Assume the Position: Memoirs of an Obstetrician Gynecologist Read online

  For the first time in decades when Board terms expired there was now sufficient interest in the community such that for the three seats available, four people wanted to be on the Board. This necessitated a county wide public election for the Board seats and I was a candidate. It was all fun, local politics at its best, and a wholly unanticipated experience for me. I was now an elected official.

  Before I left for Africa I established a professional web site, essentially an electronic business card that highlighted key aspects of my past medical career. The major areas of my past experience that I emphasized were practice management, medical legal consulting, pharmaceutical and medical device research, and medical industry consulting. I felt I had knowledge and expertise I wanted to share, but on my own terms. I had an 800 number listed on the web site, my curriculum vitae, a picture and biographical background, and an email contact. Somehow people who were interested in an OB-GYN consultant found my website. I clearly had a disclaimer on the site that I was not looking to dispense medical advice over the Internet to individual patients, something I considered unethical without the ability to examine the patient. I was grateful that the business took off faster than what I had imagined it would.

  My business generated some interesting twists. I received a call from a ‘Young and Restless’ TV soap opera producer to consult on a story line about keeping a pregnant pre-eclamptic woman in a coma for a while. I consulted with a Wall Street firm interested in understanding the potential of a new medical device being brought to market. I did work for a Pharmaceutical company on a new hormone trial on which they were about to embark. I did some practice management consultations, helping other physicians with difficult business decisions they needed to make. But by far the largest part of my new business was the medical legal expert witness consulting. Interestingly, though all the medical legal work I did while still practicing medicine was for defense of physicians, once I accepted one case for the plaintiff, the defense work disappeared. It was as if I had become a traitor now that I was willing to testify on behalf of patients who had indeed been maligned. So it was plaintiff’s attorneys that found me, often either by word of mouth or by repeat business. I enjoyed the work. I could spend the morning skiing, come home to a nice warm mountain retreat, and spend part of the afternoon on the phone either discussing new cases with inquiring attorneys, or reading through medical charts that had been sent for me to review and offer opinions. I would write opinion letters, accept or reject cases that came my way depending on my sense and established written best practice standards of the American College of OB GYN. I would either arrange for my depositions to occur in the town of Telluride, or I would travel as necessary, both for depositions and trials. I had no payroll, no staff, no office problems, and no mutinous partners to deal with. The new professional role I had created suited me just fine.

  Nothing in life, however, remains the same for too long. My wife had devoted most of her adult life continuing her education while being the primary care giver for our family. I was clearly involved in raising our family since other than medicine my family life was my primary interest. I didn’t play cards, hit the bars at night, golf, or find other things to do that kept me away from home. When I wasn’t working, I was always involved with family life by choice. But I worked a lot, and that kept me on the go away from home a lot, which was just the way life was for me. My wife was clearly the major source of a steady home life, homemaker, bread maker, Mom, and daily constancy for the kids. Before we left Arizona, she completed her Bachelor’s degree in studio arts, years earlier having left her first career as a medical laboratory technician. She produced art, she taught art in the school districts, she instructed the kids in art, and she got involved with the local art therapy community, her true love. Then it was no surprise that when we were in Colorado, she decided to pursue advanced education and received her Master’s degree in Art Therapy and Counseling. During the educational process, she worked with various local internships in Colorado to complete counseling requirements. When she graduated, she then decided to seek employment in the field, and found a permanent position with the State of California, which required another move for us. By this time in our life, we were open to change and looked at it both as a challenge and a new experience for us. My consulting business was portable, so off to California we went for the next four years of our life. Our kids were all gone from home, and we were free to relocate. Once again friends said to us: “ How can you leave Telluride for California?” particularly at a time when everyone travelling on the interstate was leaving California for Colorado. We were once again in touch with our nomadic genes, as we called them, and didn’t mind swimming upstream away from what everyone else was doing. There was no longer a fear of the unknown. We embraced change, and the excitement it brings.

  Although actively licensed in medicine, I became subject to more criticism from the witness stand, and it just wasn’t where I wanted to be. The case at hand needed to be the focus, not me. I too needed a change of direction. And I needed to be supportive of my wife’s desires and aspirations for her new career.

  As a licensed physician, there are many paths to explore and many directions in which one can turn if so inclined. Fear is the only reason not to do so. An MD degree is a valuable and portable degree, especially if one is open to new and challenging things. I eventually found employment as a medical director for a Philadelphia based company with a new office located in California and went back to work. I had skiing out of my system, and enjoyed the opportunity to continue to use my medical knowledge on a daily basis. I was surprised how much information about general medicine was still in my head. As I tell people, I used to be a physician before I was an obstetrician, and I still am a physician. It was nice to be working for someone else, especially a large corporation owned by someone else, and watch others deal with the business headaches. I didn’t always agree with their business decisions, but I enjoyed the work I was doing, found it quite easy, and no one was asking me for my opinions on how to run the business anyhow. That wasn’t my role anymore. There were no malpractice issues about which to worry. Admittedly, when I started, I was a bit apprehensive having been out of active practice for a while. I needed to learn new computer skills, and dealing with medical issues outside of Obstetrics and Gynecology, but it didn’t take me long to get up to snuff. They provided all the training necessary to do the job. So it turned out to be a good fit for them and for me.

  After retiring from active practice, I incorrectly assumed that my acquired sleep disorder would at some time disappear. Now that years have gone by, there seems little hope that will ever happen. Years of up and down at all hours of the night, the necessity to be instantly awake when called upon to make at times life and death decisions, the need to give orders over the phone to the nursing staff and to direct patients what to do and when to do it, driving back and forth in the middle of the night, performing surgery and/or deliveries have all left me with a pattern of sleep that is hard to change. I have tried just about everything, including medications, and now simply just deal with myself as I am. I can fall asleep at the drop of a hat, but rarely can I stay asleep for more than 3-4 hours straight, after which I wrestle with my covers and myself the rest of the night. I wander around the house in the middle of the night when I am unable to fall back asleep, and eventually distract myself and my thoughts sufficiently that I can usually fall asleep again, but for only short intervals for the rest of the night. If one were to add up the hours, I suppose it is enough sleep, at least for me, but never what I feel is truly restful.

  As I inevitably age, as we all do, we tend to find ourselves sitting on the exam table in front of other physicians. Most of my life I was comfortable seeing a physician every day by just looking in the mirror and making a quick assessment. But that isn’t always going to work. So now I have turned myself over to others and just bite the bullet like everyone else in the world. I have many observations about the state of medicine now, most of which
I won’t share. I simply will discuss two of them.

  Obamacare. What an interesting word. I assume the term is at least partially patterned after Medicare, a program in which I now participate because the calendar tells me I am eligible. But take Obama out of Obamacare and substitute ‘Medi’ again, and we are back to where we should be. Why reinvent the wheel? I am intimately familiar with the medical side of Medicare, since most of the work I did as a medical director involved hospitals and Medicare patients. I find it most interesting that the conservative side of the political isle denigrates government medicine and government intervention in medicine. I believe current statistics will show that almost 18% of the Federal budget is Medicare dollars, a rather astounding figure of billions of dollars. The simple fact is that the system works. Even those who denigrate Obamacare on TV, in Congress, and wherever they have the chance to pontificate still belong to Medicare and utilize it. Why? Because overall it is a good system, it works, it keeps people healthy, and it keeps them from financial disaster when illness strikes, as it will for the elderly. It pays hospitals and providers. It just works! Sure, it has problems, but so does everything that chews up a large part of the federal budget. After all, isn’t paying several thousand dollars for a toilet seat an important part of the Defense budget? Come on folks, let’s get real. Take the greed and selfishness out of medicine where it has no place. Keep fixing the problems, keep auditing hospitals and doctors offices, keep returning money to the federal government when the audits produce millions of dollars of overpayments and expose fraud. Isn’t that what elected officials are paid to do? Including the President, whomever he or she may be. Manage the government and exhibit fiscal responsibility. But don’t scuttle programs that work for everyone, and which keep us healthy and out of financial ruin. Which brings me back to Obamacare. The system we have is what we have because of some sort of compromise forced upon us by the vocal minority and the Democrats who couldn’t stand up for what they knew was right. If any system doesn’t work properly, just fix it and make it better. Kind of like what we do with disease systems in medicine. The easier and wiser path would have been to just extend Medicare to people under the age of 65. How many millions were wasted in initiating and keeping a new program up and going? The system was already in place, it already works, and even though Republicans hate government intruding into our lives, better to be alive and solvent than poor before one dies. Government running medicine, they say. Horror upon horrors! It will never work. Just like Medicare and the VA don’t work, yet keep millions of us alive and functioning well as vital parts of society while we age long beyond what anyone thought possible just decades ago. Government managed medicine – I am all for it. And just think how much money will be saved as we watch the private medical insurance business slowly drift off into the sunset where it belongs! Billions of dollars of profit in the insurance industry returned to investors. Why should there be profit in sickness and the medical insurance industry? Do we really want to profit from other people’s misfortunes? Doctors and hospitals can be well paid without the private insurance sector. Don’t get rid of government medicine, expand it, fix it, audit it, and keep it healthy. How many Republicans over the age of 65 do you hear complaining about Medicare? None, you say! Why not? Because they are happy with it, like everyone else; they just don’t have the courage and honesty to tell you so.

  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!

  About the Author

  “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 my
self 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.