Shadowing in a Sexual Health Clinic

Nota Bene: I talk about medical/bodily things. If you do not like reading about genitals, I urge you to skip.

Today I shadowed two doctors at a sexual health clinic here in London. The clinic was based in Lambeth, which I quickly learned had the highest amount of STDs (especially HIV/AIDS) in ALL of England….Awesome.

I realized at 11 PM last night that I should probably figure out how to get to the clinic since (a) I had never been there before and (b) It was not close to any tube stop.

Being in Denmark Hill, I had to use a bus. After about an hour of frantically looking at different routes, I found that Bus 40 took me straight there.

The clinic on google maps.

Since I am always terrified of getting lost/being late, I woke up super early, got dressed in my ‘clinic’ clothing (a dress, tights, cardigan, and boots), and walked to the bus stop. I was so proud of myself when my bus dropped me off right in front of the clinic. It is the little victories that count!

As usual, I got there 45 minutes early, so I got coffee and breakfast. I waited outside the clinic, so now everyone must think I am swarming with STDs. As I finally got in, I sat right down and got started.

The first patient we saw was a Polish man, who was complaining of testicle pain. A fun fact is he had a prosthetic testicle from a problem when he was younger. We took his urine and some discharge and looked at it under a slide. The doctors made sure to point out everything they saw on the slide to me and explain the different processes they were undertaking. In the end, the doctor diagnosed him with non-specific urethritis (NSU), most likely caused by Chlamydia. To be safe, the doctor gave him the Chlamydia medication, which is one dose of 4 strong antibiotics that you take then and there. She said they used to give them 7 days worth of antibiotics, but people would crush it up and secretly give it to their sexual partner without telling them that they may have an STD. At the end, the doctor told him that he would need to tell his girlfriend to come in and get tested (which makes me wonder how he got the STD in the first place….hmm…)

The next man was young, but was suffering from erectile dysfunction disorder. He came in spouting information he learned on the internet, which is obviously 60% bogus and just made him more stressed out. They tested him for STDs, diabetes, and hepatitis just to rule out any of those as causes.  (Since Lambeth has so many STDs, almost everyone that walks in is recommended to get an HIV test along with other STD tests. People kept on freaking out that the doctor thought they had HIV, but they were continually reassured that everyone gets asked). Since he has been so stressed out with this problem, he admitted to drinking and smoking weed a lot to calm him down…all things that make his ED worse. He was recommended to a sexual psychosocial clinic and told he should probably start cutting down on the drugs etc. The guy was freaking out the whole time saying some hilarious things, so I had to literally bite my tongue from laughing. When a man is screaming in front of you “I just wanna get it up!” it takes a lot of self-restraint to hold back giggles. Obviously something I must work on.

Next we saw a woman that was complaining of vaginal pain and dark colored menstrual blood. In private, the doctor I was shadowing informed me that this woman probably had nothing wrong, but was just freaking out. We still did the full screen and saw she did not have any clear STDs or infections, but we still sent out the work to the labs to get checked out.

I got to see my first cervical exam, which was to be honest…eye opening and slightly terrifying. It is somewhat surprising how open patients are with people watching, especially if they think you are a doctor in training or student. I saw the woman’s cervix and got to observe the doctor swab it down for any diseases. [Note to self: never get an STD since you do not want to go through this].

The final patient was a woman who has had bacterial vaginosis (BV) multiple times and she thought she had it again. After doing the vaginal and cervical exam, we looked at his discharge under the microscope and did see signs of the infection. The doctor gave her antibiotics and some advice in not getting it again. Basically BV is caused when the vagina becomes alkaline (or basic) and is usually caused by douching or washing down there too much. The doctor recommended an acidic gel, which one could easily pick up at the chemist. Along with all the other patients, this woman got the full STD screen too just to be safe.

What normal vaginal fluid should look like...

What we saw under the microscope with a patient who has BV

This clinic had its own lab set up, so any bacterial swab could easily be looked at under a microscope and results could be given in 10 minutes. Even cooler is the fact that each doctor withdrew blood right there in the room. Instead of getting a nurse to do it, they just pulled out the needle, stuck it in the arm, took two vials of blood and then shipped them off for testing. While waiting for lab results, I met a 5^th year medical student at Kings College, who was doing his rotation at the clinic. He was super nice and we were comparing medical school and the health system between the US and UK. He was trying to get me to move to the UK to practice since he was convinced it was that much better, but don’t worry mom- I ain’t goin’ anywhere.

In the end, I actually extremely enjoyed this clinic. I loved hearing the doctor-patient interactions and hearing the stories. I mean, obviously the stories were about sexual partners and if you use condoms, but the trust that patients give you is genuine and honorable. I would definitely go back and work there again. Even though I was there for 4 hours, I literally could have stayed all day and not even realized that the time had gone by. The doctors were super nice and made sure I was aware of everything that was going on. I actually lucked out too since other kids in my class shadowed a doctor at the HIV clinic, which is no fun since all it entails is watching doctors hand out medicine to HIV positive people. I got to see the real deal, as in see hands on exams and the lab. In the end, I got to talk to the doctors about how they deal with patients, especially with ones who you would otherwise judge. Meaning, most of the time you may morally disagree with their decisions, but as their doctor you cannot judge nor condone them. Obviously sleeping with 10 partners at once is not the smartest, but in order to gain trust from patients you cannot just call them out for that. When I mentioned to them how I had previously almost laughed at the patient with ED since he was saying ridiculous comments, they agreed and said sometimes they had to leave the room since they couldn’t hold it together. In reality though, you kind of have to have an alter ego when you work in a place like that.

I have one more shadowing experience with the General Practitioner and then a chance to sit in on some surgeries. Maybe I’ll even consider going back to the sexual health clinic...we'll see!