Dealing with doctors

[dash]

"What day of your cycle are you in?"/"When was your last period?"

I don't cycle. The end. I don't care they "need to fill in that field" and or that they need a date, no matter how far back. Not relevant. ESPECIALLY not relevant when I've come in for an ENTIRELY unrelated medical purpose. No. (Or maybe I'll tell them "July 4, 1776.")

"Are you sexually active?"

I laugh and give them a very emphatic NO, OH NO and they drop it right there.

"Is there any chance you could be pregnant?"

I got asked this after the question about sexual activity! (Hey, maybe she thought I meant "not in the last month" as opposed to NO REALLY, NO? I don't think she was thinking deeply enough to be considering that I could have had IVF instead.)

Anyway, my response in the future will be, "not without supernatural intervention!"

Some day, maybe I'll find a doctor who can do an exam of reproductive organs while still recognizing that having these parts doesn't "make me a woman." It seems like some medical folks can handle what I say about my gender right up until they're examining me, and then it's all out the window.

[Heart]

I always wonder what they mean when they ask if you're sexually active. What, like this instant? No, I'm sitting here talking to you.

But seriously, these questions are all so vague and probably mostly irrelevant given how subjective many of the answers are. Is there any chance I could be pregnant? I'm a physicist; there is almost always at least a negligibly small chance of anything. But I'm about as likely to be pregnant as I am to fall through a wall, does that count as "no"?

And then they ask the Dreaded Question; how much pain do your cramps cause on a scale of 1 to 10?

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Or maybe these are just the questions I ask myself and obsess over in order to not have to think about the fact that I have ovaries and might even be capable of pregnancy... *shudder*

^ the biggest source of body dysphoria in existence for me.

But yeah. I don't know if this is where you were going with this or not, but this seemingly innocent series of questions poses the biggest barrier to me to going to a doctor. I have to climb a wall of dysphoria just to get the the bit where we talk about what's actually wrong and how to fix it. A supposed one-size-fits-all system that doesn't actually fit us all... nothing new I guess.

[Kappamaki]

And then they ask the Dreaded Question; how much pain do your cramps cause on a scale of 1 to 10?

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Outside all the uncomfortable dysphoria that can arise in a doctor's visit, this question and its variants drive me up a wall.

How the hell am I supposed to rate my pain based on a scale of arbitrary values? What's 1? What's 10? And your chart doesn't help at all! It's just a bunch of increasingly frowny faces!

So I wind up saying something like "I don't know, 3?"

And then the doctor will be like "Oh, that's not so bad"

Except 3 is literally 1/3 the pain I'd expect when being actively mauled by a bear

[Arthany]

i wish i'd been asked how painful it is. I think on a scale of 1 to 10, it's a 700. oh, and the look on her face when I said I was asexual was priceless. She's the only one I've told though and she was ok. I'm going to have to pick a new dr now though, so that'll be fun...ugh. Please, someone educate them about us when they're in medical school.

[Kelly]

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Probably logarithmic, see:

http://www.scielo.br/scielo.php?pid=S0104-11692008000400011&script=sci_arttext

http://www.sensorysociety.org/knowledge/sspwiki/Pages/Labeled%20Magnitude%20Scale.aspx

http://spectrum.ieee.org/podcast/biomedical/bionics/does-the-brain-work-logarithmically

[Guest]

I wonder do males get these health related questions? As a male I do not remember the last time I was asked by someone if I am sexually active.. <_< I am lucky I guess?

[Sisky]

How the hell am I supposed to rate my pain based on a scale of arbitrary values? What's 1? What's 10? And your chart doesn't help at all! It's just a bunch of increasingly frowny faces!

I'm glad I'm still treated like an adult. Last time we used faces for anything was in grade school... (read: we don't do that dumb shit here.)

I've only ever been asked those question by one doctor, and that medical issue happened to be related to those things, so... yeah.

[dash]

And then they ask the Dreaded Question; how much pain do your cramps cause on a scale of 1 to 10?

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Outside all the uncomfortable dysphoria that can arise in a doctor's visit, this question and its variants drive me up a wall.

How the hell am I supposed to rate my pain based on a scale of arbitrary values? What's 1? What's 10? And your chart doesn't help at all! It's just a bunch of increasingly frowny faces!

So I wind up saying something like "I don't know, 3?"

And then the doctor will be like "Oh, that's not so bad"

Except 3 is literally 1/3 the pain I'd expect when being actively mauled by a bear

I think you should tell them exactly that: "One third the pain I'd expect when being actively mauled by a bear." That is far more specific than "3", and will certainly get their attention.

How the hell am I supposed to rate my pain based on a scale of arbitrary values? What's 1? What's 10? And your chart doesn't help at all! It's just a bunch of increasingly frowny faces!

I'm glad I'm still treated like an adult. Last time we used faces for anything was in grade school... (read: we don't do that dumb shit here.)

To be fair, I think they do this for people who don't speak English, to help them communicate better with their doctor.

[Sisky]

To be fair, I think they do this for people who don't speak English, to help them communicate better with their doctor.

Okay, that makes sense.

[Heart]

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Probably logarithmic, see:

http://www.scielo.br/scielo.php?pid=S0104-11692008000400011&script=sci_arttext

http://www.sensorysociety.org/knowledge/sspwiki/Pages/Labeled%20Magnitude%20Scale.aspx

http://spectrum.ieee.org/podcast/biomedical/bionics/does-the-brain-work-logarithmically

...how do they expect laymen to understand logarithmic scaling? Honestly, that's the first thought to my mind, though it makes immense sense that pain would be sensed on a logarithmic scale :)

[butterflydreams]

I always wonder what they mean when they ask if you're sexually active. What, like this instant? No, I'm sitting here talking to you.

But seriously, these questions are all so vague and probably mostly irrelevant given how subjective many of the answers are. Is there any chance I could be pregnant? I'm a physicist; there is almost always at least a negligibly small chance of anything. But I'm about as likely to be pregnant as I am to fall through a wall, does that count as "no"?

Ugh! I actually googled it once. "What do doctors mean when they ask if you're sexually active?"

Being "sexually active" in a general sense can have lots of different interpretations, but I believe doctors are only asking based on one: are you bumping uglies with anyone or messing around with someone else's uglies? They're trying to suss out risks for pregnancy, STDs, etc. They technically shouldn't care about anything else.

Still doesn't make the question any less uncomfortable though. The only thing I don't like is when I'm not believed when I say 'no'. I had trouble with illnesses my first year in college, including a UTI. I knew what it was, since I'd had one before, but I needed antibiotics. The campus health center didn't believe I wasn't sexually active. They were sure it was an STD. They insisted on doing a physical genital exam. The first time I'd ever experienced something like that :( After tests, shocker...it was a UTI.

Which is why I felt so much better when I had the same conversation at the gender clinic a month back:

Doc: Are you sexually active?

Me: Nope.

Doc: Ok, that's fine. We won't bother running an HIV test with your blood-work then. Normally we do it, but it's pointless for you. Unless you want us to?

Me: Nah, don't bother.

Doc: Ok then :)

They still had to do a physical genital exam there, but were very accommodating and understanding. It made all the difference. I'm ok if doctors/nurses are "surprised" by my sexual inactivity...that's fine. It's a justified surprise, but that doesn't mean they can't be accommodating and understanding about it.

Oh, and everyone should understand logarithmic scaling! It's awesome! Plus, binary searching running in log n time tickles my computer science brain area ^_^

[dash]

Which one means pain/no pain, 1 or 10? What absolute value of pain is 1? What is 10? Is it logarithmic or linear??

Probably logarithmic, see:

http://www.scielo.br/scielo.php?pid=S0104-11692008000400011&script=sci_arttext

http://www.sensorysociety.org/knowledge/sspwiki/Pages/Labeled%20Magnitude%20Scale.aspx

http://spectrum.ieee.org/podcast/biomedical/bionics/does-the-brain-work-logarithmically

...how do they expect laymen to understand logarithmic scaling? Honestly, that's the first thought to my mind, though it makes immense sense that pain would be sensed on a logarithmic scale :)

I agree that it's probably logarithmic. I know that how people perceive the loudness of sound is logarithmic, so I would imagine pain works in a similar way.

I don't think they expect laymen to understand logarithmic scales as much as they're trying to get a more quantitative-ish measurement than "it hurts a lot", "it only kinda sorta hurts", [patient just shrugs because they don't like showing pain], etc. It doesn't completely work, but it gives them numbers, and so they can pretend that when one person says 5 and the next person says 5, they are actually talking about the same level of pain. (Which is problematic for several different reasons!)

[dash]

Or maybe these are just the questions I ask myself and obsess over in order to not have to think about the fact that I have ovaries and might even be capable of pregnancy... *shudder*

^ the biggest source of body dysphoria in existence for me.

But yeah. I don't know if this is where you were going with this or not, but this seemingly innocent series of questions poses the biggest barrier to me to going to a doctor. I have to climb a wall of dysphoria just to get the the bit where we talk about what's actually wrong and how to fix it. A supposed one-size-fits-all system that doesn't actually fit us all... nothing new I guess.

I went to the doctor (someone on call at the after hours clinic, who doesn't know me), presenting with a minor skin condition, and the question about being sexually active was to rule out it being from an STD (before the doc even looked at it). No, no it is not an STD. No. The question about whether I could be pregnant, asked after the question about being "sexually active," was I assume standard for anyone who they read as female, regardless of the relevance or irrelevance to the issue.

The massive dysphoria came yesterday when I had to have my sex organs imaged because of what I mentioned before, trying to freeze gametes. (I refuse to call any cell in my body an "egg.") Yes, they did it externally, but that was very uncomfortable for other reasons (I won't TMI you all but your bladder has to be VERY full), and in order to do the ultrasound they place warm green slime all over your lower abdomen (and they had to do so more than once) -- they squirt it out of what looks like a mustard squirt bottle, and it's warm and green and slimy and smells nasty. Then they talk about what they see in my abdomen.

(I'm going to see what I can do about avoiding the green goo next time. Since I will have to have this done every day for a week, I will just tell the folks at that clinic in advance, "I'm super grossed out by that stuff, DO NOT WANT," and let them deal.)

Oh and they usually do these ultrasounds in the "Women's Imaging" section of the hospital (though they CAN, and eventually had to, do it in the regular imaging room) -- but no, they booked me at the "Women's Imaging" center with the pregnancy magazines on the table and only women who work there, and the whole place made to be "comforting to women." Which basically means a nightmare for me.

I got called from the waiting area with "Ms." and my last name, so I told the woman there I don't go by Ms. or Ma'am or anything like that, and she gave me a COMPLETELY blank look and said nothing and then just led me inside to the changing area.

There's a certain way women act when it's a "women's only" space and they're trying to do the whole "caring for other women" thing and you know? Here they're trying to be nice and the more they do this the more I feel triggered. I mean, I'm walking into a space that has a big sign outside for "WOMEN'S IMAGING" and then inside a big sign for "BREAST IMAGING" and there are only women sitting around. I told the technician I was really anxious and she said, "Is there anything I can do to make you less anxious? Explain things to you?" And I said nothing at all because NO, EXPLAINING THINGS TO ME WILL MEAN TALKING ABOUT MY SO-CALLED FEMALE BODY PARTS AND WILL JUST MAKE ME MORE ANXIOUS.

All the tests in the future will be at a different location. But now I know I need to come up with a plan for how to pre-educate everybody there not to turn this into a dysphoria nightmare.

(And I think if after I've already told the technician I don't cycle, if they keep asking me for the date of my last period because "we have to put something into the system," I am perfectly in my rights to tell them "1492.")

[Heart]

Doc: Are you sexually active?

Me: Nope.

Doc: Ok, that's fine. We won't bother running an HIV test with your blood-work then. Normally we do it, but it's pointless for you. Unless you want us to?

Me: Nah, don't bother.

Doc: Ok then :)

^How all interactions with doctors should always go. Always. A+ to them!

I don't think they expect laymen to understand logarithmic scales as much as they're trying to get a more quantitative-ish measurement than "it hurts a lot", "it only kinda sorta hurts", [patient just shrugs because they don't like showing pain], etc. It doesn't completely work, but it gives them numbers, and so they can pretend that when one person says 5 and the next person says 5, they are actually talking about the same level of pain. (Which is problematic for several different reasons!)

But the scale is literally just putting a number to "it really hurts bad!" or "it kinda hurts". So instead of five unreliable but at least descriptive words, you get one completely meaningless number. It's meaningless because pain is subjective, everyone's going to put a different number to the pain they feel, and heck, at least five words gives you something more to go on than "2".

grrrrr.

How about something like "Can you still walk? No? How about just move the leg? Yes?" Ok, now we have lower and upper bounds. Much better than a number from one to ten that's given without any explanation to the scale or anything.

Sorry, I'll end my rant there. The medical system and I aren't friends, as you can tell :P

But yeah. I really hope you manage to navigate the system! Maybe writing a letter would help? That way, you could ask your doctor to send it ahead of you with the referral, or whatever they send to get you an appointment, and that would save you the trouble. Also, that way you can re-use it with everyone instead of having to re-explain it every single time you have to visit a new specialist.

[dash]

Doc: Are you sexually active?

Me: Nope.

Doc: Ok, that's fine. We won't bother running an HIV test with your blood-work then. Normally we do it, but it's pointless for you. Unless you want us to?

Me: Nah, don't bother.

Doc: Ok then :)

^How all interactions with doctors should always go. Always. A+ to them!

I don't think they expect laymen to understand logarithmic scales as much as they're trying to get a more quantitative-ish measurement than "it hurts a lot", "it only kinda sorta hurts", [patient just shrugs because they don't like showing pain], etc. It doesn't completely work, but it gives them numbers, and so they can pretend that when one person says 5 and the next person says 5, they are actually talking about the same level of pain. (Which is problematic for several different reasons!)

But the scale is literally just putting a number to "it really hurts bad!" or "it kinda hurts". So instead of five unreliable but at least descriptive words, you get one completely meaningless number. It's meaningless because pain is subjective, everyone's going to put a different number to the pain they feel, and heck, at least five words gives you something more to go on than "2".

grrrrr.

How about something like "Can you still walk? No? How about just move the leg? Yes?" Ok, now we have lower and upper bounds. Much better than a number from one to ten that's given without any explanation to the scale or anything.

Sorry, I'll end my rant there. The medical system and I aren't friends, as you can tell :P

But yeah. I really hope you manage to navigate the system! Maybe writing a letter would help? That way, you could ask your doctor to send it ahead of you with the referral, or whatever they send to get you an appointment, and that would save you the trouble. Also, that way you can re-use it with everyone instead of having to re-explain it every single time you have to visit a new specialist.

Re: numerical pain scales, as I said, it's problematic for a whole lot of reasons. But a lot of people feel like numbers are objectgive and therefore more meaningul, even though it's still completely subjective, and can (and will) vary between people. BUT NUMBERS. /sigh/

Re: writing a letter, I wish. :( I've been told by docs not to do that, as docs won't have the time to read it before the appointment, anyway. ("But you're a smart and articulate person, I'm sure if you explain it to them when you come into the appointment, they'll understand right away." NOT.)

Also I'm often dealing with different staff people, who would never get the memo (literally), if I sent it to the doc. Say she sends me for tests -- everyone I interact with will be someone who didn't get the memo. And sometimes I'm seeing the doctor who is in the after-hours clinic, and those docs rotate every day. (The staff there are really good, though -- they know me by now.)

There are some folks I can contact in advance, if they're the sort who is OK with that. But those people also aren't usually the problem. :)

[bicoastal]

Re: numerical pain scales, as I said, it's problematic for a whole lot of reasons. But a lot of people feel like numbers are objectgive and therefore more meaningul, even though it's still completely subjective, and can (and will) vary between people. BUT NUMBERS. /sigh/

Hey, interesting topic and I totally get what you mean about the number scale -- it bothers me too. But we just had a conversation about this at work today, (I'm a lifeguard, and we use the 1-10 scale to assess pain as well) and I thought I'd share the conclusion we came to, just cause the number scale definitely doesn't make sense but there's not much else that is better.

So, at least where I work, the 1-10 pain scale comes along with a whole lot of other questions for trauma and medical scenarios where we need to know where the pain is, what it probably feels like, how bad it is, etc. So, since pain is completely subjective, we use the numbers. 10 is supposed to be the worst pain the subject has ever felt and 1 is no pain at all -- if the number they give us is above 5, we're concerned. If it's above 7, you know they're probably in a lot of pain (unless the worst thing thats ever happened to them is a stubbed toe ). Of course this also depends on what's happened and who they are and everything else which influences the situation. The basics are merely, if the number is high we need to do something quick -- either call an ambulance or immobilize or treat them per the scenario -- but if the number is low, it might just need an ice pack or a simple remedy. Sometimes people overreact, and sometimes they don't so its good to have a baseline. If the number when asked later is higher than it was before, things have been getting worse

Also, something a friend told me a couple years ago, is that if you're getting treatment for pain or something thats wrong, don't try to be tough when it comes to the pain scale. Its always better to check and have it be nothing than tough it out and say you're a 2 when you might really be a 5 or 6 and have something go wrong or get worse.

Sorry if I crashed this thread, just thought some of you might be interested! Good luck with all future doctor visits, hopefully they are at least tolerable if not enjoyable.

[nerdperson777]

As an extremely detailed person, I hate lying and giving doctors an inaccurate number, as I thought it was just a tracking device. But I stopped remembering when I did have it last so that doesn't really help.

I was surprised when I found out that the Richter Scale for earthquakes was actually by magnitudes of 10 and not linear. And it's hard to tell what is pain to a person compared to another. I've been hit a lot when I was younger, especially on the head, so a slap on the face is nothing to me, as it was a regular experience (and I was threatened with it a month ago too). I crashed into the sidewalk two years ago, and I could not feel the pain in my forehead. It just didn't hurt, yet I was put into a hospital overnight and they barely treated me, just gave me a few expensive brain scans to send my parents bills one right after the other. Two months ago, I fell on my ankle after doing a jump, but I have flexible ankles so it was mainly the shock of the roll that crippled me for a few days, not the stretching of the muscle. Everyone has a different perception to pain. But I always say I'm fine since a lot of my pain is dulled so I don't think I have a good sense of it. I think I would actually have to fracture a bone for me to feel extreme pain.

[helana12_03]

And then even when you tell them you're a virgin and that there's NO WAY you could be pregnant, they ALWAYS do a pregnancy test anyway, because they don't believe you (especially at the ER) and then they inform you that you're not pregnant (as if you didn't know). SO ANNOYING !

[Heart]

And then even when you tell them you're a virgin and that there's NO WAY you could be pregnant, they ALWAYS do a pregnancy test anyway, because they don't believe you (especially at the ER) and then they inform you that you're not pregnant (as if you didn't know). SO ANNOYING !

Captain Obvious' close sibling, Dr Obvious... <_<

And thanks bicoastal for the explanation. It makes me feel a bit better that a lot of people use it for a relative measure, that makes (slightly) more sense. But I guess I've been the butt end of that pain scale way too many times. I've experienced pretty dramatic pain in my day, like the kind that blacks me out so much that I can't even hear my own name being said right beside my ear, can't uncurl fromt he fetal position or think a single thought kind of pain. As a consequence, it's hard for me to justify telling a doctor anything above a 5, even if I am in so much pain I can't walk; if I can talk and hear and think enough to understand plain English, then to me, it can't possibly be above a 7.

I know that's probably a bad way of going about it, but for some reason, that's just how my brain works. And when I'm in that much pain, it's hard to remember to scale my "10" so that "10" means "the most pain I would be in if I could still communicate the answer to this question". I figure that's probably what they want, since they wouldn't give you a possible answer that was actually impossible, but it's just hard to process that much thinking when in pain :( And then, when I'm in less pain and can think myself through things like that, I still end up giving low numbers, because I'm not in much pain :P

I have, however, found a good way to communicate. I now never actually answer that question, and instead when it's asked, I find something that I can't do because of the pain and tell them that. For example, rather than try to come up with a number, I just say "It's too painful to walk," or "It's painful enough that I can walk, but it takes concentration," or even "The pain is not debilitating in any way, but does make it hard to concentrate over long periods of time." I have found that doctors respond well to that kind of thing. Or at least, I have been more effective in communicating the level of pain and being taken seriously than when I tried to use the numbers, and they don't ever seem to object to me answering that way.

And dash, maybe a letter is still a good idea? I don't know about you, but I tend to freeze up sometimes around doctors and I can't explain myself properly. So sometimes I write up a letter before hand and just give it to them when they walk in the room. Or read it out loud to them. I feel like you're better at talking to medical professionals than I am, but a letter that you can hand over might also help with the exasperation that comes from having to repeat yourself a thousand and one times, and sounding like a broken record every time you deal with a new staff member. A letter to hand to those who you'll be interacting with more might help that, and maybe a badge or nametag with your preferred name and pronouns would help with people like secretaries that you'll only ever see once. I'm just trying to think of ways to make it easier than having to repeat yourself every time... but I'm very sorry that the medical system has become a field of landmines of dysphoria :(

[nerdperson777]

And then even when you tell them you're a virgin and that there's NO WAY you could be pregnant, they ALWAYS do a pregnancy test anyway, because they don't believe you (especially at the ER) and then they inform you that you're not pregnant (as if you didn't know). SO ANNOYING !

And thanks bicoastal for the explanation. It makes me feel a bit better that a lot of people use it for a relative measure, that makes (slightly) more sense. But I guess I've been the butt end of that pain scale way too many times. I've experienced pretty dramatic pain in my day, like the kind that blacks me out so much that I can't even hear my own name being said right beside my ear, can't uncurl fromt he fetal position or think a single thought kind of pain. As a consequence, it's hard for me to justify telling a doctor anything above a 5, even if I am in so much pain I can't walk; if I can talk and hear and think enough to understand plain English, then to me, it can't possibly be above a 7.

I know that's probably a bad way of going about it, but for some reason, that's just how my brain works. And when I'm in that much pain, it's hard to remember to scale my "10" so that "10" means "the most pain I would be in if I could still communicate the answer to this question". I figure that's probably what they want, since they wouldn't give you a possible answer that was actually impossible, but it's just hard to process that much thinking when in pain :( And then, when I'm in less pain and can think myself through things like that, I still end up giving low numbers, because I'm not in much pain :P

I have, however, found a good way to communicate. I now never actually answer that question, and instead when it's asked, I find something that I can't do because of the pain and tell them that. For example, rather than try to come up with a number, I just say "It's too painful to walk," or "It's painful enough that I can walk, but it takes concentration," or even "The pain is not debilitating in any way, but does make it hard to concentrate over long periods of time." I have found that doctors respond well to that kind of thing. Or at least, I have been more effective in communicating the level of pain and being taken seriously than when I tried to use the numbers, and they don't ever seem to object to me answering that way.

I feel like it's hard for anyone to take my pain seriously due to my reaction to everything. Exaggerated normal reactions and under-exaggerated pain gives off an always neutral expression. I'm part of a martial arts club at school, and everyone forgets about me there. I'm not taken seriously by our coaches and they don't seem to care about giving me the best instruction. Whenever I hurt myself, I don't scream OW in pain. Once a coach told us to do full forms (which one is very tiring). One guy stubbed his toe and the coach massaged his feet. A few minutes later, my knee went out of place (again) when I was doing mine. When asked how I felt, I said I was fine and just sat in the corner, even though I was still feeling something. I did not get any treatment. But my friend told me that all I do elsewhere is complain and not do anything about it. My idea of pain is very different. Another time we were in a non-structured practice and my knee gave out on me again. No one noticed, as many people were talking in a circle. Most of my verbal indications of pain are just random odd sounds that aren't loud at all. So then I tend to walk off my pain most of the time. I can take a lot of pain, but I wish people would take me seriously sometimes.

[dash]

And then even when you tell them you're a virgin and that there's NO WAY you could be pregnant, they ALWAYS do a pregnancy test anyway, because they don't believe you (especially at the ER) and then they inform you that you're not pregnant (as if you didn't know). SO ANNOYING !

Captain Obvious' close sibling, Dr Obvious... <_<

And thanks bicoastal for the explanation. It makes me feel a bit better that a lot of people use it for a relative measure, that makes (slightly) more sense. But I guess I've been the butt end of that pain scale way too many times. I've experienced pretty dramatic pain in my day, like the kind that blacks me out so much that I can't even hear my own name being said right beside my ear, can't uncurl fromt he fetal position or think a single thought kind of pain. As a consequence, it's hard for me to justify telling a doctor anything above a 5, even if I am in so much pain I can't walk; if I can talk and hear and think enough to understand plain English, then to me, it can't possibly be above a 7.

I know that's probably a bad way of going about it, but for some reason, that's just how my brain works. And when I'm in that much pain, it's hard to remember to scale my "10" so that "10" means "the most pain I would be in if I could still communicate the answer to this question". I figure that's probably what they want, since they wouldn't give you a possible answer that was actually impossible, but it's just hard to process that much thinking when in pain :( And then, when I'm in less pain and can think myself through things like that, I still end up giving low numbers, because I'm not in much pain :P

I have, however, found a good way to communicate. I now never actually answer that question, and instead when it's asked, I find something that I can't do because of the pain and tell them that. For example, rather than try to come up with a number, I just say "It's too painful to walk," or "It's painful enough that I can walk, but it takes concentration," or even "The pain is not debilitating in any way, but does make it hard to concentrate over long periods of time." I have found that doctors respond well to that kind of thing. Or at least, I have been more effective in communicating the level of pain and being taken seriously than when I tried to use the numbers, and they don't ever seem to object to me answering that way.

And dash, maybe a letter is still a good idea? I don't know about you, but I tend to freeze up sometimes around doctors and I can't explain myself properly. So sometimes I write up a letter before hand and just give it to them when they walk in the room. Or read it out loud to them. I feel like you're better at talking to medical professionals than I am, but a letter that you can hand over might also help with the exasperation that comes from having to repeat yourself a thousand and one times, and sounding like a broken record every time you deal with a new staff member. A letter to hand to those who you'll be interacting with more might help that, and maybe a badge or nametag with your preferred name and pronouns would help with people like secretaries that you'll only ever see once. I'm just trying to think of ways to make it easier than having to repeat yourself every time... but I'm very sorry that the medical system has become a field of landmines of dysphoria :(

Many of the gendered interactions would not be prevented. For example, unless I have previously spoken with the people in that department and had them make a note in my file not to call me from the waiting room with Ms. [surname], and the person coming to get me has seen this note and registered it, I will be addressed this way. To a room full of people. And then I want to turn and run out of the room rather than go to the appointment I've been waiting weeks for. So, I go. I say to the person who came to get me, "I don't go by Ms. or Miss or Ma'am or anything like that." I get a blank look. This person leads me to another room and leaves, like I never even said it.

I can announce "I'm transgender, I'm not a woman," but then I have to out myself to all in earshot, and so that's also hard to do if there are other people around. Also, as I look like a cis woman, what I'm saying often doesn't make sense to them. (Maybe they could understand someone who appears to be a man, in the women's imaging department, announcing that yes he does belong there because he's trans -- maybe -- but they don't understand someone who appears to be a cis woman saying they're not.)

I think a lot of women who go to work on OBGYN do so out of a love for/deep pride in womanliness and the functioning of women's bodies in the reproductive capacity. So saying "I'm not a woman, and actually it's very upsetting to me for you to talk about my body in terms of childbirth" isn't just incomprehensible to them, it's also an affront to who they are and why they're there. So they feel morally bound to help me out of this "fear of my body" or otherwise "negative attitudes about the wonderousness of the female body," and what results is not pleasant.

[Heart]

Sometimes even the best laid intentions go wrong.

I send you more cake and mental support dash. All the mental support I can muster!