What One Doctor’s Viral Tweet Shows Us about Gynecological Care

Dec. 16, 2021 — A doctor’s tweet that started as a simple question about office design has exploded into a viral vehicle for commentary on gynecological care — a corner of medicine that many believe often neglects the comfort of patients.

Early this month, Indiana urogynecologist Ryan Stewart, DO, asked his followers on Twitter to help him design his new office.

“I have the opportunity to design my office from scratch. I’m asking women. How would you design/optimize a visit to the gynecologist’s office? Problems, frustrations, solutions. No detail is too small,” he wrote.

He posted the tweet before taking his son’s friend home from a sleepover. By the time he returned a half-hour later, replies were already rolling in about issues with comfort, diversity, gender stereotypes, and pain management when it comes to gynecological health care.

Five days later, the post was retweeted more than 2,000 times and had more than 9,000 likes.

Stewart says the sheer number of replies, and range of issues addressed, are testaments to how much the field needs to improve.

“A lot of the replies are common sense, and the fact that they came up at all tells me we have a lot of work to do,” he says. “I will never know what it is like to be a gynecological patient, and my only option is to listen.”

Some replies were as simple as asking that the bottom of the table not face the door, and requesting the office not be saturated in pink.

Others touched on more serious matters, like the need for diverse representation and painkillers for painful procedures like cervical biopsies.

“Make sure if you have pictures/pamphlets, they include depictions of people of color,” tweeted a fellow urogynecologist.

In fact, the absence of patient-centered features in many gynecology offices is rooted in the history of the practice, says Nicole Plenty, MD, a gynecologist with Obstetrix Medical Group of Houston. J. Marion Sims, MD, also known as “the father of gynecology,” pioneered techniques in the field. But he did so through cruel experimentation on enslaved Black women without anesthetic.

“The OB field was started by men,” Plenty says. “From there, more women began entering the field, but society is still very man-led. The people who built these spaces and established these practices were mostly men.”

Researchers have found that a lack of pain prevention in gynecology can be attributed, at least in part, to the inaccurate perception that women experience pain less than men. The same issues persist when comparing pain levels of white patients to that of patients of color.

Simple measures to make patients more comfortable — such as taking time to warm the speculum under water, listen to concerns, and explain what is going to happen during the exam — might be skipped over in some cases because insurance companies encourage rushed appointments by paying doctors based on the number of patients they see, Plenty says.

“It’s important that we listen, talk people through it, really take that time and not let insurance companies completely dictate our day-to-day,” she says.

Doctors face challenges when designing their offices, which often have rooms that are not used only for gynecological exams, says Megan Schimpf, MD, an obstetrician-gynecologist affiliated with the University of Michigan.

But taking each patient’s specific needs into account is important — including their emotional needs, she says.

“There’s a lot of anxiety that can go into coming for an exam. People may worry, ‘Do I have cervical cancer? Is this going to feel like a past traumatic experience?’” she says. “I think it starts with taking a step backward and saying, ‘If I were the patient having this exam, what would that feel like?’”

Stewart says he plans to take what he has learned from his Twitter replies and write an op-ed for an obstetrics and gynecology journal to help educate other doctors in the field.

“The fact of the matter is, as doctors, our training encourages us to objectify things, and a tweet like this drives home the human side of medicine,” he says. “These are humans first, not disorders or diseases.”