Quick Overview of My Intro to Urology Clinic

The first clue about the maturity level of your typical urologist, can be gained from seeing, on the door of the doctors' lounge, a labelled picture of the handsome animal featured above. These urologists strike me as the future incarnations of Kumar, the guy from that White Castle movie.

In contrast to the bawdy behavior of the urologists, one of our patients, Mr. Smith, was the quintessential "gentleman." He thanked us for taking the time to see him. Whenever he referred to any portion of the male anatomy, he said "Sorry, to the ladies, I don't mean to be impolite talking about these things." He was fully aware of his prior condition, and had followed his previous doctors' advice. The juxtaposition becomes especially absurd, however, when you notice the patient's right leg that is cuffed to the bed, and the two police officers sitting in the corner, mindlessly surfing the web, Berreta 92s intimidating from their holsters. The patient has scars on his back and legs, all from multiple previous gun shot wounds. Based on the manners of most of the patients who head over from County Jail, I can only assume that Cotillion is scheduled between recreation and lockdown.

No kid grows up dreaming of becoming a urologist. Even medical students tend to not think of it (I want to work with urine!) The thing is, however, unlike the "stereotypical" image of a surgeon, who might be seen angry and annoyed, the urologists love to make jokes, have fun, and really get along with their patients, all the while doing a cool fusion of medicine and surgery. The two attendings whom my group assisted today are volunteers, who spend one day a week away from their private clinics, just to teach us lowly Second-Year-Know-Nothing-Medical Students. They showed us the procedures for inserting a Foley catheter, doing sonogram assisted prostate biopsies, and performing a cystoscopy. They were all so eager and excited to teach us whatever they could, and we were all having a blast. It's kind of like an old boy's club, but one where young boys and all girls are invited, too.

Pelvic Examination Training

First, a word of warning to all the women out there:
If you see a male second-year medical student with a speculum in his hand, drop everything and run.

Luckily, our victims this week were vinyl dummies, not-unlike the kind sold to lonely middle-aged men who visit unsafely-searched websites. These unenthusiastic volunteers, come with a set of interchangeable parts (Cervix with endocervical polyp! Cervix with neoplasia!, Pregnant 10 week uterus! Two adnexal masses!). The sneaky doctors mix up Eva's (as she is always called) internal organs, so we can test our abilities to palpate and identify her various pathologies. Eva does not charge by the hour, but her $597 fee ought to be returned if you diagnose her correctly.

I've noticed a bit of a difference in how we are taught to perform the male versus female pelvic exams. The gynecologist gets up, and with a soft, sympathetic voice, talks about how she carefully drapes the patient, and eases her into the examination, by first placing her hand on the patient's knee and then thigh (she recommended that all doctors do this, to comfort the patient, but I insist that any male doctor who cares about retaining his license ignore that advice), before performing the exam. All anatomy is referred to by the most professional sounding jargon we have in our medical toolbox. "Sensitivity" and "comfort" are each mentioned about 12 times during her presentation.

In contrast, the urologist is crass and bawdy, talking about his own and others' mastrubation habits, and joking about how Los Angeles doctors, many of them Jews, are clueless about the fact that patients can get severely edematous retracted foreskin, if the patients fail to put it back where they found it. He seems to imply that the most important thing is to reduce the "unmanly" factor as much as possible when you position the patient during the prostate exam ("I call this the last position any male wants to get into"). He described an inguinal hernia as "Dude, where'd my penis go?"

Of course, we are taught to interact respectfully and professionally with all of our patients. But I do wonder if there is a silent understanding among doctors, that some men prefer to have their discomforts dispelled by bluntness and Adam-Carolla-style humor, while women often prefer to be treated with sensitivity. Of course, the above observations are gross generalizations, but it's the impression I've gotten so far, watching the style and mannerisms of the gynecologists versus the urologists. During the pertinent rotations, I'll report back on whether I still find this to be the case, or if generic "doctor-speak" is employed for all.