AIBU to complain about smear test experience?

[Ktmc94]

On Monday I contacted my GP surgery to get a new prescription for my pill. I spoke to the nurse who sorted that out but then proceeded to ambush me into a smear test appointment. I have looked into the screening for myself and was not convinced that I wanted to participate (I'm 26). I got flustered and agreed to the appointment thinking that at the very least I could have a discussion with her about it.

Then yesterday I arrived for my appointment. Blood pressure taken for pill and then I was weighed (didn't see the weight on the scale but I'm about a size 14/16). What came next was effectively a lecture about my weight which sent me reeling because I was already feeling nervous and uncomfortable about what was to come.

I was then ordered to strip behind the curtain without further ado, I tried to intimate that I was feeling apprehensive and was basically told to get on with it "it's only 20 seconds it's fine". No reassurance, no chat about the procedure or pros and cons of screening.

She then presented which, to me, looked like a rather large speculum and I voiced my concerns about it and was told that due to my weight a larger size was needed (I have never given birth). I was shell-shocked by this pronouncement and the bloody thing hurt before it was even opened but was once again told to relax and get on with it.

I left the appointment absolutely devastated at being lectured about my weight while feeling too vulnerable to assert myself. Fine, I need to do something about it but to launch immediately into a diabetes and heart disease lecture and then telling me that because I'm a bit chunky it means I must have a fat vag and offering no further explanation on the matter was just too much in my view.

I couldn't sleep last night tossing between wondering if I'm overreacting and feeling very upset about what happened. I phoned the practice manager this morning to discuss what had happened and was not encouraged. She skipped over the part about me trying to make an informed choice before deciding to screen and said "but you're 26 you should have had one by now" and "the nurse has been doing these on a daily basis for 30 odd years" and then rounded off by saying "not in any way to diminish your feelings about what happened" while having no comment on the fact that a weight lecture took up more of the appointment than some much needed reassurance about an invasive test.

I can't find anyone of any size who has been refused even a try with a smaller speculum and if I'm being honest I'm not massively fat, just pandemic misery has got me seeking dopamine in the biscuit tin but she could not have cared less about the state of my mental health. I'm still spotting and cramping which I had to find out for myself were side effects.

In my opinion it's 100% my fault I got cancer. I got a letter every 3 years inviting me for a smear test and I didn't go.

Don't say that. It's not your fault, if we go down that line of thinking then we might as well say 'well it was probably my fault for having sex' as well. It's simply not a case that having a smear would have prevented your cancer. It's just one of the risks of being female. You can reduce your chances of cancerous cells from getting out of control, but nothing is for definite with cancer. You can do everything right and it can still be horrendous.

@justwanttobemum

A wonderful display of ignorance, bravo. Like the Priti Patel school of human kindness right there.

On the general issue about staff sensitivity and kindness : good communication is not fluffy stuff that doesn’t matter, and in my opinion the majority of NHS staff are incredibly well trained and understand the importance in shared decision-making . Our adult son is currently in hospital with a traumatic brain injury on Dec 3rd. The treatment and care he has received is outstanding. The care taken with us as his parents has also been phenomenal which has made a major difference to how we are coping on, which has a knock-on effect on supporting our daughter. Occasionally a member of staff has been brusque or impatient and whilst we know they are under huge pressure (he’s at the Royal London) it has added to our distress. Thankfully we have a clinical nurse specialist guiding us through the process and what’s happening in his care and we can contact her by email. She was understanding when I described an incident - she didn’t make excuses and said “I’m sorry, that’s not how it should be done”. I felt better knowing I was not being unreasonable. Also I felt better with her suggestion that if it happened again one response was to politely end the conversation and call back and try to speak to someone else. We don’t know what is going on for that HP who just might not be not able to deal with things at their best at that moment because of something going on that we’re not aware of. Yes, some nurses etc. can be ‘no nonsense’. That can be a great quality and reassuring. When it tips over into insensitivity (I’m NOT saying this was the case for OP as I wasn’t there) then constructive feedback from patients will help clarify if the HP could improve. I think the way to look at it might be that if constructive feedback is given and it’s the only one, the line manager knows it’s a one off. If lots of comments are saying the same thing it suggests improvements could be made.

I think her bedside manner might have been a bit off. You needed to hear about your weight, especially with the increased covid risk due to being overweight but probably not quite in that way.

I think I'd cut her some slack. Most practice nurses are now working 6 or 7 full days a week as they are on a vaccine hub rota too. All the ones I know are truly exhausted trying to do the best for everyone.

YANBU. I hate health practioners with attitudes like this. No doubt they think of themselves as "no nonsense" and "straight talking". Women DO NOT have to put up with being treated like this, potentially life-saving procedure or not.

@Ktmc94

I'm sorry you were treated in such a brusque fashion

I don't think YABU at all. The nurse's bedside manner was sorely lacking.

I don't find smears easy and I always feel apprehensive beforehand. As a young woman, a male GP tried to get me to 'hop up on the bed' as my smear was due. I told him no, I am not here for that, I will book a separate appointment. I have to 'psych myself up' for that kind of appointment.

I think you need to work on being assertive as feeling bulldozed as you were and lectured/talked at has understandably left you feeling crap.

I hope you got the nurse's name because next time you make an appointment with a practice nurse, you can say 'I don't want an appointment with Nurse Ratched thanks'

I haven’t read the whole thread, but as someone who is carrying out a lot of smear tests at the moment I would not like that particular nurse to be doing mine! A big part of it is explaining what you are going to do and why, and putting your patient at ease. Especially if it’s your first smear test! She needs to go and do an update if she’s been doing them 30 years

@SunsetBeetch

YANBU. I hate health practioners with attitudes like this. No doubt they think of themselves as "no nonsense" and "straight talking". Women DO NOT have to put up with being treated like this, potentially life-saving procedure or not.

Yes this!

Her manner could put somone who was very anxious off.

Whether your weight needs addressing or not you've seen the hatred fat people get on here op. There are plenty of medical staff who also have this hate.

@justwanttobemum

YANU. You are obviously extremely over sensitive and dramatic IMO. It's hardly a procedure. I was lucky enough to get one last week (even though most are cancelled with covid but I am long over due and I got a sympathetic but to the point nurse on the phone who basically said, I don't know what the bloody guidelines are these days but I'm of the opinion you girls need your smears so come in and I'll do it and to hell with any guidelines. Your in, whip your bottom half up put your feet up and she's in and out, clothes back on and off you go? I'd speculate I was probably in there 2-3 mins? There's a pandemic, they're busy, they want to limit time in proximity of patients. Pros and cons? What cons do you possibly think there are to a smear? Please don't waste nhs time by complaining.

For gods sake. It’s not like this for everyone. Please read my post on the previous page!

It sounds like you got a nurse who did not have a very good bedside manner and even the practice manager wasn't very sympathetic :( It flies in the face of everything say say about patient-centred care doesn't it?

I think it was insensitive of the nurse to bring up your weight in that context when you are about to have your first smear test. Especially if she did "lecture" you about it, that's not appropriate, she could have gently mentioned it and asked you if you wanted to book another appointment to discuss it.

@Mackerelpizza

There are literally no downsides and it could save your life.

This comment is how we know you don't have a clue what you're talking about because it is a false statement. Pure ignorance.

And sorry she's literally doing her job!

The job of a nurse is not to assault people because she has not sought or obtained legally valid consent prior to conducting procedures or examinations. Go look at the guidance on consent from the Dept of Health, decided cases (ie legally binding law), and all of the medical professional bodies.

This is not what legally valid consent is.

Google implied consent. You quite literally have no idea what you're talking about.

There are no cons to getting a smear test, and there are different sizes of speculum. FFS get a grip

Your in, whip your bottom half up put your feet up and she's in and out, clothes back on and off you go? I'd speculate I was probably in there 2-3 mins?

I have vaginismus.

My last attempt at a smear entailed two nurses (one quite new, the other an old hand) and four tries before the experienced nurse refused to keep trying as she was concerned that I was on the verge of passing out. I
wanted her to keep trying as I felt horrendous and didn't want it to all be for nothing, but there we are.

I don't know why it worked out for me that way, as I've had two previous smears that went just fine despite the vaginismus, but hey ho.

Smears are NOT always an uncomfortable, yet simple enough procedure.

OP I'm sorry you felt upset. However it sounds as though you were being extremely oversensitive and nit picky. We only have your word to go on that the nurse was brusque. From the extremely emotive language you're using, I'd say that was your interpretation rather than truth.

This is ridiculous, pandemic or not, there is no place in the field for HCPs who cannot at least make some attempt of bedside manner and kindness. Tone of voice and smiling do not add any extra time to appointments.

I am a surgeon, yes we are all stressed and have our workloads increased, but that is no excuse to treat patients poorly. As HCPs we should be showing even greater compassion as people are generally more anxious and worried.
Part of the job is reassuring nervous patients, discussing their concerns and helping them choose the treatment pathway which is right for them, even if it goes against our advice, it is the patient`s right to choose.

OP should have ideally discussed concerns by telephone first, or refused the appointment, but no HCP should ever be pressuring, coercing or bullying any patient into any medical procedure, be it an appointment, screening or surgery.
I would find it very concerning if such a thing was ever reported to me, and it is not something any patient should ever have to tolerate.

Oh and the reason for the unsuccessful 'tries' with the speculum was that my cervix was 'hiding'.

I went for a private smear test with a gynaecologist, about a year after I had a child, by an elective cesarian (So no vaginal changes as such).

I’m very petite, like size 4/6 and she held up the speculum and did say she would be using the smallest one as I was tiny and to not be nervous.

So it could just be that it is due to size what they select.

I think even if they talk you through it, it is still not a pleasant activity.

They encouraged you to get a smear which is good.
She encouraged you to lose weight, which leads to better health outcomes.
Her tone obvs needs work, but the nhs is very stressed right now.
It’s not massively pleasant when you get the results you’ll hopefully feel better

I was diagnosed with cervical cancer after my first smear when I was 21 - this was 31 years ago when the screening started at age 18. I was told if it hadn't been picked up then, I would have been dead before I was 30.

Like @Elouera, I have a retroverted uterus and back when I was still having smears the large speculum was always used for my ease and comfort (due to cancer treatment there is so much scaring I now go straight to a colposcopy). During that time I never weighed more than 9 stone.

Stop worrying about whether you have a 'fat vagina' and hope that your results are clear.

You are not being unreasonable. From your post it sounds as though you felt rushed into booking an appointment, and when you actually attended the procedure ; humiliated.
It is right that surgeries encourage people to have smear tests. It is right people are spoken to about their health, weight etc. There are ways of doing it.
A competent nurse should be kind as well as efficient. A smear test is never pleasant but having had many over the years they have been done expertly, without to much trouble but also poorly done. My last one was quite appalling. It is a very intimate and intrusive procedure. It isn't always just a few seconds either. And who knows what your personal history is?
Write down what you want to say if you find it hard to be assertive and stand up for yourself. Write down what you want to get out of the conversation, and what you want to have happen. Regardless of the virus etc no nurse should have a poor bedside manner. Feedback might help her think about how she comes across to the next poor soul unfortunate enough to be 'nursed' by her. I wonder whether she would like her test to be along the same lines ?

I could cry for you OP - treated harshly at your first smear that you were anxious about anyway - being penetrated internally by something large and metal in the most dismissive way when you are at your most vulnerable

That sounds a bit melodramatic.
It was a smear test, pre-booked, speculums are always metal!

If you think that’s bad try having a transvaginal ultrasound on a surgical assessment ward at 2am (because they found a locum doctor who thinks he knows how to work the equipment)! Then he has to get a nurse to shine a flashlight between your legs because the cubicle’s too dark. So nurse is standing there with flashlight in one hand, other hand holding curtains shut, doctor is putting lube on a vaginal probe then inserts it whilst still complaining the machine isn’t the same as the ones he’s used to. Takes him half an hour of moving the probe and trying to make the screen zoom in on various organs before he’s done. Meanwhile the entire half hour you can hear the doctor in the next cubicle talking to a patient about his very personal medical diagnosis.

I didn’t complain because it’s the NHS, the staff were rushed and didn’t have the right tech to hand or enough staff, and they were trying their best. The scan was painful and the doctor was brusque but thanks to him I got a diagnosis and had surgery the next day.

Things could have been worse OP!

I do find it so frustrating the way people will tell the OP that their smear test was like that too, but its the results that count, HCPs are stressed and working long hours right now, >insert other excuse here>.
No, just because one person is prepared to accept sub-standard care does not mean we all should. Raise your own standards rather than expecting others to lower theirs.

I don’t think you’re overreacting. It sounds like you were treated badly, and if women don’t complain about shoddy treatment, it will continue.

There’s a time and a place to discuss a patient’s weight, and that’s not right before a very intimate examination in my opinion.

It must have been obvious to the nurse that you were in two minds as to whether screening was the right choice for you. She should have discussed it with you, not shoehorned you into it.

It isn’t as straightforward a decision to have screening as many people seem to think. It always leads to over treatment, sometimes on a massive scale. This is especially true for women in their twenties. For each case of cancer detected, there could be a hundred women treated unnecessarily, in some cases with serious side affects.

I didn’t know, as a PP said, that the screening had been changed to detect HPV rather than cell changes, which hopefully makes it more efficient. But this is exactly why it is important that women are fully informed on the risks and benefits, so that they can make up their own minds what is right for them.

HikeForward, my apologies, cross posted. That experience sounds horrible, however it is still no reason other people should accept sub-standard care.

Not unreasonable to complain if you've got the energy for it and you've got another reasonably accessible GP surgery available locally [just in case the response to your complaint is vindictive and they remove you from the practice's list - I know they can't do that, but you don't want to be without a GP completely]

Situations like yours are one reason why some people decline cervical screening, so the attitude is counter-productive to the public health goal of trying to spot pre-cancerous cervical changes.

Assuming they don't find any changes now and you're invited again in three years time, consider whether your local sexual health services offer it. They might be better in terms of attitude that the practice nurse. There are some specalist services about for those who've been sexually abused etc.

Separate family planning/contraception services are often run in conjunction with sexual health services. If there's a point where you're advised to stop taking the combined contraeptive pill they'll be likely to have a range of other contraception to suggest that they know better than practice nurses who do lots of other things besides contraception.