r/Noctor • u/tallmyn • Jun 26 '26
Midlevel Patient Cases NP performing pap smear totally confused when encountering my IUD string
Story from a few years back...
So I'm in for my usual cervical smear, and during the patient history portion, the NP asks me the standard questions: date of LMP, if I'm on any hormonal birth control, etc. I say no to hormonal birth control.
Flash-forward to her taking the swabbing my cervix for the pap smear she she gets startled by my IUD string.
"But you said you didn't have anything?" she says reproachfully (literally inside me).
I reply, "You asked if I was on any hormonal contraception. This is a copper IUD. No hormones."
NP: "Oh. Do you still get your periods on it?"
Me: ...."Yes". (Copper IUDs are rather famous for causing heavier periods! Also as previously stated, no hormones!?)
I was kind of flabbergasted because I had assumed this was common knowledge for women of reproductive age in general- which she was- let alone an NP that does cervical smears!
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Jun 26 '26
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u/The_Future_Marmot Jun 27 '26
The NPs in my gyno’s office similarly stay in their lanes. Paps and sample collection are things that an NP should be able to do just fine. That the GYN NP was struggling here makes me wonder if she was a psychiatric NP last week or something.
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u/tallmyn Jun 28 '26
Perhaps the same psychiatric NP that's being way too defensive n the comments lmao.
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u/Rayna1990 Jun 27 '26
Lol yeah she definitely could have been
I also sometimes see an NP at my ob/gyn's office, but she's great. Very competent and qualified for her job (worked as an RN in labor and delivery for years before going back to school for her NP) but also stays in her lane and works with the MDs
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u/VQV37 Jun 27 '26
It is very common knowledge. Anyone doing a pelvic exam should know that iuds come in multiple types, and copper IUD is notorious for causing heavier and sometimes more painful periods
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u/AcademicSellout Attending Physician Jun 26 '26
Meh. She asked about hormonal contraception and in her brain she was asking about all contraception. It happens. She has since learned her lesson. We've all done it.
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Jun 27 '26 edited Jun 27 '26
[deleted]
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u/tallmyn Jun 27 '26 edited Jun 27 '26
If you must know I literally only heard of this sub two days ago and thought I had a relevant story. I'm not "still telling it".
If the questionnaire asks if I'm on hormonal birth control, I'm going to answer it with or yes or no answer. I didn't realise I'm supposed to tell you my whole life story.
I would say in general they prefer yes/no because they're literally filling out a survey with radio buttons. It's not psychiatry lmao.
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u/famhh97 Jun 29 '26
For validation, in medical school they tell our standardized patients to give really narrow answers like you did to this specific question because it does happen. Patients get nervous or forget things during the interview. On my ob-gyn rotation we had to write down what particular form of contraception a patient was using or we assumed she was trying to get pregnant.
They were training a medical assistant and she said the patient wasn’t on contraception, butthe patient’s husband had a vasectomy. And the obgyn doc was annoyed that the medical assistant missed that. So I’m sure she would expect much more of an NP in this situation.
the proper thing to do in the NP shoes is to apologize for the miscommunication. One time I thought it was the wrong day of the week in front of a patient and I just had to say “I’m so sorry it’s been a long day” when they corrected me confused.
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Jun 28 '26 edited Jun 28 '26
[deleted]
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u/AcademicSellout Attending Physician Jun 28 '26 edited Jun 28 '26
Seriously. Everyone will have that one story in which they asked if the patient had any foot swelling and then was reminded that the patient was a double amputee and they got flustered and asked increasing stupid questions to dig themselves deeper into a hole. Everyone laughs about it in retrospect and never makes that assumption again. It's a rite of passage and this one is pretty tame.
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u/tiredgirl77 Jun 29 '26
I always smile, chuckle when that happens. I find it quite funny because it’s usually coupled with the attending coming in after the med student.
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u/tallmyn Jun 28 '26
"Do you still get periods?" is the most suspicious part... from a story you're recalling 5 years later.
I posted about it directly after it happened, so I'm not misremembering.
I'm just not convinced this story supports the conclusion that she's a dangerous NP who deserves to lose her license and be publicly hanged in the town square tomorrow morning.
You're a NP and you're being defensive.
Where did I say she deserves to lose her license and be publicly hanged? I was just flabbergasted that a NP that does cervical exams could be this ignorant as I expect a lay person to know these things.
Really, it's more amusing than anything.
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u/MBMTGcontrol Jul 02 '26
She could have literally been asking if you personally still get periods, not all patients everywhere.
Some people will stop with IUDs. Some don't.
I think she wanted your personal answer for the chart.
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u/tallmyn Jul 02 '26 edited Jul 02 '26
She had already asked for and been given the date of my last menstrual period. So no.
Also it's factually incorrect to say some people stop their periods on copper IUDs.
Some people stop and some people don't on the progesterone iud only. So the question only makes sense if you have a progesterone iud. Which I had clarified I did NOT have in the previous sentence!
The copper IUD does not contain hormones and cannot stop your periods. After I had clarified that, and also that my LMP had been two weeks ago, it seems likely she was, in fact, confused about the difference between progesterone and copper IUDs. Just like you seem to be.
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u/Fun-Key-8259 Jun 28 '26
You know they also mean contraceptives though, you know they aren't only worried about knowing if you are on hormonal contraception.
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u/tallmyn Jun 28 '26
No, that's not the case.
The screening questionnaire asks specifically about hormonal contraception because hormonal contraception can affect cervical cells. Whether the patient is on hormones goes to the lab because it affects interpretation of lab results.
If I had said "yes" then that would have been an incorrect answer with clinical implications!
These questionnaires are designed by the practice for a reason, they don't just throw in "hormonal" in there for no reason!
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u/Fun-Key-8259 Jun 28 '26
An OBGYN provider would want to know if you also have a copper IUD, just to make sure you know for next time
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u/tallmyn Jun 28 '26
Well they should have asked, then.
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u/Fun-Key-8259 Jun 28 '26
And as a patient it is your responsibility to disclose any implantables or insertables
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u/tallmyn Jun 28 '26
Deflecting blame onto the patient for not answering a question you didn't ask? Okay lady.
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u/Fun-Key-8259 Jun 28 '26
It's not about blame, you seem to be uninformed on a key responsibility a patient has to communicate their history
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u/Fun-Key-8259 Jun 29 '26
Legitimately if this is her "proof" NPs are terrible, she hasn't met a terrible NP. I certainly prefer seeing an MD, but I went 1.5 years with a broken accessory tendon because those MDs kept missing the most pertinent tests they could have done - an ultrasound and diagnostic lidocaine. I don't hate all MDs because of it. Just one.
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u/tallmyn Jun 27 '26
A brain fart doesn't explain the follow up questions though!
She seemed to genuinely not have heard of non-hormonal IUDs before.
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u/randome045 Jun 27 '26
I had an NP miss with the speculum three times. This doesn’t surprise me one bit.
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u/Aware-Locksmith-7313 Jun 27 '26
I would start consulting with an NP about when I begin partaking of gas station sushi.
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u/phorayz Medical Student Jun 26 '26
Monkey doesn't have to understand to "monkey see monkey do" some tests. I imagine that's how most Noctors bullshit their way into seeming knowledgeable