AIBU about suggested treatment path and possibly complaining about/asking not to see a specific doctor.

[Winduprobot]

I had cervical cancer 10 years ago. I had an op that removed the cancer but left my womb and reproductive system otherwise intact. I'm in my early 40s now. I've never had a recurrence or anything more than one instance (a couple of years ago) of low grade cell changes that any woman might have.

At my last checkup I had a colposcopy to check things over. This wasn't the plan, I was supposed to have a smear, but the doctor I saw (who I've seen before and tbh wasn't keen on his manner) decided to do the colp. I am not keen on them, because they are a bit grim and also have bad memories of the one that found the cancer. So I freely admit I was a bit teary when he suggested we do it when I wasn't expecting it. He saw something that he wanted to check out and so took a biopsy. This hurt, really hurt, which it never has before, and I said 'Ow' (admittedly loudly) when he did it. This made him very uncomfortable at the time (both I think my distress beforehand and my reaction to the biopsy).

He rang today to say both biopsy and smear were completely clear, no cell changes, no HPV. He doesn't want to discharge me, which is fine, so suggested yearly colps for the next couple of years. I was about to agree to this (as cheerfully as anyone would), when he then said 'Or we could do a hysterectomy'.

I was (and remain) baffled by the suggestion. I asked if there was any clinical indication to do it and he said 'No, but it would save you from coming up to have the appointments and I did think you found the last one difficult'.

TBF, I did, but I am entirely unconvinced that the correct medical treatment for nervousness and discomfort is the complete removal of my womb and all the potential issues that might cause.

He didn't massively press me on it, but it just seems such a left field suggestion - to even bring it up - partly because I feel like he's suggesting my reactions at the last appt were enough to warrant such a measure and because now I am thinking 'Oh I've refused this treatment, what if something could be wrong, even if no indication of that, and I refused this, how bad will I feel if something happens'.

I'll be honest, I've never liked his way of dealing with me (I've seen him once before and had a couple of follow up calls with him), in contrast to everyone else in the dept and at the hospital who are all fucking brilliant, but I am really quite upset at the suggestion of an operation with all its risks (even if small) and potential post-op issues because I got upset.

Full disclosure, I feel like this is a somewhat female issue too - like I was too uncomfortably hysterical (using that advisedly given the context) so he's chosen to suggest something that would stop him having to deal with what made him uncomfortable at my last appt. I am partly basing that on him telling me that 'the biopsy shouldn't hurt', which made me feel like it was my fault for feeling the thing I felt.

Sorry, essay because I am trying to not drip feed. I don't want to complain exactly, but I feel like I want to talk to someone else, and try and understand exactly what the thinking is here and maybe ask if I can possibly no longer see this specific doctor because, frankly, he has made me feel awful and really, I don't know, uncomfortable and wrong, twice now. On the flip side, maybe I am being unreasonable, this is an excellent hospital and a world leading treatment team and everyone else has always been brilliant.

So AIBU to think about making a fuss about a specific doctor when I maybe should just be grateful I am getting the standard of health care I am getting?

I'm not sure you're being totally unreasonable, but I also don't think he is either. If you were truly so distressed and appeared so at the last appointment it sounds like he is more concerned that doing it yearly would get harder and harder for you, so wanted to offer you the option that would mean you wouldn't have to go through it again. Yes it's a very extreme option, but potentially so was your reaction - from his point of view imagine 5 years down the line and you've struggled through 5 annual check ups and it's just got worse and worse then someone mentioned you'd have been able to avoid this with a hysterectomy - you'd understandably be upset it hadn't been offered before. Especially as you've mentioned bad memories associated with the procedure that found the cancer, it would make sense to be made aware of all options (however drastic they might seem!).

I think there's no problem perhaps investigating the possibility of moving doctors though, especially if you're not feeling great about your current one.

I agree with santa that it's not about you getting upset and him feeling uncomfortable with that, but a suggestion to prevent you any further distress in the long term. Also agree with looking at the possibility of changing doctors. Hope you are doing OK OP

That's an interesting POV @santaslittlehohoho and I promise I will think about it properly when I'm feeling less 'WTF?!', but I would say that I don't think my reaction was insanely OTT. It's hard to convey in words, but I was just a bit teary, not weeping or wailing, just a bit quietly distressed, enough to be noticeable but not enough that anyone had to spend any time comforting me or anything. And it did hurt, so I said 'Ow'.

I've also had multiple colps and a few biopsies over the years, none of which upset me visibly, some I joked through, so I don't have a history of 'INCONSOLABLE WEIRDO' written over my notes (I wouldn't think). This one just took me off guard as I was expecting a smear and a discharge note.

Sorry, I am taking your points on board, but I really don't think my distress should have hit alarm bell levels.

@Winduprobot

It's definitely a WTF moment when it happens to you!! It happened to my mum (in her 40s) to combat another problem - she was also very much as you are with future procedures to consider (full disclosure she actually went with the hysterectomy in the end) and this was why it was suggested - to avoid the next 40 ish years of her life being compromised by lots of check ups that she really didn't fancy.

Hopefully you'll be able to get some understanding of why he suggested this from the clinic when you're less in the WTF stage

'The biopsy shouldn't hurt' is such bullshit - it really grinds my gears when I hear that (I've had several cervical biopsies, and they do hurt!). He's never bloody well had one, has he?!
YANBU, OP. If a healthcare professional makes you feel that awful, however unintentionally, you shouldn't have to go through that. Can you ask the nurse or receptionist when you check into the clinic to make sure you see another clinician? They should be able to do that discreetly, assuming he's not doing the whole clinic on his own every time.

I’d find it a bizarre suggestion too, OP. Like suggested chopping your feet off if you get freaked out having your toenails cut (kind of!)! Sounds like it has precedence as an option from previous posters though.

Hah @cinnamonroll1 - I generally find them a bit ‘nippy’ for want of a better word, but this was bloody painful. I did have a ‘how would you know’ moment.

When I got home my DH asked if the local anaesthesia didn’t work and that was why it hurt and his eyebrows pretty much hit the roof when I said they don’t give anaesthesia for a biopsy there. He said ‘they bloody well would if they were biopsying a man’s genitals’

@wishing3 that was my feeling too - like it was a nuclear option for what might have not been the best reaction on my part, but I didn’t cause a chaos in the hospital or anything. I really feel like my discomfort has been over exaggerated in his mind, and we’ve ended up somewhere bizarre

Yes hysterectomy was suggested after couple of few abnormal colposcopy results. I was Cin2 so felt like way over the top for it to be suggested so casually and it was a letter too. Hysterectomy is not thought to be a big deal and it is even after menopause. Also btw I was very very anxious through out all my procedures and very very weepy. Felt so invasive.

My consultants were lovely though and didnt make me feel bad for being so weepy. Ask for a female consultant?

@mrsmuggins53 - if I’d have had years of CIN2 cells I’d understand it more if agree that that still seems a bit extreme. I haven’t - one result of incredibly minor cell changes 3 years ago (in 10 years of follow up). The last 2 smears have been clear and this smear/biopsy showed nothing at all. No CIN, no HPV, nothing.

Also sorry, lots of sympathy. It does feel invasive unless the consultant is really good, and I have had wonderful consultants until now.

This makes me incredibly angry, windup. This issue got a lot of publicity this year in fact, in April / May - see for example Caitlin Moran’s column about IUD insertion in the ztimes here www.thetimes.co.uk/article/why-we-all-need-pain-relief-when-having-an-iud-fitted-7qks82srw or the campaigns around the same time to get women adequate pain relief during coil insertion and FUCKING COLPOSCOPY PROCEDURES. sorry.

You should complain, he has reacted in a bizarre way as he feels uncomfortable because he hurt you unintentionally and he can’t process so this is his clumsy solution. This is not appropriate in 2021 to offer to whip out a lady patient’s troublesome plumbing rather than just saying sorry, clearly that hurt you and left you upset - what could I do differently next time?

This is what is now expected of doctors - to be reflective practitioners who get better at their jobs from these horrible encounters so next time round is better for you - you might get pain relief or at least a discussion about options and choices ahead of time by someone who has gone off and learned about oral, gel and injections used as numbing agents and pain relief or a nice diazepam beforehand…

A complaint about his communication skills may also trigger him to have to go and do some refresher training or again to write reflections on how he needs to access his issues. So it can lead to some very useful outcomes for him as well as for the patients under his care.

Plus it may help you sort through things like this thread can do - writing stuff down is always good! Complaints are not a bad thing and nothing will ever change, especially in women’s health, if we don’t speak up.

on your clear results.

Thank you @Leaningtoweroflisa, I know it’s traditional on AIBU to put more weight on posts that agree with you, but everything you’ve said rings true to me. I’ve had wonderful care in the past from both male and female consultants who never elicited this reaction from me. I do wonder if it would be a good thing to do, to say something, for others as well, but I have this horror of causing trouble for anyone. I’m a bit calmer now, but I still don’t believe I was the main problem. I wasn’t a perfect patient, but I was a bit ambushed and then hurt and in the situation I was in I honestly don’t think it was me who needed to manage the feelings going on.

Also woman has feelings = hysterectomy is still feeling quite astonishingly reductive.

Could make an appointment to talk through everything you've written here?

I've woken up this morning still thinking I should do something, maybe an appointment, but that feels like taking up the time of busy people who are doing fair more worthwhile things than listen to me whinge.

I am surprised by how much it's upset me.

@Winduprobot your husband is absolutely right, I bet they would! I asked for a local anaesthetic before one of my biopsies - the consultant looked at me like I was nuts

If you want action to be taken, which would be entirely reasonable, you could speak to PALS at the hospital. You don't have to make it an 'official' complaint if you don't want to, but they can help you to ensure that your feedback gets back to the person involved and ask that they reflect on it.

Ask for a second opinion. Hysterectomy is still a major operation and should certainly not be offered during a phone consult like a cup of tea.

It’s absolutely fine to request to not see a certain clinician although in practice it can be difficult to achieve if they all cover for one another.

Lastly, I’ve no experience of colposcopy but have had several IUCds fitted over a long period and they have become more painful. The last one (I’m now post menopause) was extremely painful. The nurse told me afterwards that loss of oestrogen makes the cervix less stretchy and therefore it hurts more, maybe that also applies here and it will become more uncomfortable. Worth the question and also the question’what can be done to make this pain free?’.

Good luck. If you don’t have a rapport with your doctor it’s always the right thing to ask someone else.

@Winduprobot I was prescribed oestrogen cream and pessaries to make colposcopy easier and anaesthetic for biopsy. It made a huge huge difference. Was way more comfortable. Also consultant will be more than happy to talk/chat to you. You can always do it under the pretext that you're considering the hysterectomy and want to talk it through. I had loads of chats with my consultant before agreeing to even biopsy and lletz.