Tuesday, August 16, 2011

Ob/gyns are terrible people who deserve to die, and other misconceptions

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.

I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (god forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

Saturday, August 13, 2011

The Pregnancy Companion

The Pregnancy Companion is a pregnancy book co-written by physician and patient (and friends) Dr. Heather Rupe and Jessica Wolstenholm . In a market that is flooded with pregnancy advice books, what makes this particular book stand out from the rest? Well, actually, a couple of things! First and foremost, this book is written from a faith-based perspective, and the authors do a great job of weaving their faith, pertinent bible passages, and religious tenets within the chapters along with personal anecdotes and solid medical information. I'm hardly an expert on the pregnancy advice book market, but, I would imagine there is a paucity of advice books which incorporate faith. For Christians, it is comforting to have this additional guidance along the uncertain road that pregnancy (and pregnancy loss) can be. Dr. Rupe's medical information is solid throughout the book and written in such a way that it is easy to understand for people who do not come from a medical background. She writes in a fluent and easy way that flows off the page, and her counterpart, Jessica, draws the reader in much as a trusted confidant or long time girlfriend. Reading the book, you can easily read it cover to cover, or chapter to chapter, based on the stage of pregnancy/information you wish to obtain. In addition, the sections on pregnancy loss and personal anecdotes from both of the authors feel very personal, and create the impression in the reader that they are receiving advice from a trusted physician and a good friend. The Pregnancy Companion stands on its own as a complete pregnancy guide, complete with the requisite "month by month" stats and checklists, but this book goes even further, delving into the spiritual side of pregnancy, how it changes us, those who care for us, and how it can, if we choose to let it, bring us closer to God. Brava, Dr. Rupe and Ms. Wolstenholm, on your book, it is a truly wonderful reference to mothers and mothers-to-be.

Monday, August 08, 2011

Into the Fray

So, I admit it, I've missed you. A lot. I've been trying and trying to stay away, but, blog, I just can't quit you! So, hello to all of those of you who know my name, I hope you'll see that even though I'm human, I am still a d*mn good physician who cares about her patients, even when the day to day grind predisposes to bitterness and sarcasm. I desperately owe my good, bloggy friend Dr. Rupe a book review, and, being just a bit OCD, I didn't feel like I could properly do it until I had the chance to read the entire book (not easy in this crazy life). Good news! I've read it (and loved it) and will post a glowing review worthy of it ASAP. I still have no idea how in the world that she was able to co-write the book, when I've barely had time to read it! Many apologies, Dr. Rupe, I wanted to do your work justice!

You won't be surprised that not much has changed around here. Work is crazy, my children are sweet, lovable, and growing up too fast, my husband is a saint, and OMFG it is blazing hot! I'm working a lot, but just came off what may have been my best weekend call of my whole entire life (got to sleep in my bed all three nights, that will never happen again)! I also dropped 20 lbs since April ( I'm thinking, mostly water weight from sweating my *ss off all day long). Most of all I have missed writing, want this outlet back, and thank you for still being out there to listen to my ramblings. Please know that everything posted about clinical situations on this blog is altered to protect every patient's privacy. More soon...