even more awkward, so I suggest 1) reading up on the breast exam 2) studying common female breast complaints and pathologies 3) acting interested and appearing knowledgable. Those will help you mentally construct your encounter as a medical problem. Also it is much less awkward for the patient if you are actively interested in her case as opposed to acting like a shy teenage boy.

 

[Disinence2]

Sensitive exams can be uncomfortable. Especially when you are just shadowing.

Just approach the situation with maturity and confidence.

If you were unsettled enough by a breast exam to quit your shadowing experience then you may want to think a bit about your career choice. You will be put in potentiality awkward situations frequently in medicine.

 

[rkaz]

I think it's important to just approach the situation with some maturity. Rather than seeing breasts as something people get perverse pleasure out of, simply realize that as a future physician you have a responsibility to your female patients learn how to assess and diagnose any health issues that involve their breasts. So you are only doing future patients a disservice by not paying attention to how to do a female breast exam. Of course, if the female patient is uncomfortable with you there and asks you to leave, then of course you should do that. But if she doesn't have an issue with your presence, then pay attention and try to learn something from the doctor you are shadowing!

Rather than getting perverse thoughts looking at your female patients, just think how you'd like the physician (or medical student) providing care to your mother and sister to act. Should they be getting perverse thoughts, or would you hope they'd treat your mom or sis with some decency and respect? Just keep that in perspective.

I think discomfort around breasts is also a social phenomenon. If you see women in some villages in Africa, they walk around without any tops. The men don't seem to have any issues with it as they are used to seeing it. It really isn't such a big deal. In American culture, people hypersexualize breasts when they are simply there to provide milk to babies. I think people get squeamish about things they aren't familiar with - and just because there is a double standard in our culture where men can go around topless and women can't - somehow that makes female breasts taboo in people's eyes. Whatever. It would be the same thing as, say, going to some conservative area in an Arab country where women are forced to cover up and hear male medical students saying "Oh my gosh, I have to touch that female patient's ankle, what do I do?" So in a way, getting squeamish about breasts is equally ridiculous, as this taboo is merely a social construct.

As a future physician, your job is to get the best clinical skills possible, and anything less is a disservice to your patients. If that requires you to get some maturity, then do so for your patients sake.

 

[randombetch]

I think it's important to just approach the situation with some maturity. Rather than seeing breasts as something people get perverse pleasure out of, simply realize that as a future physician you have a responsibility to your female patients learn how to assess and diagnose any health issues that involve their breasts.

I read "assess" as something else at first lol.

 

[synapse lapse]

people hypersexualize breasts when they are simply there to provide milk to babies.

Let's not go too far now

 

[RevDM]

.

 

[MilkmanAl]

I feel like I should address a thought that goes through every pre-med and med student's mind at some point before actually doing any of the female exams; don't worry, you're not going to get turned on. Believe me, there is nothing less sexy than giving someone a physical exam. That goes double if you're in a room with a bunch of classmates who are just as nervous as you. I thought I was screwed when I had a surprisingly attractive SP for the breast exam, but it's not really any big deal. As with just about everything in med school, the worst part is the anticipation.

 

[batista_123]

I just wanted to clarify something
I do NOT get turned on. I am AFRAID that the woman will think i am getting turned on, or she will think i am a pervert. so I start acting kind of uncomfortable and I am pretty sure they can tell...so that makes it worse.

 

[MilkmanAl]

Errr...I wasn't saying you were. My post wouldn't have made much sense otherwise. I didn't even think this thread had anything to do with anyone getting turned on at all, actually. I guess that cat's out of the bag, though.

 

[eschaton88]

I'm a girl and I've been shadowing on male inguinal hernia exams, prostate exams, hemorrhoid/anal fissure exams...pretty much all the embarrassing stuff. As long as the patient gives consent they really don't mind, and it's only awkward if you make it awkward. I was shadowing a really good doctor so he would stop and point things out to me, ask me questions, etc. He also had me feel for the guy's hernia which WAS a little embarrassing, but the guy didn't care at all so really I was the only one who got awkward. For most of it if you just stay analytical and interested you're fine. Definitely look at whatever is being examined! I usually held my questions until the patient had left, mostly just because I didn't want to interject into the conversation between the doctor and patient.

I've also shadowed a doctor who would just ask me to step out for any sort of private exam, even female. I think the patients usually would have been fine with me in the room, but he was just more comfortable with me outside. If it really makes you squirm you can always just excuse yourself and come back in when they are done...probably won't be as realistic of an experience but it's your choice. You'll have to learn how to do them someday.

 

[rkaz]

I just wanted to clarify something
I do NOT get turned on. I am AFRAID that the woman will think i am getting turned on, or she will think i am a pervert. so I start acting kind of uncomfortable and I am pretty sure they can tell...so that makes it worse.

As Alexander Pink mentioned earlier in this thread, it actually makes patients more uncomfortable when you act like YOU are uncomfortable. If you aren't comfortable yet at looking at breasts then spend some time looking at anatomy books to desensitize you (no, I'm not referring to looking at porn magazines, that would only make things worse. 🙄 I mean bona fide clinical anatomy texts with lots of pictures. This helped me to get desensitized to cadaver dissection.)

Just show a genuine friendly interest in the patient, give a small warm smile, and a genuine interest in learning how to perform the exam, and things should be alright. Averting your gaze from her face, and acting stand-offish will only make things much worse. In fact, it may help you to realize that your outward display of awkwardness due to your own social conditioning is actually quite a selfish act on your part... as you are putting your own comfort above that of your patient's. Think about that the next time you are in such a situation.

 

[MossPoh]

As a premed I was usually just left out of that stuff. A few times they gave permission. We left it up to the patient though. If they give you permission then you look at what they are doing and be appreciative.

It only gets more awkward before it gets less. First time you begin palpation and what not you are all of 2 months into being a medical student. Gets pretty awkward.

 

[swamprat]

I honestly got a little flustered when I was shadowing a GP doctor and they sometimes had to examine "personal" areas, the patients never really said anything but since I am not a med student yet I didn't want to make the patient feel uncomfortable. Another time in the ER I was shadowing a doc and a patient had been in a car accident and the doc asked him to take off his shirt so he could examine him and the patient felt very hesitant, idk if it was because I was there with a tag that said volunteer or just generally hesitant because he didn't know the doctor either... but the patient had gastric bypass a while back and had a lot of sagging skin which he mentioned as he took off his shirt. I felt bad for the patient as well because I didn't want him to feel uncomfortable with another body in the exam room (me), but the doc nor the patient said anything really and I observed the exam and it was ok!

 

[batista_123]

I feel kind of selfish looking at their breasts...like I get to see her naked, but she wont get to see me naked, not fair to her?
no never mind, thats not what i feel, i dont know how to describe it, other people who have felt the same could perhaps add to this?

OK i know what i want to say, after she gets dressed, i keep thinking "i have just seen this woman naked...I have seen her naked"
you know that episode of friends where Ross keeps telling himself "she is your cousin...she is your cousin"

 

[synapse lapse]

I feel kind of selfish looking at their breasts...like I get to see her naked, but she wont get to see me naked, not fair to her?
no never mind, thats not what i feel, i dont know how to describe it, other people who have felt the same could perhaps add to this?

OK i know what i want to say, after she gets dressed, i keep thinking "i have just seen this woman naked...I have seen her naked"
you know that episode of friends where Ross keeps telling himself "she is your cousin...she is your cousin"

Ok dude, I think you seriously need to grow up lmao.

 

[GoSpursGo]

You're there to learn what a doctor does, right?

Well, I strongly doubt you're going to learn that from looking at the floor, wall, or anywhere else but the breast

 

[FloatOn]

I feel kind of selfish looking at their breasts...like I get to see her naked, but she wont get to see me naked, not fair to her?
no never mind, thats not what i feel, i dont know how to describe it, other people who have felt the same could perhaps add to this?

OK i know what i want to say, after she gets dressed, i keep thinking "i have just seen this woman naked...I have seen her naked"
you know that episode of friends where Ross keeps telling himself "she is your cousin...she is your cousin"

LOL. This is one of few times on SDN that I have actually laughed out loud. I shadowed an OB/GYN for some time. It was awkward the first couple times, even as a female, but the vagina just became another part of the body. Shadowing a general surgeon, the male patients had no problem dropping their pants on command. Again, the penis is just a body part. The only time I felt compelled to step out of the room was a bloody rectal exam.

 

[chman]

A couple points.

-I know you say you don't get "turned on" which is good. But, if you are you just need to look past that and focus on the task at hand. It does not make you a pervert if a sexual thought comes into your head, after all you are human and that is our nature whether we are a man or a woman. What does make one a pervert is if they do not push that thought out and say to themselves that the patient is there to get treated and needs help.

-Next, I would venture to say that you are more apprehensive than many of the women. After all, most women that have had kids have breast-fed in public and have gotten past it, or at least the ones I have met. I could see how it might be different for a younger patient around your same age or something.

-Lastly, I am a firm believer in reading people's body language. You should be able to tell fairly easily if the patient is uncomfortable or not. If it seems like they are maybe just excuse yourself to the restroom or something.

To me, it seems like you have a good gig. I would love to find a doctor that would let me shadow that thoroughly.

 

[dw2158]

As with just about everything in med school, the worst part is the anticipation.

thanks for this. 👍

i think i may tattoo this to the inside of my eyelids to keep from getting anxious 😛

 

[QofQuimica]

As others have said, you watch the exam itself, not the walls. You're there to learn, and most patients understand that if they go to a teaching hospital, there will be students there. If the patient does not refuse to have you be present in the room, then your job is to observe. Some other helpful tips: First, make sure you introduce yourself to the patient and shake her hand when you walk in the room. This helps build rapport and makes you less likely to get thrown out of the room. Second, watch what your preceptor does, and try to anticipate what he'll need. For example, if he's doing a breast exam, grab a sheet or hospital gown so that you can cover the woman's other breast while he examines the first one. If you are assisting him, that will also help make things less awkward.

In general, it's a lot less awkward when you're the one doing the exam instead of watching someone else do it. I always start by asking the patient if she does breast self exams. The vast majority of the time, she'll say no; you'd be surprised how many women don't even know how to do them. So it's a great time to do some education, which has the added benefit of making the situation less awkward. What I mean is, while I'm doing the exam, I explain to the patient what I'm doing, and I give her instructions for how to do the exam herself. That way, we're both focusing on the exam and there is no awkward silence. The same goes for Paps. If you talk the woman through the process and let her know what you're doing and why, you can educate her about women's health while you perform the exam, and the situation will feel less awkward.

 

[dingyibvs]

Another tip, which sounds like it'll be useful to you:

If you pitch a tent during the exam, try to hide it.

 

[JFK90787]

I shadowed an osteopathic surgeon on one of his clinical days. He was bending this wicked hot and flexible woman wearing tight clothes in all sorts of positions I was just like gahhhh. Luckily I was wearing briefs

 

[ILikeDrugs]

do you look at the patients face and smile?

LOL. That would have to be the creepiest thing to do. She opens up her blouse and a big ol smile comes on your face.

I don't think I would have a problem with people being naked in front of me since I didn't giggle like a little school boy back when I use to draw live nude models. Just look at the breasts as you would an elbow.

 

[synapse lapse]

I shadowed an osteopathic surgeon on one of his clinical days. He was bending this wicked hot and flexible woman wearing tight clothes in all sorts of positions I was just like gahhhh. Luckily I was wearing briefs

I was on peds and had this ~14 y/o girl who came for a wrist fracture but we also saw a new path biopsy report from 2 weeks previous that came back neurofibroma. So the attending and I check and see cafe au lait spots and he wants to check if she has scoliosis. Mind you she is in her underwear with a patient robe on (I guess the nurse had her get like this) and she bends over and the attending is standing behind her running his hand down her back. Mind you this is an old white dude and girl/mom were black. Mom was in the room and it was AWKWARD and attending is like "come check this out" I was like "yeah dude I see it" and he's like "no, come check it out". Needless to say, that was about the most awkward position I've been in in medical school.

 

[batista_123]

First, make sure you introduce yourself to the patient and shake her hand when you walk in the room. This helps build rapport and makes you less likely to get thrown out of the room. Second, watch what your preceptor does, and try to anticipate what he'll need. For example, if he's doing a breast exam, grab a sheet or hospital gown so that you can cover the woman's other breast while he examines the first one. If you are assisting him, that will also help make things less awkward.

OK,
1. introduce yourself. do i say "hi, I am Tom"
or "Hi, I am Tom, I am a premed student and I am here to learn"
or what?

2. covering patient with a sheet- there is always a nurse who does all this. And even if there wasnt, i wouldnt do that because i would be afraid of making a mistake and getting fired or reported to the volunteer office. i know this sounds a little paranoid but i dont want to make any mistakes.

 

[FloatOn]

OK,
1. introduce yourself. do i say "hi, I am Tom"
or "Hi, I am Tom, I am a premed student and I am here to learn"
or what?

2. covering patient with a sheet- there is always a nurse who does all this. And even if there wasnt, i wouldnt do that because i would be afraid of making a mistake and getting fired or reported to the volunteer office. i know this sounds a little paranoid but i dont want to make any mistakes.

The doctor has always introduced me to the patient so I never had to say my name or explain who I was and what I was doing there. After the intro, I would often shake their hand and say "Hi, nice to meet you" or "Hi, how are you?" Sometimes I would forget because the doctor would immediately start talking after introductions.

 

[Rendar5]

If it makes you feel any better, while most of the time it is anything but a turn-on, I've had 1 or 2 patients (I'm EM so I do these exams quite regularly) where I did find myself turned on during breast/pelvic exams. You know what I did? I accepted that this was happening, sucked it up, did my job, finished my exam, got them dressed, left the room, and moved on, and didn't think about it for a second thereafter. I've also had patients interested in me for some reason or another (honestly, if it's obvious enough for me to pick up on, it means there's some personality disorder or issue), and again, I did my job, accepted this, and moved on immediately without any problems.

My point is that weird dynamics can and will occur between a doctor and patient. The absolutely worst thing you can do is to try to bury it and avoid it. The best thing to do is accept that it exists with all its awkwardness, act professional, and move on. That means looking at the breast, talking with the patient if it's warranted, acting like you're into learning the trade professionally, and moving on to the next situation knowing it may or may not happen again.

 

[ZFanatic]

I'd just stand there and observe, not too excited, but not looking at your feet either. I was a senior in high school last year doing my first internship/shadowing, and the ortho. surgeon had to do a few injections into an older ladies hip and butt. She just laid down and dropped her pants, not a big deal. Just act like you've seen it before and it's not a big deal, then there's nothing to get embarrassed over.

 

[chman]

If it makes you feel any better, while most of the time it is anything but a turn-on, I've had 1 or 2 patients (I'm EM so I do these exams quite regularly) where I did find myself turned on during breast/pelvic exams. You know what I did? I accepted that this was happening, sucked it up, did my job, finished my exam, got them dressed, left the room, and moved on, and didn't think about it for a second thereafter. I've also had patients interested in me for some reason or another (honestly, if it's obvious enough for me to pick up on, it means there's some personality disorder or issue), and again, I did my job, accepted this, and moved on immediately without any problems.

My point is that weird dynamics can and will occur between a doctor and patient. The absolutely worst thing you can do is to try to bury it and avoid it. The best thing to do is accept that it exists with all its awkwardness, act professional, and move on. That means looking at the breast, talking with the patient if it's warranted, acting like you're into learning the trade professionally, and moving on to the next situation knowing it may or may not happen again.

👍👍

 

[QofQuimica]

OK,
1. introduce yourself. do i say "hi, I am Tom"
or "Hi, I am Tom, I am a premed student and I am here to learn"
or what?

As a student, less is more when you're introducing yourself. You should never misrepresent yourself as a physician, but there's no need to emphasize that you're a premed, either. Thus, the first intro is best. If the patient specifically asks what your position is, then you will tell her that you're a student.

2. covering patient with a sheet- there is always a nurse who does all this. And even if there wasnt, i wouldnt do that because i would be afraid of making a mistake and getting fired or reported to the volunteer office. i know this sounds a little paranoid but i dont want to make any mistakes.

In that case, I would ask the nurse what you can do to help. Again, if you have some kind of "job" to do while you're in the room, it will be better than standing awkwardly in the corner.