In my previous job, I essentially functioned as a solo practitioner, so I could be fairly certain that (like it or not) I would deliver nearly all of my OB patients. Not that I didn't wish sometimes that a few of them would happen to deliver on one of the 4 days that I was freed from the hospital. In many ways, knowing all my patients from beginning to end was really wonderful. I knew who was stoic and who was, er, well....not stoic. I knew who was a worry-wart, who never had a single complaint, who had a birth plan, and who wanted an epidural when they hit the front door. I knew who was having complications, how far along (ball park) they were, and sometimes could even remember how dilated they were at their previous checks (should they arrive in triage thinking they were in labor).
The very best part, however, was the relationships I developed with the patients during the span of their pregnancies. We got to know one another, build trust, and when the time finally came for delivery, the rapport was usually strong enough for us to communicate well during the process, and to celebrate together when the delivery was complete. Sometimes this could actually be somewhat detrimental, as getting "emotionally attached" to patients can be a hindrance to good medical care, but mostly, while I cared for women on a personal level, I was still able to objectively direct their care. Of course, I didn't "click" with every single patient (that is impossible) but I did feel like a level of trust and mutual respect was able to be fostered with many.
Now, in a much larger practice where there can be anywhere from 60-80 patients due in a single month, it is much harder to develop the same rapport. There are times when I haven't even had a chance to *meet* a patient before attending her delivery. We try to have the patients see every physician at least once, but sometimes it just doesn't happen. This makes it much harder to develop trust in one another, during a very crucial time. So far I have overcome this by taking some time when admitting the patient to review all the records (sometimes helpful, sometimes not, depending on who was doing the documentation) and to discuss the plan of care with the patient and their family members. It is strange to deliver someone that you don't know well, and though I did experience this with some of OtherDoc's patients back in Whooville, it was not on the same scale.
Another adjustment I have had to make, and I think I may have mentioned this before, is adjusting to the "way of the group." Before, the medical decisions I made about patient care were mine alone, now I have 4 other physicians that have to be somewhat on board with a plan of care. Not to mention the way that they handle gestational diabetics and inductions is very different than to what I had become accustomed in the prior four years. Plus, when I order certain tests, sometimes another physician is the one that gets the results and then makes the decision on how to proceed. Scheduling inductions is also tricky, sometimes I can't schedule them for myself, and worry that I may tick someone off by scheduling someone on their call day.
Through all of this, I have noticed a strange new phenomenon. It isn't consistent, but I am starting to be able to "feel" who I am going to deliver. I know, it sounds completely bat shit crazy, but it is the strangest sensation. I just get this little gut feeling with certain patients that I am going to be the one that does their delivery. It matters not if I happen to personally like the patient or if the patient is one with whom there is not a strong connection. There is no basis in anything concrete, and it sounds so new-agey and non-scientific when I write it out like that, but, so far, each time I have "gotten that feeling" it has been correct. Verrrrry interesting. I will continue to observe as time goes on. Has anyone else, patient or physician, experienced anything like that before?
The really nice thing about getting my bearings and settling in to the new job is how well I am clicking overall with the patients and the nursing staff at the hospital. It is so great to hear the nurses tell me that they like the way I manage patients, or to have a patient tell me "You were my favorite, I hoped it would be you delivering my baby!" Very satisfying, indeed. Happy weekend, all!