Assume the Position: Memoirs of an Obstetrician Gynecologist (25 page)

     My second pet peeve is computerized medicine.  I grew up in the era before computers.  I actually graduated from college without having ever used one, if one can still imagine that.  But I embrace them fully, love them as much as the next guy, and can’t imagine life without them.  Computers and technology have changed medicine forever, and mostly for the better.  But we still have a way to go.  When I go into a doctor’s office now, usually before the physician even comes into the room, as I sit in my gown on the exam table and assume my new position in life, I usually sit and stare at the computer which the nurse has turned on awaiting the arrival of the doctor, or watch as the doctor comes into the room carrying her laptop.  If only the computer could talk then I wouldn’t even need the physician and man and machine could get down to the exam!  But we aren’t quite there yet!  He or she then arrives, sits down and begins talking, and typing.  In other words, something has come between the physician and the patient. It used to be only a stethoscope. I appreciate fully how this has happened, why, and understand the utility of efficient electronic medical records.  Heck, I would even embrace the implantation of a small silicone chip under the skin of a newborn baby at birth that would forever allow that individual to carry his or her medical records with him everywhere he goes, forever.  It would have far more utility than a circumcision. Simply get scanned at the beginning or end of every medical encounter, whether conscious by consent or without consent when unconscious, extracting old information and entering new as necessary.  Bingo! There is your medical history on the computer in front of your health care provider, who may need it to save your life at that very instant.  It is done at the grocery store with bar codes and a scanner.  I just miss the way a physician and patient interact without a machine between them.  However, I don’t think that is in our future anymore.  Life changes, as must we!

     “Are you aware you are making an entirely emotional decision by choosing to go into Obstetrics and Gynecology?” was the way my Professor of Internal Medicine responded to hearing I had not chosen his field, but rather Obstetrics and Gynecology, when he asked me which internship programs I would be applying to upon graduation from medical school.

     At the time during my fourth year of medical school when I finally made this life long commitment, I can’t say that I was aware of the emotional commitment I was making.  To me it was a thoughtful decision that came after four years of higher education post high school, hours of studying, nights and weekends on call, examinations both written and oral, clinical rotations through all the specialties of medicine, endless lab sessions, and simply trying to figure out which parts of medicine interested me the most, and the least. 

     I assessed myself as best I could.  I needed intellectual stimulation. I needed an active and challenging life on a daily basis. I could not be sedentary. I was good with my hands and enjoyed surgery. I had received academic honors in both internal medicine and psychiatry yet I didn’t want to choose either as a life long commitment. I loved the two elective rotations I had spent in Obstetrics and Gynecology.

     Much of medicine I found depressing, not something I really had considered much before entering medical school.  As important as many medical subspecialties are, for me I did not enjoy dealing with chronic diseases, nor did I enjoy the medical clinics that brought these patients in week after week with the same chronic complaints which necessitated pushing the same medications over and over again. I was not enamored with cancer and its ravages on the body and the person.   It was painful for me to watch and care for dying patients.  

     I enjoyed the challenges of making a diagnosis based on my clinical acumen and diagnostic skills.  I loved the variety of patients and problems that Obstetrics and Gynecology brought to the office.  For me, the thrill of caring for otherwise healthy, young, hopeful women over a nine-month period of time to help them bring a healthy human being with all its potential into the world was exciting, then to send it off into the world as the picture of health with enormous god given potential.  If the infant wound up having a difficult life, I didn’t want it to be as a result of lack of good medicine when on my watch for nine months.   I liked the fact that surgery was part of the specialty, such that with my hands, eyes, ears and thought processes I could use my talents and education to offer people immediate relief from problems amenable to surgical correction.  I liked the fact that in one fashion or another almost every patient required some sort of counseling and reassurance before they left the office, even if they weren’t aware of it.  I enjoyed dealing with infertility issues and bringing happiness and joy to otherwise fearful patients who thought they would be childless. I often found myself in the midst of life cycle changing events of the women who presented to the office, and I appreciated the trust and responsibility placed in me to help them not only with their health but also achieving their goals in life.  One’s social status, age, financial status, heritage, race, religion or even values did not matter to me.  I enjoyed the challenge of being totally non- discriminatory and accepting of whomever found their way into my office.   I constantly strived never to preach, moralize, or make someone feel guilty or doubtful about the decisions they were making, regardless of how I might personally feel about their situation in life.  This was often the biggest challenge of Obstetrics and Gynecology – to be non judgmental and accepting of everyone without hesitation or question, and simply to provide the patients with the best medical advice and care available under their particular unique circumstances with their reproductive, hormonal and emotional life often in the balance.  It was indeed a yearly, monthly, daily, and often hourly challenge, day and night that required constant vigilance, perception, patience, and understanding.

      As I came to realize, my Professor of Medicine was indeed correct.  It was an emotional decision that I was making at the time.  I just didn’t know how much of one it was! Every single patient had emotions that needed to be assessed and discussed.  Every single patient brought out emotions in me, none of which could be assessed and discussed.  There wasn’t time for me to deal with my own emotions while in clinical practice, because I was intimately involved with everyone else’s.

     One can imagine all the negatives one hears about going into the field of Obstetrics and Gynecology, often expressed by my medical colleagues themselves.  I heard them all:  “The hours are awful”; “The patients are needy”; “ Your family life will be terrible”; “ The smells can be overwhelming”; “You will always be exhausted and sleep deprived”;  “Why would you want to deal with women all day long”; “It requires an inordinate amount of patience”.  These were but a few.  But for me the positives far outweighed the negatives.  The decision was made and my life was about to change forever – I hoped for the positive, because I was about to jump in 100%.

     After 28 years in medicine, and 20 years in active clinical practice of Obstetrics and Gynecology in one of the largest group practices in Phoenix, Arizona, the medical vignettes I have recounted are all true; the fears I have tapped into, my own and those of many of my patients, are as they occurred; the trials and tribulations of my patients are recounted as accurately as possible with names deleted or changed.  For many people, the life of an Obstetrician and Gynecologist is often the butt of many late night jokes at parties and on television.  The mythology surrounding the specialty is extensive.  I have tried to bring the patients and their stories to life.  My personal experiences and thoughts in dealing with these patients, heretofore known only to me, have now seen daylight.  Many readers will I am sure see their own fears and lives exposed; and many will be able to relate only in the sense that they are glad that none of these events and scenarios depicted have ever happened to them.  Husbands, boyfriends, significant others will now know more about what goes on behind the closed doors of a world which many wonder about, and many choose not to enter.   And perhaps for those considering the specialty in the future, this book will be an eye opener. Medicine in general requires dedication and love.  It becomes our master. We cannot escape the fact that we are physicians until we hit the grave.  But it is a fulfilling and all encompassing life from which one can learn a tremendous amount about the depth and breadth of the human species.  It is a totally unselfish existence.  At its core, it simply demands caring for other human beings.