Women’s Healthcare in Ireland

Guest post by Katherine O’Meara. We are sharing this not to endorse the US healthcare system, but to show how shocking the Irish culture of deference to medical professionals can be to someone who has never experienced it.

Two months ago I attended a women’s clinic in Dublin, which I have attended, on and off, since 2000. I was told there might be something wrong with me.  I was told there was no chance they would perform the exam I’d booked. I was told there was nothing they could do.  I was told all of this in an extremely demeaning, condescending way while simultaneously trying to scare me that there was something amiss.  They were wrong.

Let me start by giving my background.

I grew up in America and moved to Dublin in 1995.  In 1993, when I was 21, I was diagnosed with pre-cancerous cells on my cervix.  I subsequently had cryotherapy.  I was advised to attend my OB-Gyn for follow up smear tests every three months for one year, then every six months for the next two years, then every year (it is common for women in the US to seek a full pelvic exam every year, in fact it’s so normal it’s known as going for your ‘yearly’).  All the smear results were fine but I continued to be diligent in my appointments.  By 1995 I was living in Dublin so whenever I flew back to Seattle I would duly visit my OB-Gyn.

In 2009, almost three years after my daughter’s birth, I received a letter stating my recent smear test had shown cell dysplasia and they’d like to have me in for a colposcopy.  I rang my GP’s office to ask about the level / result of cell dysplasia (as I had been given this information in the US).  They referred me to a company they sent their smears through.  So I rang that company.  I was told that they didn’t have that information, that what they get from the US company (where all the lab work is done) they pass onto GPs and that I should ring my GP.  When I rang my GP’s office (again), they said they didn’t have any of that kind of information but I could contact the company they outsource to (again).

I booked the colposcopy for the following month.  Unfortunately, the timing of this hit me like a ton of bricks.  After 16 years of good results, it completely caught me unawares.  I was also under a huge amount of pressure at that time, working full time and being a single mum with my family 7,000 miles away.  I was so upset during the colposcopy that I started to cry.  All I could think about was, ‘If something happens to me, what will happen to my daughter?’ One of the attending nurses was not impressed that I was crying and suggested I stop.  “Its only a procedure.” she chided me.  She kept asking me, throughout the procedure, ‘Why are you crying? Why are you crying?’, until another nurse tried to intervene and get her to leave the room.

Afterwards I was just happy it was over.  Until a couple of weeks later I got a letter stating I was being referred to Holles Street hospital for another colposcopy.  The letter didn’t state why.  When I rang my GP’s office they didn’t give me any further information but reinforced that I was being referred.  I found this so frustrating, that nobody would tell me what was going on and that even asking was treated as somehow undermining their supreme omnipotence.

When my colposcopy appointment finally arrived I was not looking forward to it to say the least.  So imagine my surprise when the medical team far exceeded my expectations.  They spoke to me like I was used to doctors and nurses conducting interviews back home.  They were extremely knowledgeable and professional.  They also informed me of my original cell dysplasia level, which both my GP’s office and their outsourcing company had refused to give me when asked.  Not only that but they told me the reason I was at Holles Street was that the labs/results from my previous colposcopy had been compromised.  That’s why I needed another one.  Nothing to do with me.  I would have appreciated that information at the time.  The colposcopy proceeded without any issue, the results were good (negative) and the doctor confirmed that continuing to meet my regular smear appointments was the right approach.

The idea of getting a yearly smear is so ingrained in me that I happily pay for it during the years the free cervical check doesn’t kick in.  Because of the merry-go-round at my GP’s office (in fairness, they are brilliant in every other aspect but women’s health) I decided to go back to getting my women’s healthcare seen to by a well known women’s clinic in Dublin (which I had previously attended, very happily, in my 20s).

I put up with being spoken to condescendingly when making my appointments (yes, I actually do know they should ideally be booked mid-cycle). I put up with explaining that I’m happy to pay for the smear test this year as I have a history and just want to be on the safe side (no, I’m not happy to wait two years for my next free cervical check, although I’m very happy that exists, thank you very much).

This year, when I made my appointment I had information to give the clinician.  My cycle has changed over the last two years, in line with peri-menopause.  As such, my periods are now about every 21 days apart and sometimes I have spotting between periods.  This is not unusual coming up to menopause.  The clinician looked blankly at me when I told her this and asked me to get changed.  As she started to perform the exam she told me I was bleeding and therefore she couldn’t do it.  To illustrate this, she took the speculum out of my vagina and stuck it in my face so close that it took a couple of seconds for my eyes to focus on what I was supposed to be seeing (1 cm of blood).  I wasn’t hugely impressed with her manner but fair enough if the exam can’t be performed.  She told me the lab would not accept any blood contamination in a specimen and to come back when I was mid-cycle.  I explained (again) that as I was pre-menopausal and my cycle was all over the place (its now settled down to every 21 days), this was harder to time.

“What do you tell your patients who are peri-menopausal?” I asked. She wouldn’t answer that but did say if my cycles were that off that I’d ‘want to get checked out’ because ‘there was probably something wrong’.  At this I stressed that changes to one’s cycle aren’t uncommon in the years before menopause and I asked, again, what she suggested to patients who are pre-menopausal, whose cycles are changing but who still want to come in for regular smear tests.  Honest to god, it was like she’d never been asked this question before.

She replied by telling me there was no way an exam could be performed today or on any day if there is bleeding.  She told me I had better make an full pelvic exam appointment straight away as I could have fibroids.  When I said I’d never had fibroids she said I could have cysts.  When I responded that to my knowledge ovarian cysts don’t bleed she said I could have polyps.  And then she asked me, “Do you even live in this country”? (my medical records there go back to 2000, if she had bothered to check).  This is far, far below the quality of care I expect to receive.  It’s so insulting I can’t even laugh about it yet.

It still infuriates me.  Because time and time again, when I ask questions in Ireland in regards to my own body and my own healthcare, the attitude I consistently get is ‘You don’t need to know unless we decide you need to know’ and ‘How DARE you question a medical professional’. The sheer nerve involved in daring to ask a question about your own body and the medical care you need or are receiving!  How DARE you. It’s like being patted on the head and told, ‘Don’t worry your pretty little head about these things you can’t understand.’ This attitude towards patients is grossly backward and ignorant.

I ended the conversation by telling the clinician that since I was visiting home in a couple months, I would get seen there.  This was not well received.

Fast forward two months to July and a trip back to Seattle that allows me to see the OB-Gyn I had started with over 20 years ago.  Inside one of the examination rooms was a information chart on peri-menopause, what to expect, etc.  For the first time in years I felt reassured and confident in the care I was going to receive.

My OB-Gyn (Dr. Bina Souri) and I had a good chat.  She told me that all the changes to my cycle aren’t uncommon to peri-menopause but no harm in having an ultrasound to be on the safe side.  She listened to me and was very knowledgeable and willing to talk about menopause and any question I could think of.  Importantly, because she didn’t feel threatened when I asked her questions, I felt more reassured and confident in her ability.  Taking full advantage of the opportunity I had a smear test, bloods, a full pelvic exam and pelvic ultrasound.  Dr. Souri did note I was bleeding slightly during the smear exam but said the lab might be able to use it anyway.  And they did! Not only was the specimen useable but I’ve no cells showing dysplasia! My ultrasound was fine (I have a small ovarian cyst that will probably go away on its own but I’ll have it checked in a couple months just to be sure), my bloods were great (my cholesterol is slightly up and my vitamin D slightly down but diet can fix that), my blood pressure very good (116/60) and I’ve no fibroids or polyps or thickened uterine lining.  As opposed to just telling me the results were fine, Dr. Souri spend time going over them with me, in detail, so I would understand them.  And that’s important – this is my body.  I want to understand what’s going on with it.

I am extremely lucky in that when visiting family back home, I can book into the medical system there.  Many don’t share that privilege.  I hate to think of other women, who have experienced the bad medical advice/professionals I have, but who aren’t able to seek care elsewhere and who are unable to challenge the bad advice they may receive.

Edited to change Mater to Holles Street.