Tuesday, April 27, 2010

Things I Say Every Day (Home Edition)**

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Things I Say Almost Every Day**

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross Posted at Mothers in Medicine**

Tuesday, April 13, 2010

"Why is my OB always running so *late*?"

Recently one of my friends posed the question as to why her Ob/Gyn physician would routinely run at least 45 minutes late, with the caveat that she would be fired for doing the same to one of her clients. In typical fashion, I posted a long, rambly, and overly detailed answer in her comments section, after (thankfully) seeing a lot of other friends chime in on their personal experiences with their particular physicians. I realized that this is most likely a very universal wonder/complaint, so I am re-posting my response for you, my dear readers. I am sure you have pondered this at least once whilst sitting on an exam table, shivering in a paper gown.

Allow me to describe my day, in order to better explain why we may routinely run late. Today I am on call, and so, while I am responsible for all that happens on labor and delivery, in the office, I do have patients scheduled. The majority of patients are OB visits, most of which rarely take more than 5-10 minutes tops for routine appointments. We also will see check problem patients (early pregnancy bleeding, labor checks, blood pressure issues, hangnail, etc.) So, our scheduling staff (none of whom are medically inclined or have any clue what we do on a day-to-day basis) has most "on call" schedules looking something like this:

8:30 OB patient 1:15 OB patient
8:45 OB patient 1:30 OB patient
8:45 OB patient 1:45 OB patient
9:00 OB patient 1:45 OB patient
9:15 OB patient 2:00 OB patient
9:15 Problem 2:15 OB patient
9:30 OB patient 2:30 Problem
9:45 OB patient 2:45 OB patient
9:45 OB patient 2:45 OB patient
10:00 OB patient 3:00 Problem
10:15 OB patient 3:15 OB patient
10:30 Problem 3:15 OB patient
10:45 OB patient 3:30 OB patient
10:45 OB patient 3:45 OB patient
11:00 Problem 4:00 Problem

So, we have anywhere from 5 to 7 patients scheduled in an hour, and if everything is hunky-dory, there are no issues, long litanies of questions, no problems, or complications, I can generally run on time for these appointments (and by, "on time" I mean that once the patient checks in (usually running at least 5 minutes late, themselves) the nurse talks to them, does any necessary screening labs, checks their weight, urine and BP, listens to fetal heart tones, brings me the chart, which I then review, I am seeing them at *best* 15 to 20 minutes past their original appointment time).

Then, add in the inability to predict labors (I had a couple of laboring patients today) and scheduled procedures (I had 2 cervical ripenings and a C-section scheduled-not by me-at 7:30 am and then another scheduled C-section at noon. Unfortunately, one of my laboring patients delivered at 12:15, smack in the middle of when I was supposed to do my noon C-section, so the section was put on hold until after the delivery. So, by the time I finished the (complicated) scheduled C-section, did all the necessary charting and orders for both deliveries (mind you, not having any time for lunch) I was able to get back into the office by 3 pm. If I am lucky (today I was), my colleagues will have mercy on both the patients and me and pick up a few charts to see patient or two in between their already over-packed schedules. If I am not, then all of the patients scheduled from 1:15 are still waiting to be seen at 3 pm.

So, (whew) does this make it a little more clear why we are not running on the spot of time? It is completely different than making one appointment (that you probably schedule yourself, when it is convenient for you, allowing for travel time, and keeping in mind how long you expect most meetings to go) with one client for the span of 30 minutes or an hour, so the two are really just not comparable...at all. Hope that this helps the next time you are waiting for your physician. P.S. If you grow to expect the long waits, start bringing entertainment (iPo.d, magazines, books, cell phone bejeweled or solitaire) or little projects you can do (bills, checkbook, cleaning out your purse), and know, it really could be worse. Back in Whoo-ville, OtherDoc's patients would wait for him for upwards of 3 hours...now *that* is ridiculous. ;)