Since my diagnosis with breast cancer, I’ve seen many different specialists (breast surgeon, medical oncologist, chemo dermatologist, plastic surgeon). My doctors appointments have gone something like this.
- Medical assistant takes my vitals
- Medical assistant directs me to remove clothing (usually waist up) and put on a gown (opening in front)
- I wait for the doctor. In the worst case, I waited over 2 hours .. but typically I wait about 10 minutes.
- Doctor comes in and talks to me (anywhere from 10 minutes to over an hour depending on the type of appointment)
- Doctor examines me (takes 1-5 minutes)
- Appointment ends and then I get dressed
I recall those first appointments. I remember feeling awkward talking to the doctor while I was undressed. I found it odd that the doctor would do the entire consulting/discussion (with appointments that were 30+ minutes involving a fair bit of question and answer) while I was undressed. I find myself wondering if this is an oncology thing or an American thing? I can tell you one thing, it isn’t a setup that encourages patient engagement. It wasn’t until a friend mentioned it, that I realized the power dynamic at play here. By being the patient, I’m already in a lower ‘power’ position in the healthcare system. By having me remove my clothes, that just increases the imbalance (or ensures the imbalance is maintained). It isn’t conducive to a collaborative dialogue, nor does it encourage me to be engaged.
Now, in Canada, I cannot talk about oncology, only primary care. In the primary care setting, the doctor first comes in and talks to me. If an exam is needed, the doctor steps out of the room while I undress and put on a gown. The doctor returns to do the examine and talks a little bit, then leaves while I get dressed. If further discussion is needed, it happens after I’m dressed. I never have those awkward moments where the doctor is explaining something to me and I’m sitting there in a hospital gown trying to ask questions and absorb all the new information I’m getting. It just doesn’t happen.
I have learned how the system works here (Stanford Women’s Cancer Center). I now bring with me a hoodie that zips up the front. After changing into the gown, I put my hoodie on. When the doctor comes in, I can ask all the questions I need to ask and feel comfortable sitting in the chair (not on the exam table). With my hoodie on overtop of my gown, I don’t feel like I’m undressed, and I don’t get cold. When it comes time for the exam, I can easily unzip and remove the hoodie. With my hoodie zipped up, I’m not sitting there half exposed while trying to have a conversation with my doctor. I feel a lot more empowered and a lot more comfortable.
I have learned how to work-around the system to ensure that I’m empowered – but I cannot help wonder why the system is the way that it is? I suppose there is an argument that it saves time, but really, given the back-and-forth and other things that are going on, especially in a teaching setting, I don’t think it actually makes a difference. Perhaps this is just a legacy practice from a time when the patient’s feelings were not considered, and with the push to have engaged patients, perhaps we need to start rethinking these processes with the patient in mind?