I got my Pap smear this morning, two full years behind schedule. I say this because I’m a white woman with a great deal of privilege and *all* the education to understand why they are so important-

But my noncompliance is nosocomial.

I got my very first Pap smear at 18. Deeply devout and the furthest thing from sexually active, it was entirely unnecessary. She only had large speculums. She had the nurse hold me down while my mother could hear me screaming in the waiting room.

It was the first time in my life I felt physically violated.

I realize that to other medical professionals this seems ludicrous- surely none of us would do such a thing. But I am telling you firmly that it did happen. It happened and now I dread Pap smears.

When we talk about non-compliant patients we justifiably focus on those who are barred from compliance by a failure of society. We also hand-wavingly refer to those with “bad experiences.”

In my experience, there is usually a subtext that this is due to a misunderstanding.

That the patient misinterpreted or was being unreasonable. I think we do this for our own comfort.

I had a bad experience and I did not misunderstand or misinterpret. Today- I had a good experience. The PA who took care of me was kind and emphasized my control of the situation.

I was lucky to have a PCP (who came recommended by other doctors) who, knowing my experiences, specifically referred me to her. I am lucky I have insurance that was not a barrier and that the weight of knowing how important a Pap is weighed heavy enough that I finally went.

But that is not the case for so many, and it must be death by a thousand cuts. To hurdle barrier after barrier to make it to people who are theoretically helping you and then have the opposite experience.

But I just wish we acknowledged more how often non-compliance is a direct result of our own actions. It does not have to be a drastic as my story, and it may not be something that we ourselves have done. But even so, some noncompliance is nosocomial.

I want to end on a happier note though so let me re-emphasize how much affirming care has positively changed my life. Not just today, but overall. My personal balance tilts firmly positive.

We truly have a privilege to be a conduit for so much good in this life.