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OUT OF OFFICE An Interview With Dr Milhouse

By: Fenwa Milhouse, MD, Down There Urology, Chicago, Illinois; Kymora Scotland, MD, PHD, University of California, Los Angeles Health | Posted on: 19 Sep 2023

The AUA was excited to facilitate a conversation between Dr Kymora Scotland, assistant professor of urology, director of endourology research, and associate director of the endourology fellowship program for the University of California, Los Angeles Health, and Dr Fenwa Milhouse, pelvic floor surgeon, sexual medicine specialist, and star of the TLC TV network show, “Dr Down Below.” Dr Scotland spoke with Dr Milhouse about her new urology show that premiered in April, as well as the importance of showcasing diversity within the urological community.

How Did the Idea of a TV Show Come to Fruition?

I often replay this in my head, how did I get here? I had started my Dr Milhouse Instagram account before the pandemic but dabbled very infrequently in it. I ramped it up during the pandemic, and it was fun for me at the time. I found it to be an outlet that I enjoyed, and it added value to my career. In doing that, I started to create a following and took that momentum to TikTok. That is how a talent, or kind of scout-type of person in Hollywood, landed on my page and said, “Oh, this could be a TV show!” She sent me a DM on Instagram, and it could have completely gone ignored and dismissed. In fact, I thought it was a scam or a joke! She called me and from there we started to get the wheels in motion. What was premiered on April 5 was a little over 2 years from the initial DM, and I am so proud of everything we put into it.

How Did You Think of Content Ideas for the Show?

It was a lot of trial and error, but I knew I wanted to talk about urology, and I wanted to get information out there to whoever wanted to consume it. As a urologist, so much of what we do is a mystery to people. It’s a mystery to our colleagues in medicine even! I really was motivated to share what it is that we do in urology because I really love being a urologist. For me, it’s easy to think of content because there is so much out there that people haven’t seen before. At this time there were a few doctors on social media, like my colleague Dr Malik, who had started her YouTube channel around the same time, but there really weren’t voices in urology.

When I am thinking about content, I know that I must be myself. At first, I was trying to be something that I thought people were looking for from a doctor account for social media, but then I quickly realized I need to just be myself, I can be myself in a way that is engaging and professional, and it started working. People liked it, people were learning, and they asked for me to do more. And then I was asked to collaborate with other people who were in social media, asked to be involved in other brands, and it started to grow from there. But it truly started from me finding a passion for urology.

Why Is Representation Important to You as a Urologist?

I wouldn’t be a urologist without representation. I grew up with not very many examples of being a medical doctor, and certainly not examples of being in surgery or a surgery specialty. Because of this, when entering medical school, I didn’t at all consider any type of surgical fields. In fact, if you had asked me my first year, “Are you going to be surgeon?” I would have laughed and said, “No way. I can’t see it. I don’t have what it takes.” Why did I feel that way? It’s the lies and the things that the world tells you about yourself. When you don’t see examples of professionals who look like you it is hard to imagine it for yourself. It wasn’t until I met a urologist who looked like me that it was almost like the walls behind me were going to crumble down, that was what it felt like the moment I met Dr Wesney. Suddenly I was wondering what’s been holding me back knowing now we can do this as women, we can do this as Black women, and we can do this as people of color. I can go back and remember that feeling that I had when I saw representation, it is absolutely critical and can change lives. I’ve already had multiple encounters with now urology residents who have said, “Dr Milhouse, I saw you on something” or “I met you at an event, and you literally opened the door to urology for me.”

Once You Started the Show, What Did You Find Was the Most Surprising Thing About that Process?

I was surprised that, honestly, in the beginning it wasn’t that hard to get people to say yes! I was shocked because this is a TV show and we are talking about sensitive genital issues, issues around sex private parts, and we don’t want to blur the patient. People have asked me why we don’t blur the faces, but we need to have the audience connect with that individual. If the audience doesn’t connect with that individual, then they see this condition as something that somebody else must deal with. They can’t see this condition could happen to somebody they love or somebody close to them. To us, it was important to share the story of the individual patients in the show, humanize them and their condition to help lose some of the stigma around these issues. I want to say the first 4 people I asked said yes, and I was shocked. These are people who met me like a few days before filming and here I am doing surgery on them. It’s really humbling to know that people are suffering from conditions and were gracious and trusting enough to have me do this all on national TV.

What Would Be Your Advice for Urologists Who Are Trying to Get Urology Out to the World and Help the General Public Understand What We Do?

I think it’s important to have a mission, goal, niche, or something that you are passionate about. I don’t think doing it for the fame is a good goal in and of itself, because it’s a lot of work. And if you aren’t passionate about something, you’re not going to want to put in the work. For me it has been another full-time job.

Second, be yourself. One thing I love about the pilot episode was how they really captured my personality. While you are being yourself, you also have to be aware about how you come across; you don’t want to disparage your patients, your other colleagues, or the public.

Lastly, you’re going to need to be consistent. It’s going to be fun, but it is work, and consistency pays off. It’s not going to be overnight. I started my Dr Milhouse account in 2018 or 2019, and it was 2023 when the show came to fruition. It takes time, but when you’re doing it for the right reasons it takes you the places that you want it to take you.

What Impact Do You Hope the Show has on People in General?

One, I want people to normalize the conversation around our genitals. Let’s be able to say penis, vulva, vagina, clitoris, and testicles, and not feel squeamish. The show is called “Dr Down Below,” which I think is cute. The name of my practice is called “Down There Urology” because that’s what people say, they rarely say the actual part. I want to normalize that conversation. These aren’t dirty words, they are completely normal biological anatomical terms.

I also hope to destigmatize urological conditions. Almost all the conditions that we deal with in our specialty have some stigma to them, even prostate cancer, which was not featured on the pilot show. Oftentimes we see that the patient feels like they are the only one dealing with it and they’re alone, but I’m constantly telling patients they are not. No one talks about it, but you probably know 2 or more people who are dealing with this too. That is why it is important to share and connect with these real-life patients and stories.

The last impact I want to make with this show is to expose a side of our specialty that is fun. I want to showcase the side of us being doctors and professionals and surgeons, but also have people be able to see us as humans, as people. I think when patients think of seeing the surgeon and going to the doctor it seems intimidating, and some doctors are very rigid and unapproachable. What I’m hoping is this show shows that we are full of personality and come with different sides of ourselves that can create this patient-doctor relationship. Especially in urology there is so much light-hearted humor, so it’ll be great to see that on the big wider screen.

Is There Anything Else That You Want to Mention About “Dr Down Below” or the Importance of Representation in Urology?

It’ll be interesting to see what impact the show will have on numbers for urology residents and applicants. With this show I have a suspicion that we’ll see an even more diverse pool of applicants. One of the medical students I work with told me that she is jokingly not excited about the show because it’s going to make it harder for her to match into urology. I’m hoping people see what I do and see that I’m having fun so they can consider rotating into this specialty.

The show is just a pilot right now, but everyone’s million-dollar question is, when are we going to get more? It is just a pilot episode, and it was meant like that to judge the overall response, but the response has been great. The viewership was almost a million on night 1, which is amazing for a show that was not heavily advertised beforehand. Also, the overall reception of what was seen has been very positive. Over 94% of people enjoyed it, and people are asking for more. So just sit tight! Overall, I’m happy with the product, and I hope I represented the urology community at large well.