Ever noticed a difference between rural and urban/large hospitals in terms of how embarrassing their exams are?

I (now) live in a small town surrounded by farmland in a southern US state. There is one clinic for miles/km around; it’s run by two doctors. They handle everything; many folks do not want or cannot afford specialist referrals. They are overworked, understaffed, and probably underpaid for what they actually do.

The closest hospital at this point is about 90 minutes away if you drive fast, probably more than two hours if you’re just driving.

Their clinic is in a building that used to be a tack shop (a place that sells stuff for horses like saddles). Although they did their best to fit a clinic in there, the space was never designed for it. Not a single one of the exam rooms is the same, and none of them are well designed for their intended use.

Appointments vary because sometimes something urgent, like someone severely cutting themselves and needing stitches, comes up. One time I was waiting for my pelvic exam, undressed, ready to go, and after close to an hour I opened my door, and the nurse saw me. She jumped; they forgot I was there. A kid had fallen into some farm structure, broken his leg at the bottom, and the doctor had left to go help him.

One of the doctors is my neighbour. It’s farmland, so it’s not like I see him every morning, but we do visit. Although he has seen every inch of my body and probed every hole I have, it never feels weird, awkward or embarrassing when I see him.

Recently they referred me to a gynecologist at the hospital. The exam room felt like a fancy suit. I’m exaggerating a bit, but it felt like they had me wrapped in so many drapes that my whole body was hidden from head to toe, and the only part showing was my vulva.

The exam felt weird. They had two students, but I was told ahead. The doctor asked all the right questions and gave me a step-by-step of the whole thing. All the words were right, but the tone and how he touched me felt weird to me.

After they sent me off to get blood work and give a urine sample.

When I left, the gynecologist was leaving at the same time. We took the elevator down. The way he looked at me for that ride of a few floors made me feel ashamed, like as if I was an object he had fondled.

Maybe it’s all in my head, or it’s because I know my doctors in town better and familiarity helps, but it also felt that the excess of confirmation of consent, draping, explanations, checks on how I was doing, and so on, made things worse for me. It created a taboo about what we were doing, both for me but also everyone else in that room.

Has anyone else experienced the difference? What do you think created it for you? Is it the type of doctor? is it me? is it familiarity?

I definitely noticed that small town doctors are less concerned about patient modesty. It seems that the familiarity makes them feel like they can do as they please. Protocols for nudity and touching are often ignored. The prevailing attitude seems to be that they have seen you naked before so you have no reason to be embarrassed. Being embarrassed is often seen as childish. I was once reminded by my pediatrician of all the people I knew from school and other activities that she's examined. It seemed like she was saying that she's seen everyone in the town naked, so no use in complaining. Larger medical facilities definitely adhere to protocols regarding patient modesty. I feel that it's embarrassing to have someone who is always clothed see you naked at least once a year. I feel like their attitude would be different if they were forced to be naked in front of the patients. It's always easier to be nonchalant about nudity when you are not the one who is naked.

A lot of the old rural hospitals have been upgraded and modernized over the years. I’m over 70, and I’ve seen some really disgusting, and poorly equipped hospitals over the years, in and outside of the United States. The worst was an old hospital in Spain. They were using gurneys with rusted iron wheels from the 1940’s, and there were bloody bandages on the floor, and thermometers on the shelf, with Vaseline that wasn’t cleaned off.

I think that it might be the difference between having layers of administration, protocols, automated surveys going out to patients, back to administration, the rigidity of scheduling, the pressure to see patients, and address everything within 15 minutes, day, after day which explains the often impersonal care, versus doctors who operate outside of the layers, aren't satellites of large medical companies, which encourage, and allow human to human interactions. The difference between going to a medical center 15 minutes away, which has been purchased by a much larger medical system for appointments versus going to a small, independent practice in NYC, which makes its own rules, is immense.

I live in a pretty rural area, and most of my experience is in such medical offices, but I have seen the same changes as ownership is taken over by larger networks. Our local hospital has become part of a larger hospital network as have many of the local doctors. My family health doctor (I've had for about 10 years) has become part of the network, a change from I assume privately owned before. Aside from the change in forms and patient portal, I feel the visits have become more rushed and less thorough, as others have mentioned. One of my first visits, he mentioned trying to spend at least 15 minutes with each patient, whereas that's not the case. He's still personable and will be more through upon request, but it seems that's no longer the standard.

Not so much the hospital's, but the differences in the clinics. I used to live in a lot smaller town than I live in now. The clinic in the smaller town was on the second floor of a very old building. It was not originally a clinic. The exam rooms were very small with no sound proofing in the walls. I was there once for a physical and as I sat waiting for the doctor I could hear him in the exam room next to the one I was in , he was giving someone else a physical. I could very plainly hear everything that was being said word for word. I could hear the rustling of the person's clothes as well as the paper on the exam table. I could very plainly hear the doctor telling the individual in the other exam room that his prostate was mildly enlarged and that was normal for his age. As I sat waiting hearing all of this all I could think about was what the other people were going to hear when I was getting my physical done.

The clinic I go to now is fairly new. The exam rooms are a lot bigger and set up very efficiently. If you hear anything it's usually just mumbling and pretty much impossible to hear what is being said a lot more private and discreet.