Hi there! Glad you're engaging with this.

> but I still remember one comment of "don't worry about how the tissue looks here, it'll feel the same and neither will notice, it doesn't have to be aesthetically pleasing. Her husband and her are gonna love this."

Yeah, that comment makes me wince a bit, too. I'm trying to picture a posterior repair surgery and where somebody might say that and really mean it. Maybe a bit of puckered vaginal mucosa? It might have been a surgical situation where she had sorted the underlying support structures and it left the mucosa looking a little odd...? I'm making this up.

I think that if your impression of this urogyn was otherwise positive, and she was otherwise compassionate and patient-centered, you can forgive a comment that didn't land right and we can give her the benefit of the doubt.

I remember a very sweet 60-year-old patient whose husband was absolutely doting. They were such a sweet couple in pre-op, and he was so warm and positive... and then as we were about to wheel her away he said "va a estar coma una quinceñera, si?" (And it'll be like it's her sweet sixteen, right?) (Except fifteen not sixteen.) And we all winced and groaned... but she laughed! And when I checked how she felt about it, said she was happy for him and looking forward to that, too.

So it's important to remember that, even if you're trying to have perfectly feminist and respectful language, your patient might not... and that's okay! Meet them where they are. Don't reflect negative ideas back at them, but engage with the positive in what they're saying.

> At this point I'm interpreting it as something the patient wanted for their own sake?

I think so. Or something that your attending has heard many times from patients. No urogyn wants to do a repair that winds up uncomfortably tight. Even if the doctor isn't compassionate, that's a miserable patient that keeps coming back unhappy! Who wants that? We're surgeons. We like to get things done right once and have them be fixed and that's it.

> (she is a great surgical educator, actually let's me cut and stitch and enjoys teaching)

I think that it's good for you to keep in mind in public forums that people are reading your words without an understanding of supervision in medical teaching.

Like, I know that we're talking, say... putting a single stitch in the exit site of a retropubic sling in an incontinence surgery... not doing the imbricating stitches of a posterior repair. And I suspect that the cutting is the trimming the excess mucosa once it's been freed up from the underlying tissue, not making the opening incision on a cesarean. i.e., appropriate times for uncertain hands, where errors can be easily guarded against or corrected.

But how will your words sound to somebody who has their surgery next week and is really nervous?