Thursday, September 03, 2009

Cool....and not so cool.

Every day in the office is a day to hear something new. In OB/Gyn, the work is pretty much the same, wherever you go (at least in the US). Annual exams are annual exams. Prenatal visits are pretty standard. Common problems are approached in much the same way in one office as another. The patients are the ones that make it different, interesting, and even, sometimes, really fun.

I am still getting acclimated to the new group setting. It is a little strange to work within a group dynamic when you are used to essentially a solo practice. You have to give up some control (difficult for a control freak). It is much harder to know the patients well and remember every detail about their history, and it is also challenging to work within the boundaries of other physicians' comfort levels. Before, any call that I made...testing, induction, observation, only had direct bearing on the patient and on me. Now, I have to consider group gestalt. I am getting there, and the time off is well worth the trade-offs thus far.

I am seeing quite a different patient population in Newville, a bit more urban and sophisticated. Ways in which this is cool...

~The patients are well educated, they are aware of their bodies and have done a lot of research into pregnancy and what is happening in each trimester. I rarely am telling them things they did not already know. Makes my job a bit easier.

~The happiness! I got to see a woman, coming in for a regular annual exam with an incidental finding of a positive pregnancy test. She was ecstatic. Her husband feigned needing a glass of water and hyperventilating. The cuteness was killing me. (I am used to tears and hysterics over an unplanned pregnancy!)

~The responsibility. These patients are amazingly compliant, and hold their and their baby's health in high regard. There are very few smokers, and I have yet to see Mountain Dew in a toddler's bottle. Unbelievable.

Ways in which this is not cool...

~The, um, "sophistication." I have met several young women for their first exams (17-21 years old), who qualify their number of partners as "really low." However, when pressed further for ballpark numbers, they toss out a number like, oh, 10-12. (!!!) Whoa.

~The bossiness. Never have I been instructed on how to treat a patient for a certain condition so often. Sheaves of information printed from the internet. "Drive-through" attempts at obtaining treatment. Sorry, honey, this isn't Bur.ger K.ing and you cannot "have it your way!" Yikes.

~The nonchalance. I kid you not, I had a woman that texted on her phone throughout her entire annual exam. Breast exam, pap, and pelvic. Holy cow! I wanted to know what she was texting..."now my breasts are being checked. Now the speculum is going in?" "Pap smears suck?" WTF?

All in all, I am settling in nicely here in Newville, and I am so happy to be back to loving my job once again. That being said, I am gearing up for my first full weekend of call (and a full moon to boot). Since I've not had a weekend call since July, we'll see how sunny I am come Monday. I wish you all the happiest of Labor Day weekends! Thanks for not giving up on this blog!

19 comments:

Anonymous said...

Ah, yes, the internet. It is with us always. I had some chick come in today for an annual exam at age 49, refused a mammogram, refused an ultrasound (she has irregular menses and I think fibroids on exam)AND she was demanding "saliva testing" for a potential thyroid condition. I sent her down the road to our local "complementary" practioner and wish them great joy of each other....Glad all is going well and best of luck on weekend call (jiminy, Labor day AND full moon)

Stella said...

I love when you pop up in my reader! I am so happy to hear that you're loving your job and you seem to be happier in Newville!

Can't wait to hear more about the new digs!!

Lisa Marie said...

I'm glad to hear that you are settling in well with the new surroundings. It's good that you are balancing out the good with the.. shall we say interesting? 10-12 partners at 17? Yikes is right.

As for the full moon, I think doctors and teachers are the only ones who notice the trend. Today another teacher asked me in the hall, "Is there a full moon tonight because the kids are absolutely nuts!" To which I replied, "Nope, it's not til tomorrow night!" In no other professions do you pay such close attention to the moon phases!

Good luck this weekend!

Old MD Girl said...

The woman texting during her exam was classic. I also wonder what she was saying.

The Lonely Midwife said...

Have had the same experience with the number of partners question--shortly followed by "No, I don't drink much at all--probably only 4-5 times per week and then it's only 6-9 drinks a night". From a very well put together 20-something going to a top 5 academic university.

The joys of suburbia!!!

dr. bean said...

Came here from MiM. So glad you are settling in and appreciating the positives of your new situation! I have been feeling for you. If you ever feel a little fed up in Newville, you can read some of your old blog posts...

embracingmyquirks said...

Mountain Dew in a toddler's bottle!?! Yikes.

Margaret Polaneczky, MD (aka TBTAM) said...

Sounds like you and I are working with the same population. The only advantage I have is that cell phone signals don't penetrate into my exam space, so they can't text during the exam.

Congrats on the new job - hope it's a long and happy partnership

Anonymous said...

Sure! I think they start 'em on that after formuala. We used to see it all the time in residency (in an undisclosed location).

Lct4j said...

I'm so glad you're enjoying your new job! You deserve all the positives. I bet the "sopistication" is quite shocking at times, especially with the young, "hip" ladies.

Anonymous said...

Glad you are enjoying newville!

Mountain dew in a toddler's bottle?! Aiee, that's even worse than coke or pepsi. I see that every once in awhile in a grocery store and I can only barely restrain myself from going over and taking it away.

Also, while I think it's rude, I think the young women texting aren't talking about the exam; they are just distracting themselves from it.

Tigermom said...

Texting during an exam probably relaxes the muscles down there.

I had only thought of yoga breathing. Now I have something new to try.

Fat Doctor said...

So happy for you!

Grumpy, M.D. said...

Texting during a GYN.

Wow.

I don't think I could text while having my prostate checked.

Anonymous said...

I'm glad you're happy in Newville, but I wish you would post again! I miss reading your stuff!

Anonymous said...

Maybe your "really low" sex partner patients should check out http://calculators.lloydspharmacy.com/sexdegrees/ -- figures out how many people you have "slept with" by proxy (i.e. partners of your partners, and their partners...)

Anonymous said...

Miss your blogging! Hope all is well in New Whooville.
Amy in OH

Anonymous said...

I love your blog, I am a medical student, who is really interested in persuing ob/gyn, and it's nice to see a physician who actually is happy practicing ob/gyn. However, I must say, that it is disheartening to me the fact that you judge those girls based on the number of partners. As a patient I always feel nervous to tell my physicians how many people i've slept with, in fear of being judged. And me sharing that information is difficult, and requires a lot of trust. The patients are really opening up to you, and letting you into your life, and that trust is something that should be respected.

I hope I didn't offend you!

eulogos said...

I would like to say something about people bringing in things from the internet. I think you have to take it as a positive, that they want to understand what is going on with their bodies, and that is one place where they can go for information. They don't have easy access to medical textbooks,or professional journals, after all. Some of them will be less able to discern what is good information and what is not-and some of them will be more so. I really think the thing to do is to restrain yourself from bristling, compliment them for trying to inform themselves-and try to mean it and not sound condescending. Then tell them you will read what they have brought in, and make a quick copy of what they have printed off. It probably won't take you more than a couple of minutes to skim it to the point where you can explain what you disagree with and why. Alternately, skim it right then and do that. Always treat the patient an intelligent person who just doesn't have the benefit of your background, find her level of understanding, and speak to her with respect. I promise you that most of the time this is what will earn you trust in those times when you need it.
I had a FP who would print out articles for me from the medical journal service he subscribed to, when there was an issue we were mutually concerned about, give them to me at one visit and discuss them with me at the next. Two issues I remember he did this for were-how likely was my third child's polycythemia to repeat in the next pregnancy, and how soon after birth would it become a critical issue, and whether my fifth child/third son's hypospadia (with the opening just under the glans) should be surgically corrected or left alone.
There was no internet in those days, but you can bet I would have read up on these things on the internet if I could have, if no one had been available to help me to more precise information. I am sure at least some of your patients are intelligent women; treat them that way! If some are less intelligent but still have a desire to know, they still deserve respect for it.
Susan Peterson