Meet Sarah, tbd clinician

Sarah is a clinician on the tbd care team. She has over 10 years of experience working as a nurse and nurse practitioner at some of the biggest hospital networks in the US. One of the many reasons we were so excited to work with her is because of the empathetic approach she takes to care. So often, clinicians are privy to many of our most vulnerable moments and intimate concerns. A sensitive approach makes a huge difference in the way we perceive our healthcare providers and can even impact our health outcomes (people are more likely to seek care if they trust and like their providers). As the world moves toward a more telemedicine-first approach, forming a connection with patients over videoconference is especially challenging. During our chat, we discuss sexual health fluency, telehealth, and medical TikToks.

[Daphne] Hello, hello! Can you hear me okay? 

[Sarah] Yes, hi!!

[Daphne] Great. Let's get started! Tell us about yourself and how you got into nursing.

[Sarah] I got into nursing because my grandma was a nurse. She was always so proud to work in a nursing home in town and every holiday, they would have a celebration. I remember how she would always take me and my cousins and my brothers from room to room with the patients that knew her well and be so proud to introduce us to them.

They were always so excited to see her come in the room, as if she were a friend. She knew them, their hopes, fears, worries, got to know their histories. And I loved that. I always thought, like that's what it takes to be a nurse, you know, to approach patients as humans first, rather than a patient chart. Everyone says they get into medicine to help people, but I think not everyone thinks about helping a whole person, versus treating a condition. In my practice, I try to really get to know my patients as whole people. 

[Daphne] What has your experience been with women's health?

[Sarah] With women's health, I see a lot of the older adolescent, young adult population in my practice. And we treat them for the full range of conditions based on their needs. This includes sexual health for many young women, who become sexually active in high school or middle school. I see them early in their sexual lives, which is a really important moment for developing healthy habits and learning about both safety and pleasure. 

[Daphne] What is young people's level of sexual health fluency, in your experience?

[Sarah] They’re most often getting sex ed from school. And in my experience, sex ed, at least at most public schools, is fairly bare bones.

It's often very much about “the function" of sex (ie pregnancy) and the body parts involved, but most courses don't really get into depth around what sex can do to the body and the mind, or how sex can contribute to or impact feelings of self-esteem and mental health. The truth is, is that it's so personal and individual.  So it's almost like you're just dipping your toe in the pool but not wading in. There’s usually a daunting STD slide show with photos of symptoms and scary headlines. And yes, so much of it is fear-based with an abstinence bent. There's so much more to sex and sexual health than a giant close up photo of genital warts. Many sex ed classes are taught by someone who isn't trained in sexual health, and so they give you the tabloidy scary headlines to scare you into not having sex but don't explain that 1) STDs are super common and nothing to be ashamed of, and 2) they're almost all treatable and for many STDs, curable. 

I also think there's just this really common misconception that sex is shameful and if you catch an STD you're "dirty" and there's this fear of judgment like "Oh my gosh, I can't believe you were so irresponsible or promiscuous". But, that's not true and it only contributes to feelings of shame, which contributes to women not getting screened for fear of further judgment or abuse. In reality, STDs are just a small aspect of being sexually active and are totally manageable. 

These pervasive stigma prevents women from seeking the treatment they need. Sometimes women will wait to come until they have symptoms. But, you know, most STIs are asymptomatic more than 60% of the time. And you know, if you do have symptoms, it's very generalized-- you might have a little bit of discharge or you might have some lower abdominal pain. The only way to know what's going on in your body, is to be screened regularly, symptoms or no symptoms.

"The only way to know what's going on in your body, is to be screened regularly, symptoms or no symptoms."

[Daphne] So what are some of the things that make STI screening challenging for women?

[Sarah] I think that one of the reasons that people tend to not be open and honest with their healthcare providers is because there is a little bit of a judgment factor, whereas like, "Oh my gosh, I don't want this provider to think that, you know, all of those negative words people might use for a woman who might have an STI." Your provider should not be making you feel that way, period. You should have and are entitled to an open, judgment-free relationship with your healthcare provider, and you should demand it. And if you don't have that open and trusting relationship, you're simply not going to get screened as often-- you will find ways to explain to yourself that you are probably fine and don't need to go. So it's really important that we take that very nonjudgmental approach of, hey, STIs are a fact of life, no scarier than the common cold. And once results are back, to be ultra clear and specific about what you got tested you for; what your results mean for you as an individual; what your appropriate treatment plan may be; what it means for your status going forward.

[Daphne] One of the things I was shocked to learn about STIs is just how much impact they can have on fertility. It took me until my early 30s to really understand that STIs can make it harder for you to get pregnant, even years later. Do you feel like most women understand the link between STIs and fertility?

[Sarah] No, certainly not. I think most women don’t know that much about their reproductive system, and this is going back to how sex ed hasn't prepared them to do so. They don't know that STIs can result in PID, and that pelvic inflammatory disease is an STI that is caused essentially causing a bunch of inflammation and infection of your upper reproductive organs-- ovaries, your fallopian tubes, and your uterus, which are the three main structures that help you, you know, get pregnant and maintain a pregnancy. So when we have inflammation to those upper reproductive organs, we have inflammation which can cause scarring, which means that the, the egg from your ovary can't get through your fallopian tubes to be fertilized and become a fetus. PID can become abscesses in your fallopian tubes, which can lead to pus and pain. And a lot of times I have people describe the pain for pelvic inflammatory disease as cramps on steroids. It's very, it's painful. And expensive to treat [ed. note: it costs an avg of $9K to treat an episode of PID], and can seriously impact your ability to conceive.

[Daphne] So many women we talk to, once they know this, they say "I wish I knew this earlier, I would have made different life decisions". I myself feel the same way. And I wish I had the kind of relationship with my provider where they made downstream effects like this clear to me. But, like most women, I only go to the gynecologist maybe once yer year. Why do you think there's not much interaction with your provider in-between visits? 

[Sarah] I think that there's that common misconception that you only need to reach out to your doctor when things are wrong or when something is off, but that's not true. Your healthcare provider is there to be a research resource for you to provide you with, you know, answers to your questions. Even if they seem like small questions. I don't know if other healthcare providers have that same mentality, but I would rather you ask the question now. Before we have to have the bigger discussion later down the road because you're symptomatic or you're very concerned about something.

[Daphne] do you feel like telemedicine is helping create that closer relationship?

[Sarah] Very much so. I think that telehealth is going to be here to stay. I think it's a really important resource for us to utilize where it does provide the patient with more immediate access to healthcare, because it’s not ok that, just to go to the doctor I might have to make an appointment 3 weeks out; I have to take off work this day; have to find transportation here. Then when I get there, I have to sit in the waiting room and wait and be anxious.

So, it is much less of a hassle to do telehealth. There are definitely still many reasons to still go see your provider in person, but telehealth is a really great alternative if you can't get there.

[Daphne] Some women don't really have a screening routine, or wait until they see their gynecologist to get tested during their pelvic exam or pap smear. And with covid-19, many women are having a tough time getting to the doctor at all or are scared to leave home. Tell us how women can screen themselves more regularly.

[Sarah] I feel like at-home testing has been accelerated due to covid, and w need at-home testing now more than ever. 

And no one wants to go to a hospital because they think, "Oh my gosh, all these hospitals have covid and I don't want to risk it" or they might think "all these hospitals are really busy with covid and have shut down their sexual health clinics", which has been happening a lot too. So we need to make screening a little more accessible to everyone. And at- home is a great way to do that. You know, at home screenings are very quick and effective, and getting treatment from an at-home test is just as effective as a treatment in the office.

I think at-home kits can help women kind of maintain a regular screening routine, even if covid weren't a reality. We are all busy and have more demands on our time than ever. We're not here to like replace gynecologists, like your relationship with your gynecologist is incredibly important. You still need to see them for pap smears. You still need to see them for mammograms. But services like tbd can help make screening routines easier, more comfortable and private, and give women more control over their sexual health. STD screening is something that I think a lot of women can control and be really effective at administering to themselves.

"STD screening is something that I think a lot of women can control and be really effective at administering to themselves."

At-home is also just the more convenient way to manage your sexual health screening, because it's something that you can do on your terms and on your time and on your schedule.  

[Daphne] So well put. Ok, final parting question. There’s a bit of a sex positivity movement happening on Instagram and Tik Tok, and more and more medical providers have accounts now, dispensing advice. What are your thoughts on these platforms and their role in spreading health information?

[Sarah] There are some healthcare providers on Instagram that I absolutely love. And then there are other ones where you're like, well, you're just, you're, you're a blogger giving medical information. That's a little, yeah, that's a little concerning. It's natural to like seek answers from places where you're spending a lot of time because you start to trust the communities there. But, they're not always giving you the most accurate or relevant information. Not because they're always malicious, but because they just might not have correct information. That said, I think it's a great platform to spread the word. That word just has to be very very accurate and back by evidence-based science.