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.

24 comments:

Lindsey said...

My hat is off to you. I am *just* a doula and I often find myself dreading the next call, even though I LOVE more than my luggage the "job" I do supporting laboring moms. It is exhausting and I'm not even the one responsible for the outcomes. Thank you for all you do and keep the faith! You are making a difference in the lives of mothers and babies!

But you knew that already. :) Maybe it helped to hear it from a complete stranger?

Anonymous said...

It seems pretty popular right now to demonize western medicine and particularly the benefits of obstetrics.
FWIW I ended up with a transfer to an OB who was very respectful of my midwife and in the end was far better than my midwife on the technical as well as communication aspects of support.
Thanks for doing the work you do.

Kim said...

*hug* Thank you for all you do, and the many in your profession. I hope you are having a better day today!

crgilvr said...

I think there are a lot of great OB/Gyns (I've worked with many), and particularly Gyn Onc folks. The main issue I see recently with the emphasis on advanced surgical skills is that some people get into OB/Gyn because they like surgery, not because they actually like patient interaction.

That said, I have HUGE issues with the anti-medical childbirth people who are, I find, self-righteous, judgmental, holier-than-thou purveyors of non-evidence based crap that makes women feel bad about their choices.

(And other than that, I have no opinion :))

ER's Mom said...

I can't add anything to this. You summed up perfectly why my hair is so gray before I'm 40.

K said...

Call me crazy but I think OB's are people. Some are personable, good communicators etc...some are not. I hit it off with some, feel awkward with others, don't get along with a few.
pretty much the same way I deal with other physicians, my dentist, my mechanic, my neighbors, my co-workers. Thing of it is, OBs are dealing with the most precious thing in the world and with an emotionally volatile (usually) person and it magnifies everything. The like (Dr. Wonderful anyone?) and the dislike.

My OB is an individual. I don't like him because he has the MD letters after his name or dislike him because he isn't a midwife. I go to him because he and I 'get' each other, communicate and trust each other. He holds up his end and I hold up mine and we work together. It's called respect and we both deserve it.

Anonymous said...

I enjoyed your post a lot, thanks. It makes me appreciate my wonderful OB that much more - I had never given too much thought to what goes into his day.

Becky said...

I thought that I would just tell you that I adore my OB. I adored his office staff, nurses, and partners. I prayed for them when they had poison ivy, broken limbs and family trouble and would have been quite upset about their deaths. They were, collectively speaking, one of the best medical experiences I've had and that's after 3 deliveries.

Carrie Huber said...

Have enjoyed your blog for some time! As always, you are preaching to the choir. Am always glad to know I am not alone in my frustrations! Feel free to check out my blog: www.obinkenya.blogspot.com

Anonymous said...

As a fellow obstetrician I could have written that myself! Ob/Gyn bashing is just as common here in the UK. Like you, it sometime gets to me; but there's just *no way* I could ever do anything else!

Anna N said...

You do a hard job and your patients are lucky to have you.

This reminds me of the education "debate" wherein people decide something must be done to improve education, but instead of tackling the complex systemic problems of our educational system, they just lash out at teachers, the very people who work hard to do as much good as they can within said problematic system, for being lazy and overprotected by tenure.

It's trendy (and I'd argue accurate) to see systemic problems in the way US medicine deals with birth, but OB/GYNs don't deserve stereotyping or snark just for working in an imperfect system any more than teachers do.

Sara said...

I think it's terrible that malpractice insurance and other aspects of "medical" care have made the job of being and OB such a difficult one. I think this is true of a lot of specialties, and it's one of the reasons why I try to avoid going to the doctor or OB by keeping myself as healthy as possible. Of course I would go if I needed to, but I prefer to try to prevent that.
I actually didn't mind my OB's office for my last pregnancy, but I will be going to a midwife for this one. I'm just taking up their time that could better be spent with someone more appreciative of the type of care that is given in an OB/Gyn office and hospital.

mamadoc said...

When I was a medical student, Ob/Gyn residents were the second-most unhappy, overworked and peculiar bunch (number one was the internal medicine folks). An FP residency in a community hospital (our program did all the health department deliveries) gave me all the exposure to that I ever wanted. It also taught me that in obstetrics things can turn on a dime and all can be normal and lovely one minute and OMDG disaster the next. Consider that not so long ago in this country (and still in a lot of the world) childbirth killed a substantial number of women. And it is the ever-dreaded "modern obstetrics" that has made that a thing of the past.

Anonymous said...

Hope the rest of your week was better! Believe me, I know what it is like to feel like your profession is hated and it's not fun. My hat is off to you and all other OB's.
Amy in OH

Ev (wife, mother, OBGYN) said...

Yes, yes. Amen. Hallelujah! That's what she said. Thank you for a perfect post.

Anonymous said...

Perhaps there is a better way to design the work of OB/GYN's for everyone's sake.

For my second delivery my wonderful husband & wife team of OB Dr's left for vacation the day I went into labor. I was already stressed becuase my first delivery was very complicated and recovery was slow.

When a nurse told me that my doctors who I trusted and felt so comfortable with were already gone and that I was placed with a partner who had a terrible reputation, I said "Oh, no" within earshot of him as he walked in the door ( I did not see him coming in)

He must have been offended becuase he shouted to me so abrasively instead of understanding how difficult this would be to switch to an unknown (and feared) Dr. at the last minute. I was treated like an object by him, and my needs were completely ignored.
After my C-sec he did not order any pain meds. I can still remember 18 years later how my metal bed was squeaking so loud becuase my body was jumping and trembling so violently in pain. Finally, a nurse was able to locate him and ask for an order for the pain meds.
It had been my plan to have a large family. But after this experience I forced my husband to have himself fixed. I never wanted to go through that again.
I don't know if he was aware of his bad reputation or not, or if he was offended to hear my reaction. But his complete lack of compassion and professionalism and his punishing me by having me suffer in excruciating pain - ended our family plans.
Surely if Dr.s are so unhappy and this behavior is known - Why do Dr's cover up for their peers??? Why is this allowed to continue?
Why don't you as a group redesign your work environment? Why must your patients pay the price?

gynecologist said...

gynecologist's work is very much hectic and requires lots of attention. I My self is Dr.Jalpa bhatt and I am working Gynecologist at Ahmedabad Bye the way , its very nice blog

Anonymous said...

I think being an obstetrician is an awesome, but hugely daunting job. As you have stated, the hours, responsibility, balancing an uncomfortable, hormonal 39 week patient's wants vs. medical protocol... is a juggling act at best. And multiply that by a whole practice full of patients. I have always seen doctors as people, who have good days and moods, and bad days just as anyone else. My OB cared for my 2nd high risk/cerclage pregnancy with kindness and calm. From the word go I knew I wanted a tubal ligation immediately after delivery; no more bedrest pregnancies for me. Delivery day came, and the nurses stated they were not sure if there would be room in the OR. I might have to return postpartum for the procedure. I was greatly distressed, thinking about the hassle involved in finding a sitter for a newborn and a 3 y.o. so I could deal with that. But I did not get grouchy or chew anyone out; just waited. The OB did my procedure a couple hours later. At my 6 week ck up, I thanked her for staying late to do my surgery. She stated she was glad to do it, but that sometimes she does want to get home to her husband. I am glad that I let her know how much I appreciate her. She has a tough job.

PaMi89 said...

Hi! It's the first time I read this blog and I must say, this a GREAT post.
I'm a med student in Spain and this year I did my Ob/Gyn rotation in a hospital for the first time. It has always been what I want to do as a specialty and was very shocked at what you described so well. Most of the doctors I saw were really bitter and not very nice to most patients at first, but after a few weeks there I realized that they're overworked, stressed and most people are constantly trying to tell them how to do their jobs. I imagined this was the case in my hospital because it is the second biggest Ob/Gyn department in the country, with 30-40 births per day, but really after reading your entry I can see it's the same everywhere, no matter the hospital or even the country.
I'm looking forward to becoming al OB and hope it's not as exhausting as it seems.

Heather said...

I think this is an excellent post. I'm not an OB, but I have often thought that you guys really don't get enough credit for what you do, and do get a lot of nasty things said about your profession that just isn't true. As a doula and nursing student, I have never met an OB that didn't care deeply about her patients.

elysiarenee said...

While you make some valid points many can be applied without much alteration to many medical specialisations and even non medical professions (feeling pressure of having important responsibilities, work life balance grievances etc) I don't believe there are enough peculiarities of the OB profession that would make any special level of bitterness justified, which is not to say I agree with the premise that obs are bitter in general.

I hardly think you'll win any sympathy with statements like " Women can be very difficult patients, who require a lot of communication...." an attitude like this is precisely why such a strong backlash against the profession has emerged. Without even addressing the question of what your definition of difficult might be (requiring communication doesn't strike me as difficult in and of itself) you just made a generalization about half of the population and 100% of your patient load! Even if such a generalization were true it would cause me to question why you would choose the specialty since having women as patients is pretty much the only way to practice obstetrics that I can think of. That would be like saying it's ok for pediatricians to be grumpy because children are such difficult patients.

OB GYN Woodstock GA said...

It's always easier to judge people when you haven't walked a mile in their shoes. It's unfair when people not only say someone they don't know has life easier than them, but also is a good or a bad person as a snap judgment. Just keep on believing in yourself and what you do. You do make a difference.

minoo bhagia said...

Hi , I just adore your blog posts because I see my reflection in your mirror.
In spite all stress I just enjoy my work .I am a born gynaecologist and want to die as a gynaecologist and that too in my OT doing LSCS :)

Anonymous said...

I am an obgyn and sympathize with everything you have posted. However, we as a specialty need to reflect critically on why some of our physician colleagues might have the impression that as a group, obgyns are 'bitter'. Specialties that are surgical in nature tend to be more stressful, period. i don't think there is something inherrently unique about obgyn that makes it more stressful per se, and therefore trying to justify behavior/ attitudes that reflect stress in an unprofessional way does not do much to garner much sympathy. I honestly believe your intentions were good in helping others understand just how stressful our specialty can be, however at the same time note the dearth of discussions about 'bitterness' among other surgical specialties and have to wonder if we are projecting too much hostility as a group, to generate generalizations that obgyns are so bitter. All physicians who practice in specialties that require emergency surgical intervention are sleep deprived, overworked, pay exhorbitant malpractice insurance and costs in general just to keep our practices running, etc., but that is not unique to obgyn. Along with this stress comes the enormous joy of helping patients through a difficult situation and the fact that many many times you have saved not just one life, but two! Which is completely amazing! I know you feel this way, and you said asmuch in your post, and we all have bad days...but on the bad days, i have found that it helps to keep this thought on the forefront of my mind and not devolve into exhibiting behaviors that are construed as 'bitter'. Just my two cents. Keep up the good fight...