When I wrote I Promise You Can Successfully Get A Pap Exam Even If You Are Traumatized, Grossed Out Or Really Really Not Into Those Parts, one thing I didn't consider fully enough is that the most equipped and empowered patient can still only get a pap exam if they can find an understanding provider.
And I also discovered that folks who weren't traumatized, grossed out and who didn't mind their parts had trouble finding a provider as well.
So until we can easily do our own paps, or until we can do them for each other (although I think our foremothers tried that in ’70s and it led to a lot of unpleasantness) consider this the supplement where we walk together in the search for a gyn provider, hand in hand.
Here we go:
Step #1: Talk to yourself really really nicely.
Sigh. I know. "Talk to yourself really nicely" sounds like something people say in Portland, Oregon, and it was the exactly the kind of remark that made me want to talk to myself in a very unkind way and poke people with a sharpened stick repeatedly until all the patchouli ran out of them.
But here's why the advice is relevant now: the American health system is not actually made to serve you. It was created for profit first and then for provider convenience. In many cases, you the patient are not a factor at all. So what you're looking for is those places and those people who think that you as a patient matter. You need some armor to wade through the rest.
The armor comes in the form of believing you deserve health care.
Because here's the thing (listen closely now) you DO deserve health care.
If you're 46 and never had a pap exam: You deserve health care.
If you've been having unprotected sex of the riskiest type with more than a thousand partners: You deserve health care.
If you're a transperson using hormones you bought on the street: You deserve health care.
If you just injected crystal meth into a vein in your neck right now while you were reading this.
You deserve health care.
Say it to yourself please, until you are convinced, or at least until you can act as if you're convinced. This is important.
Step #2: Consider: do you already have a provider that could do gyn care?
If you have a primary care provider, the answer -- I'll bet you a fancy coffee drink -- is indeed, you do. Most primary providers are able to do routine gyn screenings. It usually doesn't happen on your annual physical; you'll probably need to schedule the exam on a separate day. You can ask either the receptionist/scheduler at your primary care office or ask your provider during the visit.
You'll also want to check how many pap exams the provider does a year. The way you get good at pap exams is to do pap exams. You don't have to do a million to get and stay on top of the pap exam game, but a provider should probably be doing them at least every week.
A caveat to this suggestion is that sometimes folks don't want their primary care provider to see their bits so close up and personal. In which case, okay, onward and upward.
Step #3: Ask around.
Nikole Gettings is a certified nurse midwife, and the director of Clinical Services at Choices: Memphis Center for Reproductive Health in Memphis, TN. She had plenty to say about how to find a gyn provider: "Ask around to your friends, family, ask your friends who have become your family, and don't forget to ask your other providers."
Word-of-mouth referral is going to be your best bet, because you know that at least one other person has had a good experience with the provider. That's a start at least.
Another word-of-mouth suggestion comes from Elisa D, a queer-identified person from Wisconsin who has had a lot of experience helping friends find providers. "Get to a gay bar! At least in the upper midwest, even the smallest of areas have at least one gay bar (even if it is 'secretly' a gay bar).Over a friendly game of darts, you can ask your newfound friends about who's cool in the area."
And I would add that, if you're recovery, you might want to try your local Metropolitan Community Church; there are MCCs in rural areas where there aren't bars. This works unless you are in recovery from drugs/alcohol and Christianity. In which, case hmmm, that makes it tougher, which is a shame, because I'm betting life is already a little tough for you.
Even if you aren't LGBT identified, the queer-friendly providers can be a great resource, since those providers may be more accustomed to patients that need a little bit more time. Additionally, one would hope that these providers might not be close-minded dickheads. This is also a plus.
Finally, if you're insured through your job, and you have a co-worker with whom having a brief bits conversation (or least acknowledging that you have them and want to get them checked) wouldn't be too embarrassing for both of you, hit that co-worker up for a name.
Step #4: Still struck out? Try online databases.
Agreed, "search online" isn't exactly a top secret tip. But there are a variety of specialized databases of providers that can be a useful next step. For example the organization GLMA: Health Professionals Advancing LGBT Equality maintains a list of LGBT friendly providers, and if you'd like to find a provider who has signed the Health At Every Size Pledge, there is an online directory for that as well.
Also, as a nurse, I am huge fan of nursing centers, where all the care is provided by (you might have guessed this) nurses, both RNs and advanced care nurses, including certified nurse midwives, nurse practitioners and clinical specialists. Thanks to boring financial reasons I won't go into here, most of these facilities are able to take more time with their patients than other types of clinics do. The National Nursing Nursing Centers Consortium maintains their own list; if you're lucky there might be one near you.
Nursing centers are dreamy. I worked in one through the late ’90s, and they now offer sliding scale primary care, dental, women's care, and they have a community garden and a demonstration kitchen and a gym and they integrate mental health and primary care. Even now when I think of that place, I want to walk right up to the building and give it a wet sloppy kiss.
But um, seriously, check out a nursing center.
Step #5: Don't give up, even if you're uninsured.
I'm not going to lecture you about your uninsured status except to say you do know about the Affordable Care Act, right? And you know that open enrollment starts November 15th and you can actually find a trained navigator in your area who can walk you through the process? Okay. As long as you're good with that info.
Even if you don't have insurance, there are facilities in many areas called Federally Qualified Health Centers (folks in the know usually say FQHC so fast the initials stay a secret) that receive federal money and are required to have a sliding scale. You can use the federal database to find one or search for FQHC plus the name of your area.
It's also worth talking to the folks at Planned Parenthood in your vicinity who often have sliding scales for certain types of services.
Step #6: Interview, interview, interview.
Once you have the name of a provider and you've made sure they take your insurance or you can access their sliding scale, the next part of your adventure begins.
Nikole Gettings explains: "Ask yourself what is the most important thing you can expect to get out of the provider. You might have to do some self-work and figure out what your needs are because your needs vary as you grow and develop and change. Then ask for a consult. A consult is different than a clinical visit; you have an opportunity to meet the provider, hear about their philosophy and ask questions. They are not creating a chart and you are not committing to being a patient. Every office should have an opportunity to do that some way, even if it is in a group."
Some factors to consider when meeting the provider:
Overall demeanor. Does the provider seem open, do they make eye contact, are they friendly or at least engaged? Do you personally feel comfortable with the provider? If you need brain surgery, you want the best surgeon even if they greet you in an inappropriate T-shirt, can't make eye contact and smell vaguely of rotting liverwurst. But in the case of a gyn provider, the personal skills are some of the most important ones.
Transparency, both in regards to finances and charts/lab results. Gettings' comment: "If I go to get my oil changed they don't start extra work on my car without telling me. The same rule should apply to our bodies, but as a culture we feel more vulnerable especially around our special parts."
Access. Do you know how to reach the provider? Can you call? Text? Email? If you can't reach your provider, is there an assistant or another provider who takes their calls?
You'll also want to evaluate the overall office environment as well: nearly all healthcare facilities forget to throw away their older magazines, but if the place is dusty and the plants are dead, take that as an omen. And if the waiting room is full of grumbling people who look like they might pick up torches and pitchforks and chase after the scheduling secretary? Yup, keep moving.
Step #7: Give It A Try But…
You don't have to finish. Obligation should never be a factor in health care decisions. Gettings reminds us: "It is very vulnerable and also very empowering to ask for what you need, and if the person doesn't respond well, you can leave and that is also empowering. Your cervix isn't going to explode from cancer if you walk away from one or two paps. It's part of the movement towards getting care."
Then Gettings puts the whole thing in perspective: "There is no rule that says you have to be barefoot and half-naked to have an exam. If the provider will not let your wear your cowgirl or cowboy boots while getting a pap smear, it's probably not the right place."