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Christy Bullock, a physician assistant in women's health, discusses her career and approach to discussing sensitive topics with patients. She emphasizes the importance of making patients feel comfortable and uses a questionnaire to initiate conversations. She also addresses the issue of involving parents in discussions and highlights the need for open communication regarding STIs. Christy identifies the shortage of obstetrics and gynecologists and changes in birth control as pressing health issues for women. She emphasizes the impact of sociocultural factors on women's reproductive health, particularly access to care and lack of insurance. Regular check-ups and screenings are crucial for cancer prevention. So, we are here with the interview with Christy, and today we will be discussing women's health in relation to sociocultural effects. Christy, why don't you introduce yourself? Hello, my name is Christy Bullock. I am a physician assistant that works in women's health at the group of obstetric and gynecology specialists. I have been there for just over 24 years. So, our first question is, what inspired you to pursue a career in women's health, and what makes you enjoy the most about it? Well, to be honest, I kind of fell into this position when I graduated from graduate school. My parents convinced me to move back home. I grew up in the Quad Cities, and I interviewed and accepted my first position at the group, which happened to be women's health. To be honest, I was going to go into dermatology, and my plan had been to work for a couple of years, pay off some student loans, and then actually move out west and go into true dermatology. But, life happens, and I have stayed at the group for 24 years. I absolutely have fallen in love with women's health, but I also get to do a lot of dermatology also, so it's the best of both worlds. My question to you is, how do you approach discussing sensitive topics such as contraception, sexual activity, and pregnancy with parents, with patients from diverse cultural backgrounds? Well, I think the most important thing is to do whatever we can to make the patients feel the most comfortable. At our office, we actually have the patients fill out on their own a questionnaire that automatically asks most of those sensitive questions. So we ask, do they want to talk about birth control? Are they sexually active? Do they want screening for STIs? So that gets the ball rolling, and then I go in and pretty much go over everything that they wrote down on the sheet. Some women definitely want to open up and ask questions and go into detail. Other women, you get the feeling right away that that's a topic that they don't want to discuss. Sometimes, I definitely encourage or try to draw them out a little bit more if I feel it's very important or to address the condition that they came in to see me today for. And then I also have a follow-up question. If a young woman were to come in with her mother, is there an option to keep the mother out of the room? Or if she's a minor, does the mother have to be in the room for these conversations? Yes. We actually encourage the patient to come in on their own. Obviously, they are usually a lot more forthcoming when the mother is not in the room, especially in the area of women's health. Birth control in the state of Iowa, you do not need parental consent. So a lot of younger girls will not feel as comfortable speaking openly about this with mom in the room. You'll also have the flip side, too, where the mother is the one pushing the girl to come in to have her first appointment, even if birth control is not even needed at the time. But we do it both ways. A lot of times the mothers will come into the room, and if I get the feeling that the patient wants to speak privately, then we will just nicely ask the mom to step out so that we can have a much freer conversation. So our next question is, how do you approach discussing STIs with patients, and what steps do you take to ensure that they feel comfortable discussing these sensitive topics? Again, I think the most important first thing is to get a good rapport with the patient. You know, I always like to talk about outside things, too, and just help them to relax a little bit. Again, that first initial contact sheet helps us a lot because it lets us know if they are concerned about any STIs. I also let especially the younger women know that we prefer to screen everyone. It's not a stigma. There are so many STIs that have absolutely no symptoms, and unfortunately, if those are not picked up upon and treated early, they can lead to a lot of issues down the road, most importantly for infertility issues. Again, we like to just help the patient relax and know that we just want to catch things early and get things treated. There's also many STIs that are not curable, and so we want to just educate patients mainly about condom usage and things like that that will help to prevent STIs in the future, but also to let them know that if they are returned positive, if they are infected, there's many treatment options and not to feel uncomfortable asking because I would much rather pick up on something early rather than have some long-term consequences. In your opinion, what is the most pressing health issue for women today, and how should it be addressed? I think there's a couple of big ones going on right now, especially in women's health care that you guys may not even know about is there is a shortage of obstetrics and gynecologists in our area, especially just across the river in Illinois, mainly because of malpractice issues. It is so expensive for malpractice insurance that many providers are either retiring early or they're leaving the state because they just can't simply afford to continue practicing. So that's a big issue. In our area here on the Iowa side, it's not as big of a concern, but in the outlying areas, it's becoming much, much more of an issue. The smaller towns are losing many of their providers, so many women go years without any care. Luckily, for our office, we're actually doing a few outreach clinics so that we're trying to help the women that are only maybe 30, 60 miles away, but if they don't have access to care, there's going to be issues in the future. Probably the other big issue that's made the news a lot is the changes in birth control. I would say that we had a big surge of patients come in around the time when the debate was increasing about access to abortion. I know that's a very sensitive topic, but our office does not perform abortions, but we obviously take care of women after and counsel many women. But many women became very afraid when the possibility that abortion was going to be banned. On the flip side, it encouraged a lot of women to come in for longer-acting birth control, ones that have much better efficacy so that they would not have to go through the scare of an unintended pregnancy, period. The next question would be, what sociocultural factors do you think most impact women's reproductive health? I think, again, it goes back to access of care and women who do not have insurance. Unfortunately, they are the ones who often put off getting any care until they have an issue. Many issues in women's health, again, do not have any symptoms, such as cervical cancer. You may not have any symptoms unless you develop bleeding or other issues, but we want to get women in before they become active so that we can talk about vaccinations such as Gardasil to help prevent cervical cancer. And then, again, we want them to get in regularly, especially after age 21 when we start doing cervical cancer screenings. And a follow-up to that is, how could that relate to, like, regular checkups for cancer prevention screenings? Again, we want women to be comfortable coming to us, so ideally, we will see a woman on a yearly basis. That doesn't mean she needs to have a pap done every year, but we would, again, like to do the screenings for STIs and do a breast exam and do what's called a bimanual exam, which helps us to feel if there is any pathology with the uterus and the ovaries. Women who don't come in are just obviously not getting those screenings and they're not getting the education about what to look for and how to best take care of themselves. That was very well answered. So this wraps up the interview for today. Thank you to everyone for listening, and a very big thank you to Christy for coming today. And myself, Mia, and Christy, we all hope that you all have learned something today. Thank you.