Like 60% of Americans, I avoid going to the doctor. I often find myself paying significantly more out of pocket than my insurance promised, even for preventive care. As a survivor of childhood trauma, I do not enjoy being touched by strangers. Years ago, my mother was unexpectedly diagnosed with stage 4 cancer, and now I worry that any trip to a doctor could uncover a life-threatening illness. Going to see a medical professional is an uncomfortable experience for me at best, and I know that I am not alone.
Last year, I turned 30, and I promised myself that I would go to the doctor more regularly. I planned to find a primary care physician, get more consistent dental and eye care, and schedule annual visits with a gynecologist. The latter is especially important, because my husband and I have decided we want to try to have a baby soon.
This is both exciting and terrifying. I am confident my husband will be an excellent father, but the complicated relationship I have with my mother makes me less confident in my own maternal instincts. It has taken years for me to be able to think I am a person who is fit to be a mother, and it is a fragile, scary, hopeful feeling.
I recently bit the bullet and scheduled an annual exam with an OB-GYN. It took two hours to navigate the insurance platform, review in-network options, and select a doctor. As the appointment inched closer, my nervousness grew. I double-checked the insurance coverage and tried to stay calm. The morning of the appointment, I couldn’t muster an appetite. Though my palms were sweating as I arrived and checked in, the kind nurse reassured me that my blood pressure was normal. Then, she closed the door, and I waited in the small, white room.
When the doctor entered, I met her eyes and tried to smile, but she quickly dropped her gaze, examining my chart. In a flat tone, she asked, “What are we here for today?” I explained, my voice an octave higher than usual, that I needed an annual exam, and I had some questions about pregnancy.
This was the first time I had ever shared that I might be ready to become a mother with someone outside my inner circle. It was frightening, but empowering. The doctor did not even look up, responding instead, “Let’s talk about your weight.” My self-confidence withered.
Stammering, I acknowledged that I had gained weight during the pandemic (like 39% of all Americans). Had she asked, I would have divulged my decades-long struggle to love my body after battling eating disorders throughout my teens and 20s. I would have said, proudly, that my husband had recently discovered a love of cooking, and his delicious (and sometimes high-calorie) dinners had been a bright spot during long months of quarantine. I would have shared that I had already lost a quarter of the weight I had gained, and that I had a plan to lose the remaining weight in a healthy, nourishing way prior to trying to conceive. She did not ask. Rather, she consulted her body mass index (BMI) chart and suggested that I lower my weight loss target an additional 40 pounds, pointing to a number on the page that I had not seen since prepubescence. I gaped, my eyes welling with shame.
Suddenly, and before I was ready, the doctor told me to lie back for the physical exam. She did not ask my permission before she opened the front of my gown and began to examine my breasts. At this point, tears started streaming down my face. I asked, more timidly than I wish I had, “Can I please have a moment?” Barely masking her irritation, she asked if I was a victim of sexual assault. I said “no” in a small voice, overwhelmed and still crying, as she continued with the exam. We were both silent until I had removed my legs from the stirrups.
Sensing the appointment was nearing its end, I tried to salvage the remaining time. I knew how difficult it would be for me to make another appointment. I took a deep breath before asking how the anxiety medication I am prescribed might impact fertility and pregnancy. I explained that I relied on this medication for my mental health and that it helped me face a demanding workload as a school administrator and doctoral student. Without it, I worried I would not be able to fulfill certain job functions or successfully defend my dissertation. Patronizingly, she reminded me that all medication that a mother takes will impact the fetus, and if I continued to take my anxiety prescription while pregnant, my child would be at risk for birth defects. Before I could reply, she suggested that I speak to my psychiatrist and promptly exited the room. I was alone, mortified and exposed, and abruptly convinced that I had no business becoming a mother.
As an educator, I am trained to consider the whole student. I cannot simply review a child’s test scores and discipline record to decide whether they will be successful. Often, there is more to a student’s story than meets the eye: An understanding of their hidden talents or difficult home life might provide a more nuanced view of their academic progress and offer valuable insight into how I can better support them. I have learned to be trauma-informed and relationship-driven in my interactions with children, since each child comes to school with unique life experiences. If I am not careful, I might inadvertently trample on a student’s budding love of learning or dampen a tiny spark of newfound self-confidence. It is my professional duty to protect my students, giving them a safe place to explore their curiosities while using my expertise to guide them.
Why is this not also the approach adopted in health care professions? It seems reductive that a patient’s BMI should be the first point of discussion between a patient and their doctor, especially since many experts question the measurement’s accuracy and relevance. When I visit a doctor, I expect them to see me as a human being with individual needs, wants and experiences. Instead of shaming patients into changing their behavior, perhaps doctors should trust that a patient knows their body best and instead use their professional knowledge to support patients’ own aspirations. Moreover, given the intrusive nature of breast and pelvic exams, OB-GYNs should be better trained to administer these procedures with care, compassion and explicit patient consent. Some even suggest having a chaperone present during sensitive procedures like a Pap smear. No patient should leave a doctor’s office feeling physically or emotionally violated.
Though there are some encouraging conversations within medical communities about offering “patient-centered care” and ensuring “size-friendly health care providers,” I can say with certainty that none of it reached my gynecologist’s cold, brightly lit office in Alexandria, Virginia. It might be tempting to cast off my experience as an unlucky case, but the reality is that two-thirds of patients have had a negative experience with a health care provider. I challenge the medical industry to rethink how it approaches patient care because every interaction a patient has with a health care professional can have significant consequences. Due to this one poor experience with a gynecologist, I walked away feeling like I had somehow already failed at motherhood — before I had even tried to conceive.
Perhaps I should take the advice of more seasoned parents and simply ignore those who tell me that I am a bad mother — but that puts me right back where I started: avoiding the doctor.
Shaun Shepard lives with her husband, Grant, and rescue dog, Achilles, in Alexandria, Virginia. She is an educator serving Prince George’s County Public Schools and is currently pursuing her doctorate in education leadership and administration at George Washington University.
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