Some Doctors Are Afraid of Vaginas. Really. →

I’m a doctor. And doctors aren’t squeamish. We love blood and guts. But not all docs can handle genitalia.

In med school, a gay classmate was completely grossed out by gynecology. When I asked how things were going, he said, “After this month, I never want to see another vagina again.”

Some docs find respite in specialties. A colleague in ophthalmology disclosed his relief at not having to deal with penises and vaginas anymore. 

Kolpophobia is the fear of genitals, particularly female. This is not to be confused with misogyny, the hatred or dislike of females that manifests in sexual discrimination and objectification of women and girls. Both disorders affect the general population—even, surprisingly, doctors.

I attended a good-old-boys’ med school in Texas, where female classmates and patients were called the most shocking pejorative terms. That was 20 years ago. Thankfully, times have changed.

Then a premed student came to me for a physical last week. She said, “It boggles my mind when men in my anatomy and physiology class geared toward people entering health professions can’t say ‘penis’ or ‘vagina’ and refer instead to these two anatomically correct names as wee-wee, vajajay, and icky stuff.”

I asked my patients what they thought of this. Here’s their message for future health care professionals:

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Pamela Wible, M.D., is a family physician in Eugene, Oregon. Watch her TEDx Talk “How to Get Naked with Your Doctor.” Photos by Geve.

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Why I Prescribe the Love Drug →

Pamela Wible lips

As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During med school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the corner while the younger one jumped all over the playroom despite his contracted and painful limbs. Why? The younger boy’s family kept hugging and kissing him. The older boy had no visitors.

People die without love.

My friend, Dr. Patch Adams, discovered that less than 3% of his patients have self-esteem. And less than 5% have any idea what a day-to-day vitality for life is about. The fact is most people are in pain. So what do we prescribe for pain? Painkillers, of course.

Recently, I attended a training on the safe use of opioid painkillers where I learned that the United States is 4.6% of the world’s population, yet we consume 80% of all opioids. But painkillers don’t seem to be killing our pain. Why?

In America, we overprescribe opioids while under-prescribing the most potent drug of all: love. And love IS a drug. How fabulous you feel with it. And how painful life is without it.  So why are we so stingy about prescribing love? 

The antidote for hate, neglect, apathy, misery, even sorrow is love. No prescription pad needed. No risk of overdose Love is my preferred potion. I give patients heart-shaped balloons. And hugs. Yes, I even tell patients, “I love you.” Some leave with my kiss on their forehead.

You don’t need a medical degree to say, “I love you.” Just three simple words can heal more wounds than all the doctors in the world.

—–> See my TED Talk on healing & vulnerability.

Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.

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How to Save 90% on Medical Bills →

Pamela Wible Rob

Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.

A few days later, I get this e-mail: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to a doctor for 5 minutes. No blood drawn, no stitches made, no X-rays, but I’m told the standard amount for the classification of my visit is $624. I called to complain and, of course, the person on the phone can’t do anything. Well, she could have sounded sympathetic. I didn’t even know that there’s a difference between an urgent care and an emergency room. Apparently, an urgent care would have been cheaper. Where is there an urgent care downtown?”

Urgent care is just 2 blocks from the ER. But why didn’t Rob just call me? He wasn’t sure. Why do so many patients like Rob end up in the emergency room with non-emergent conditions? Let’s think this through.

An emergency is a serious, unexpected, and often dangerous medical condition requiring immediate action such as a heart attack or gunshot wound. An urgent medical condition is a very important, but non-life-threatening situation that needs immediate attention such as a dislocated shoulder or kidney infection. A routine medical condition is neither urgent nor emergent such as high cholesterol or hemorrhoids.

Let’s say I’m your family doctor. It’s Saturday morning and your kitty bites you. Your hand is suddenly red, hot, and swollen.

Should you go to our 60-room, 44-bed, 30,000-square-foot emergency department and trauma center that includes a waiting area with a fireplace and a children’s playroom? Do you really need 2 psychiatric holding rooms, 2 trauma suites, and a decontamination room with a dedicated entrance for patients exposed to hazardous material? Upon arrival you may be treated by up to 4 doctors and 17 nurses, all emergency-trained and you’ll have 24-hour access to anesthesiologists, neurosurgeons, and all manner of specialists. In case you need to arrive by helicopter from the 8-county service area, expect to enter an extra wide mega-elevator that will enable your continuous care during transport from the hospital’s rooftop helipad. By the way, if you need this level of care, please call 911.

Or should you go to our 6-room, 3,000-square-foot urgent care that staffs one family doctor, a nurse, and a medical assistant? They do X-rays and labs and they’re open from 9:00 am until 9:00 pm every day with six locations in town.

Or should you call me? I work in a cozy 280-square-foot clinic. I have no staff. I handle urgent and routine conditions and perform minor surgeries. Once, I even removed metastatic lung cancer from a guy in my office. I work most afternoons, but I’m available 24/7 for urgent needs. Best part: my low overhead allows me to pass savings on to you. How can I do this? Watch my TEDx Talk.

Today Rob sends another e-mail: “In addition to my initial fee of $624 associated with my cat bite, I got a second bill for $194.70. It’s totally different looking and is from the Emergency Physicians. The bill references a nurse practitioner. I suppose I never actually saw a physician.”

The truth is: you could get treatment anywhere for your cat bite. The real question is: how much do you want to pay for it?

Emergency room: $818.70.

Urgent care: $99.

My office: $50.

Your choice.

Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.


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Meet the Happiest Doctor in America →

Most docs aren’t happy. I wasn’t either. Until I left assembly-line medicine.

In 2004, I held town hall meetings where I invited citizens to design their own ideal clinic. I collected 100 pages of testimony, adopted 90 percent of feedback, and we opened one month later. Now, my job description is written by patients, not administrators. I’m finally practicing medicine the way I had always imagined. And I’m happy. Here’s why:

Disintermediation: I “removed the middlemen” so now I enjoy direct relationships with clients in a cozy office with no staff. I’m 100% solo. I don’t miss the bureaucracy. Nor do patients who get uninterrupted 30–to–60-minute appointments.

Autonomy: No more committee meetings. If my patients and I want to change an office policy, we do it. I’m available 24/7. I even do housecalls! I control my schedule. That means I can take vacation whenever I want. Problem is last time I left town, I missed my patients.

Finances: Without a bloated bureaucracy, I have super-low overhead. I pass on the savings to patients. Care is VIP with no extra fees. Insured and uninsured are welcomed. Nobody is ever turned away for lack of money.

Authenticity: I dress casual, not corporate. Mostly Levis and clogs. Patients like me to be me. A recent thank-you card reads: “It’s so refreshing to meet a doctor who is a real person with a real personality.” Forget professional distance. Let’s be real. Professional closeness is what people want.

Fun: I’ve got a giant gift basket with prizes for patients who lose weight, quit smoking, or reach other goals. Other gifts award folks who bicycle or walk to the office. Plus Fridays are Patient Appreciation Days with balloons and dark-chocolate hearts for everyone!

Inspiration: The best part: I stopped complaining. If doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged. If we want happy, healthy patients, why not start by filling our clinics with happy, healthy doctors? By enjoying medicine, I inspired my colleagues to find joy too.

Oh, and patients are happier than ever! Happiness is contagious, ya know.

Pamela Wible, MD, is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. She hosts  biannual retreats to help doctors love being doctors again. Many have opened ideal clinics too! Photo by GeVe.

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Patient Profiling: Are You a Victim? →

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences. For the first time, people share their stories:

“I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

“In 1986 I was in a motorcycle accident. I tore up my face on the road. I was taken to the ER and treated like crap because I had no insurance. They cauterized my facial wounds rather than stitch me up, and then dumped me on the sidewalk with amnesia. I still have distinct black scars; people think they’re tattoos. I went into collections and it took years to pay that one off. Six weeks ago, I fell while trimming a tree. When the ER found the insurance card in my wallet, I was treated like gold.” ~ James Cummings

“I was pressured by our doctor from my son’s birth all the way through grade school. I kept telling him no vaccines whatsoever, zero, nada. I was hassled, shamed, talked down to, and more. Not a fun experience, whatsoever. I was profiled as a bad mother.” ~ Sheri Ricker

“As a teen, I fractured my nose. Many sinus issues later, I consulted an ENT specialist. He insisted that I damaged my sinus passages by using cocaine. His assumptions caused me pain, humiliation, confusion, and anger. I repeatedly assured him that I wasn’t a user. Two surgeries later, my septum was removed. Afterwards, he was so cruel as to continue his tirade about my cocaine use. As the gauze was being removed from my nose, I fainted. When I was roused, he insisted that I leave immediately showing no concern about whether I could even make it home safely.” ~ Lonnie Stoner

“It was 1975. I was 23 and I’d been on the pill for 4 years, but I became concerned about potential negative side effects of long-term hormonal manipulation.  So I researched other contraceptives and felt the diaphragm was the simplest and safest option for me. When I went to the county clinic to get fitted, I explained what I’d researched to the doctor. He scoffed at my concerns, urged me to stay on the pill, and disputed any potential negative consequences. He reminded me that taking a pill each day was SO much easier than having to be responsible for using the diaphragm properly. It was clear he thought I was too young and clueless to make this decision about my own reproductive health care. Although he tried to dissuade me from switching to a diaphragm, I insisted that’s what I wanted, and he finally fitted me for it. After he left the room, the nurse said, ‘Don’t worry, dear; it’s quite easy to use. I’ve been using one for years with no problems. It’s a good choice for you to make!’ It was clear she didn’t approve of his patronizing attitude either.” ~ Patsy Raney

“I injured my back at work. I couldn’t get time off, so my family doc prescribed pain meds so I could get through the day and Xanax for sleep. I returned every six months for two years and he always accused me of taking more than I was prescribed. He got progressively more rude and angry. I brought my wife with me to see if I was imagining it. She witnessed it too, so we searched for another doctor. I asked my new doctor to taper me off of the pain meds and Xanax so I could try medical marijuana instead. He was skeptical. He told me to go to the pain clinic. I’d gone there once before and was treated like a criminal. I didn’t want to go there!  So he wrote up a contract that said I would agree to take pain meds and Xanax and I’d be drug tested monthly to make sure that I wasn’t using medical marijuana. When I told him I wouldn’t sign the contract, he told me to find another doctor. This was at a critical time when I needed real help and was worried about taking the meds for over two years.” ~ Carl Williams

I’ve been a doctor for 20 years. I thought I’d seen it all. Drug addicted patients have altered my prescriptions, even forged my name. Patients have lied to me. Many haven’t followed my treatment plans. Some have died as a result. Still, I try to treat everyone fairly and with respect. But now I’m wondering, “Have I ever profiled a patient?” I bet I have. So on behalf of my colleagues and myself, I’ve got a message for any patient who has ever been misjudged or mistreated:

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Want ideal medical care? Here’s how you can get it.

Frustrated? Here’s 7 steps to get what you need from your doctor—fast!

Pamela Wible, M.D., is a family physician in Eugene, Oregon, where she founded the first ideal medical clinic designed entirely by patients. She is author of Pet Goats & Pap Smears. Watch her popular TEDx talk “How to get naked with your doctor.” Photos by GeVe.

Do NOT ask Dr. Wible your medical or legal questions. She will not respond. She can not legally give medical advice unless you are a current patient. Thank you.

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