Friday, September 23, 2011

She's Complicated

A commenter from the post below states that I'll not likely elicit sympathy by stating that women can be difficult patients, who require significant amounts of communication. The question is also raised why I would "generalize" 100% of my patient population, as surely, if there were no women to treat, I could no longer be an Ob/Gyn (sic). I find it overall amusing that anyone would believe the post below was written, in any way, to garner sympathy, and I also find it a bit irksome to be told that I "shouldn't generalize." I'm not. I am speaking from my own personal experience. Perhaps I should expound upon this point.

I went into Obstetrics and Gynecology precisely because I enjoy caring for the(complicated, difficult) female patient. I would not do anything else, but I would be absolutely lying if I said it wasn't without its difficulties. For the record, I happen to find male patients, no offense guys, infinitely more simple in many ways, but less likely to follow any directed care of a physician unless there is fear of loss of life or, ahem, other *important* functions. In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it). Women patients, quite simply, are different. They do require a lot more communication; not just about the reason for certain symptoms that they may be feeling, but also for the rationale behind the treatments to alleviate the symptoms.

Usually, this is not a problem for me, being a woman myself, particularly verbose ("talks too much" was a very popular comment on my report cards sent home from school), and, not to mention, I happen to like explaining physiologic changes in a way that women can understand and to which they can relate. However, sometimes something as relatively facile as communication can cross the line. At times, it can be repetitive and monotonous (likely not so different from other jobs). At other times, I feel as though I am speaking a script, word for word. Sometimes, it can be frustrating (for both the patient and myself), because no matter how I frame the explanation, I cannot communicate my point. Most of all, it can become emotionally draining. Women routinely tell me things that would feasibly make most people's ears burn, make me worried for them, and sometimes bring me to the brink of tears. I have an impeccable poker face, but over time the walls get chipped away and I find myself unable to stop bringing my work home with me.

I suppose it is a good thing to be human, but in medicine it is important to remain detached in order to stay objective and to provide good care. It is a difficult balance between being connecting with the patient without becoming emotionally *involved* with the patient. This is difficult and soul-grinding, especially for those of us who have a tendency to try to "fix" people. It is a burden I more than willingly shoulder every. single. day, but honestly connecting with patients can be good for them and harder for me. I'm not willing to stop doing it, but to say that it shouldn't affect me emotionally is far more presumption than I would have the wherewithal to make from the outside looking in. In summation, saying that women are "difficult and complicated" patients is not meant as an insult or to "generalize" women, it is simply a statement that I find to be true, not only of my patients, but of myself, as well.

14 comments:

Ethel said...

Why can't you cry when they tell you bad things? It is just, sometimes a point gets across better when emotions are allowed.. I know I know, you don't want them turning around and treating you but if you are afraid for them then tell them, if it makes you tear up say so.

I don't expect my doctors to be blank, they're people - and perfection isn't ideal, an identified ideal outcome with concerted effort to reach it is (since everything is a moving target anyway and resilience and dynamic response is needed).

Just saying.

Libby said...

I absolutely "get" this post as a physician. I have the advantage of comparing my male and female patients as I am in family practice. It's not a generalization - it just is what it is!!

And to the commenter above, the physician needs to be an objective force in their patients lives. The poker face is an essential part of our practice. Not that it isn't broken, but if I did allow all my interactions to touch me deeply or if I could not remain detached, I'm pretty sure practicing medicine would kill me. It's very difficult to explain the emotional burden of physicians and many times we remain detached not only to survive but also to give the best, objective care to our patients. There are still times we cry and show our patients our true reponse but it is a carefully guarded thing.

Iowa Sunshine said...

Dr. Whoo - I think even with your delicate balance, poker face and setting healthy boundaries with patients, you continue to be and are seen as human. I find similar aspects of what you shared within my work as a mental health therapist. Thank you for taking the time to write ... you have a beautiful writing style and powerful, thought-provoking posts. Enjoy your weekend!

Teka said...

After being a CNM for 25 yrs, I don't think I could do it without a meditation/mindfulness practice every day. I find I hold others' pain in a softer way and take less of it home. I celebrate the small ways we(clients/myself) find joy and health in our lives. I rarely cry with clients with the exception of a fetal/infant death. With deep listening, I am very present but also attached in a lighter way. Thank you for the healing you do in women's lives.

Michael said...

"In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it)."

That's not been my experience at all.

You sure this is true about the patients and not just your experience because you weren't able to engender a sense of trust and cooperation with patients of a different gender and ages when you were a young female medical student?

For example, your description might be an accurate description of the reaction I got when seeing men at a VA or women in a maternity clinic. Both appeared distant and cold, but when the men learned I was also a veteran or the women that I was raising a child on my own, suddenly both the social and the medical relationship changed to much more open and engaging.

mamadoc said...

Libby, you are so right. After 30 years of family medicine, women and men are generally different in the ways described above but there are certainly excpetions. The poker face is just part of the job. And like you, if I hadn't learned to be detached this job would have done me in for sure.

MS2 said...

Thank you for sharing your personal experiences and perspectives! :) At the end of the day, this is YOUR blog isn't it?! (so if anyone has beef... they can just close the browser, in my opinion)

I really enjoy reading your thoughts on practicing women's health, as I am very interested in specializing in OB/Gyn (I am an MS2). Again, thank you for your honesty and insight!

Jess said...

Hi there,

I'm a 4th year med student who just took the dive into committing to OB! Waiting on interviews now. I just came across your blog, and I look forward to catching up on it. None of my OB mentors have offered any insight into how their career has affected their personal lives. Thank you for offering your experiences to us.

Fizzy said...

Just read this post. I see equal numbers of male and female patients and I'm not sure I agree. I've had SO many talkative male patients. My most memorable continuity clinic patient from residency was a guy who would always come in with The List of Problems, and the list would always be ridiculous. One time he went into this I'm a Little Teacup pose, and said, "Doc, it hurts when I do this." I swear to god.

This is an interesting topic though. I may quote you on my blog, if that's okay.

"Dr." G said...

Dr. Whoo - thank you for this post. I agree with you 100% - and yet, this does not make me want to go into a different specialty. Women's health is where we are meant to be, regardless of what that entails or brings with it.

OB GYN Woodstock GA said...

I think these things can be cyclical. Sometimes you'll have a period of time with a lot of emotional patients, then maybe move toward angry patients. In any case, there's a big danger in generalizing based on any classification, including gender, because you can't really anticipate how many differences there can be.

LauraT said...

I think your generalization about male patients vs. female patients is true. Women are more challenging! That being said, I was so happy to see the look of satisfaction on my female FP doctor's face when she told me that, "You're the kind of patient I went into medicine for." I had just lost about 60 pounds, had started to exercise regularly and was seeking to lower my antidepressant medication. I think I made her day. Yeah!

Anonymous said...

One reason you don't cry is because the person in the next room expects to see a happy perky doctor. So, to get through your day you push your emotions aside then close a door and let the tears flow. You feel really fake. Sometimes numb. Sometimes overwhelmed with the sorrow you carry for your patients, especially if you get attached. If you spend time crying with one you can't just say to the next "sorry I'm running behind, I just diagnosed a stillbirth (or miscarriage or cancer), but how are you today". Sometimes I think the reason so many doctors have poor bedside manner is because the ones that actually feel emotion burnout earlier.

Sammy said...

First let me start by saying, and seconding, that I too think you have a very powerful way of writing and thought-provoking voice. Although I am not a doctor or med student I have been a patient from a young age and have experienced many different "bedside" manners. My first surgery was done by my male gyn at the age of 12 and he was my hero. Not only because he saved my life (how to you ever repay or express your gratefulness for that?)but also because he treated me like a person, not a child. Granted there were times that HSM (high self monitoring) could have been better as some of the facial expressions when discovering my issue, the sense of actionable urgency gave me slight anxiety. But that said thank goodness that he did not tear up or get emotional. That is not what I would want at 12 or, I would think, at any age. That would not give me a larger sense of confidence in my own concerns or their ability to help. Personally I prefer medical professionals to be calm, logical, honest, objective, analytical, have adaptable communication skills, and most importantly intelligence and experience. Having a doctor with great interpersonal skills and making me feel like I am important and treats me with mutual respect is always a bonus. I do often ask the whys and hows with docs but there are times I have experienced doctors that talk excessively, some just redundantly (almost to the point of insult...yes I understood the last two times you said it in a slightly different way:) It is nice to build a rapport, etc., but starts me thinking, do they have other patients right now? Also there is excessive talking and I only speak a sentence. And I am a patient person but do not respond well to being "talked at". Those to me are flags that sway me to believe they are unable to understand or participate in basic communication. And if they cannot do that...is that a sign of other intelligent flaws? (this may be a "slippery general slope" I know but hard to avoid thinking). In my personal and professional experience I, for the majority, communicate more easily with men. I am fairly certain it has something to do with growing up with three older brothers and a very practical father:)

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