Perils of Partnership

Before I begin, is anyone else flashing back to Data from "The Goonies?" "Pinchers of Peril! I've been saved by my Pinchers of Peril!" Anyone? Just me? Ah, well.

So, hi! I guess working full time, having a 4 year old and an almost 8 (!) year old in multiple activities, actually having a bit of a social life from time to time, and experiencing a intense sense of perfectionism if I do have the chance to write = no blogging for me.

We've been keeping very busy in the practice, and I have been navigating the waters of working with a large group of physicians, who may or may not treat patients in the exact way that I would treat them. Sometimes, with the really complicated patients, it almost feels like a game of "hot potato," with each physician hoping that they are not the one left "holding the bag," so to speak. I've never experienced this to such a degree, and there is one culprit who rises to mind beyond the others. It really ruffles my feathers, because I was always trained to do the best thing for the patient at the time, even if it was inconvenient for you, as the physician. I don't know if this is something that comes with being older in practice, more burnt out, perhaps? Being one of the junior partners, I can't help but feel, at times, that I am expected to "prove myself" to the more senior physicians in the group, by working just a little harder, complaining a little less, and dealing with getting the less than desirable cases. Kind of like being a glorified resident in many respects, and, let me tell you, that is d*mn tough to swallow. I also feel like I have to fight to bring up to date practice standards into the group managed patients, in this, I am having some success. This makes me happy because I think it benefits all of our patients. I am really hoping to adjust the way that we see patients while on-call, and have been hashing out some ideas to discuss in some upcoming meetings. I am happy to say my schedule is always full, but this is also daunting, because sometimes it is over-full (am I forever doomed to struggle with scheduling issues??), and I have had patients tell me it is difficult to get an appointment with me. I suppose all of these issues are swirling around my brain because in a few short months I will have the opportunity to become a full partner in the business, and I don't know what I don't know.

I'm excited and nervous to make the next big step in my career. Any wise words from those who have gone before me? Any questions to ask? Things I need to know before signing the dotted line?

Call Hierarchy of Needs

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.

*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."

*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).

*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.

*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)

**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Mothers In Medicine

Well, tonight, thank G*d it's them, instead of you...

Does anyone else think that "Do They Know It's Christmas?" is the most uncharitable "charity" song around? It's downright laughable! So much so that I can't help but wonder if there isn't meant to be some sort of sardonic undercurrent beneath the song's earnestness. I mean, there's the most awful line, the line mentioned above, then, later on, we raise a glass to everyone, including "them, underneath that burning sun." ACK! Mix in some "clanging chimes of doom" and "bitter sting of tears" and, well, I admit it, I laugh my *ss off every time I hear this song. Probably not what "Band Aid" was going for, but I digress...

The true meaning for my title really pertains to how I feel when one of my partners is on call and it isn't me. I thank G*d it is them instead of me; because we have been insanely busy. Last call I delivered 8 babies in a 24 hour shift and admitted 9, 10, and 11 in labor. All of the rooms were full and our overflow was spilling into other rooms in the hospital. I have no idea what was going on nine months ago, people, but holy geez, the babies can stop coming any old time! We are T-minus 10 days from Christmas, and I didn't have enough to do, so I thought I'd sit down and let you know that I am still alive...and mostly well...and still wishing to win the lottery so I can become independently wealthy and play internet games and get buff and be the envy of the botox set (without using botox) and never, ever be on call again. I don't think Santa can deliver that kind of present, unfortunately.

This is going to be a magical Christmas for the Whoo family. Bean is 4 and CindyLou is 7 and both are steeped in the wonder and magic of the season. Their joy and wonder is palpable. I love it. It brings a tear to my eye. We only have so many magical Christmases with them, and I happen to be on call on Christmas-flipping-Eve this year. So my Christmas wish is that none of my patients get a special Christmas delivery in the wee hours of Christmas Day morning, so I don't have to miss out on the magic this year...hopefully Santa can manage that. Merry Christmas to all 2 of you still reading out there, may your holidays be Merry, Bright, and Doom Free! :)

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.

Ten Years

Ten* years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are 10 years old, nearly ready for 5th grade. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Five years ago, my husband was attentively watching the commemorative movie on television. I have no desire to see any films about that day. I didn't understand why five years was the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did ten years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

*Originally posted on 9/11/06

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.

The Pregnancy Companion

The Pregnancy Companion is a pregnancy book co-written by physician and patient (and friends) Dr. Heather Rupe and Jessica Wolstenholm . In a market that is flooded with pregnancy advice books, what makes this particular book stand out from the rest? Well, actually, a couple of things! First and foremost, this book is written from a faith-based perspective, and the authors do a great job of weaving their faith, pertinent bible passages, and religious tenets within the chapters along with personal anecdotes and solid medical information. I'm hardly an expert on the pregnancy advice book market, but, I would imagine there is a paucity of advice books which incorporate faith. For Christians, it is comforting to have this additional guidance along the uncertain road that pregnancy (and pregnancy loss) can be. Dr. Rupe's medical information is solid throughout the book and written in such a way that it is easy to understand for people who do not come from a medical background. She writes in a fluent and easy way that flows off the page, and her counterpart, Jessica, draws the reader in much as a trusted confidant or long time girlfriend. Reading the book, you can easily read it cover to cover, or chapter to chapter, based on the stage of pregnancy/information you wish to obtain. In addition, the sections on pregnancy loss and personal anecdotes from both of the authors feel very personal, and create the impression in the reader that they are receiving advice from a trusted physician and a good friend. The Pregnancy Companion stands on its own as a complete pregnancy guide, complete with the requisite "month by month" stats and checklists, but this book goes even further, delving into the spiritual side of pregnancy, how it changes us, those who care for us, and how it can, if we choose to let it, bring us closer to God. Brava, Dr. Rupe and Ms. Wolstenholm, on your book, it is a truly wonderful reference to mothers and mothers-to-be.

Into the Fray

So, I admit it, I've missed you. A lot. I've been trying and trying to stay away, but, blog, I just can't quit you! So, hello to all of those of you who know my name, I hope you'll see that even though I'm human, I am still a d*mn good physician who cares about her patients, even when the day to day grind predisposes to bitterness and sarcasm. I desperately owe my good, bloggy friend Dr. Rupe a book review, and, being just a bit OCD, I didn't feel like I could properly do it until I had the chance to read the entire book (not easy in this crazy life). Good news! I've read it (and loved it) and will post a glowing review worthy of it ASAP. I still have no idea how in the world that she was able to co-write the book, when I've barely had time to read it! Many apologies, Dr. Rupe, I wanted to do your work justice!

You won't be surprised that not much has changed around here. Work is crazy, my children are sweet, lovable, and growing up too fast, my husband is a saint, and OMFG it is blazing hot! I'm working a lot, but just came off what may have been my best weekend call of my whole entire life (got to sleep in my bed all three nights, that will never happen again)! I also dropped 20 lbs since April ( I'm thinking, mostly water weight from sweating my *ss off all day long). Most of all I have missed writing, want this outlet back, and thank you for still being out there to listen to my ramblings. Please know that everything posted about clinical situations on this blog is altered to protect every patient's privacy. More soon...

Like a Hurricane

So, yeah. That, apparently, is my new nickname on Labor and Delivery. Hurricane Whoo. Because it is more than just a "black cloud." Because just about every time that I happen to be on call, it's bound to be a sh*t storm. It has gotten to the point, so I am told, that the entire nursing staff offers up a collective groan when they hear that I am the physician on call. Yikes. They hasten to add that they still love me, though. HA! Apparently babies and pregnant ladies love me, too. A lot. The last weekend that I was on call, I delivered 12 babies admitted 2 more in labor before I was finished. It makes the time fly by too quickly, and I hate to find myself wishing my life away. To say that work has been busy would be an understatement, add to that increasing children activities (soccer! Daisies! tumbling!), the arrival of warmer weather, and the presence of a pool at our ready disposal, and my blogging has languished in the corner for more than two months with hardly a glance in its direction! Sorry about that. It's not you, it's me.

If you have been reading for a while, then you may know that my blog started as a primarily anonymous outlet (and boy, have I used it to vent!), save for a few people (Mr. Whoo and one friend who also happened to have an anonymous blog). Well, it so happens that those few people told a few more people, then I told a couple of people, and made a couple of bloggy friends, who were then my face.book friends and boom! Not so super-anonymous any more. This was not a big deal, as it was still mostly amongst my circle of friends, from whom I lived far, far away, and trusted to know me as the person behind the words. Then I moved, and I was closer to some friends, and those friends knew friends, and friends of friends, who also went to the practice where I am working. This is where I keep running into an ethical dilemma. Some people reading this blog know who I am, where I live, and where I work, but are not my close personal friends (friends of friends of friends). Given the atmosphere surrounding the Internet, face.book, and social media with respect to physicians in general, this makes me a bit edgy. Let's face it, I'm not the type to mince a lot of words on this blog, and this is who I am when I am being me. (Because this is my blog, dammit!) My professional persona is not nearly as raw. In fact, if you asked most of my patients, I do believe the word "sweet" would come up more than once. (STOP LAUGHING!! It's totally true!)

At any rate, now I am unsure of my reading audience, and I find myself trending more and more toward self-censorship, which I hate. I just keep wondering if the patient sitting across from me is wondering if I am filing her experience for a blog post for another day. I don't want this to interfere with my relationships with my patients. It was never meant to be a blog that my patients, who knew me as a professional, would read. Maybe that is narcissistic. For all I know, my patients could care less about my ramblings in cyberspace. Patient confidentiality has always been, and will always be protected. Any clinical scenarios that I post are altered from actual occurrences, I imagine I will be posting less of these in the future, as well. So, this blog will be evolving as I try to navigate this slippery slope. Bear with me, readers, and thanks for sticking with me this far...

Office Dos and Don'ts

When I am not on call and juggling office visits and catching babies, I am still working in the office seeing both OB and GYN patients every single day of the week. I realize that most of you spend only a fraction of that time in any physician's office, and frankly, we can tell. Here are some helpful hints to make your day at the GYN go a bit more smoothly:

Ob/Gyn Office *Dos*
1. Do make an early appointment. Whenever possible, make your appointment the first appointment of the morning or the first appointment after lunch. Trust me on this one and see below.
2. Do arrive for your appointment at least 10-15 minutes early. I know, I know, why would you want to show up early when you just *know* you are going to be in the office for *hours* on end. Here's why: The Snowball Effect. Invariably, as is required by the office, your insurance, or pencil pushers from various state and local agencies, you will be asked to fill out some kind of form upon your arrival. These are usually not mind-shatteringly difficult, but they can take time. Then the receptionist has to verify your information, make sure your insurance is still good, find your chart, and send it down the line to the MA/RN who will be bringing you into the office. The MA then fills in any new information, takes your vitals, asks the reason for your visit, and takes you to the room. Imagine what happens when you are "just 15 minutes" late for your appointment, everything that has to be done gets done further and further away from your appointment time. Before you know it, you are in the exam room 30 minutes after your appointment time, and if you think your schedule is thrown off, multiply that by 12-15 patients in a half-day. If all of them are even 5 minutes late for their appointment time, it creates a significant backlog for the physician to overcome. We're good, but we can't reverse time. It's just not feasible.
3. Do know your personal and medical history. Be sure that you have approximate dates of any surgeries or hospitalizations that have occurred in the last few years. Know what body parts you do and do not have. Know what medications (and their doses) you are taking, for the love of all that is holy! I have no idea what birth control pills are in the pink rectangular package, and will not be able to divine it easily. Have a tentative idea of when your last period happened. I also have no idea what is in your medical history unless you bring your records to me to look at or have them sent to the office *before* your appointment, so please don't wave a dismissive hand and mumble something about how "it's all in there somewhere."
4. Do bathe. Applying soap and water to your body sometime in the 24 hours before the appointment is considered common courtesy. I really don't care if your legs or any other areas are shaved, hair maintenance really doesn't concern or bother me in the least, but the courtesy of bathing is much appreciated.
5. Do know what you want to accomplish. Write down the questions that you have or issues that you want to address at your appointment. In the hustle of the office routine, you will probably forget something. Keep a little list on a piece of paper or on your phone to review...and I stress *little.*

Ob/Gyn Office *Don'ts*
1. Don't make a routine appointment for an out of the ordinary problem. This, of all things, is my number one pet peeve when it comes to office visits. If you are feeling depressed, your libido is in the toilet, your uterus is falling out, or you feel like you are bleeding to death every month, even if it *is* just about time for your pap smear, please, please, PLEASE don't call the office to make an "annual exam" appointment. Believe it or not, GYN physicians do more than just pap smears. If you want to see the doctor for a problem, make an appointment for such. Here is something you may not realize: You do *not* have to disclose to the scheduler *what kind* of problem you are having! Simply stating you have a problem you would like to discuss with the physician is totally adequate and spares you any embarrassment you may feel. Annual exam appointments are usually given about 10 minutes, but problem appointments can be scheduled for 15 minutes-30 minutes. This means you get more time with your physician to discuss treatment options and formulate a plan to get you feeling better. In the same vein, don't save up all of your problems for your annual exam; there is only so much we can do in an annual exam. Change your birth control? Yes. Change your birth control, cure your depression, diagnose your infection, and evaluate abnormal bleeding? Not so much. Scheduling the appropriate kind of appointment sets up a "win/win" situation for all involved.
2. Don't expect to get an immediate answer/treatment/cure after one visit. Some problems (like infections) are easy to solve, but some problems are more complex and require data gathering and imaging studies. Your initial appointment may need to be followed by a secondary appointment in order to assimilate information and assess treatment efficacy. You may not have all the answers after seeing your physician one time, but I can assure, you will be headed in a definitive direction for treatment.
3. Don't be rude to the office staff. They are there to do a job, and when you get seen, how you get seen, and certain office policies (like late policies) are totally out of their control. We all work together as a team, and you can bet that if you are a raging b*tch to my MA, I am going to hear about it before I step foot in the room. I can't guarantee a warmed speculum in those cases, either (I KID, NO HATE MAIL, PLEASE!!) On the flip side, if our staff is rude to you we want to know about it, so please share your experience with us.
4. Don't expect your physician to (do even more) work for free. Trust me when I say that much of the "behind the scenes" work that we do goes uncompensated. It is common courtesy to inform you of your lab results over the phone (usually our nurses or clinical staff will do this), however, if you want to discuss the interpretation of your labs or formulate treatment plans based on the lab results? Make an appointment. Physicians' clinical opinions are based upon what we spent years learning; this is our professional service, and we deserve to be compensated for services rendered.
5. Don't attempt to dictate your own treatment. Dr. Google is great for answers in the middle of the night, but printing sheaves of paper dictating how you *think* you should be evaluated/treated is incredibly off-putting. I value an educated patient, and appreciate when my patients "do their homework." This is not the same thing as demanding of a physician a specific test or treatment that you happen to think you may need. We want to collaborate with you about your care, and have spent years of training learning how to do this. Our knowledge is not so easily replaced by We.b.M.D. or W.ik.ipe.d.ia.

And two more months slipped away...

Happy Belated New Year, blog and blog friends! I will spare you the "busy, busy" rigmarole because you've heard it all before. Needless to say, it hardly seems real that the last time I logged on to post anything on the blog was back in October! Life and time have continued to move forward at the speed of light. Over the holidays we (or, more precisely, our builder) finished building the house, we closed (i.e. hemorrhaged money), and then, for extra fun, we moved in...the week before Christmas. Why (you ask incredulously)? Because I'm insane (in the membrane...er, sorry), apparently, and, more accurately, because I already had requested that week off in order to (HA, HA!) relax the week before Christmas. To add to the fun (and this torture was completely self-inflicted, by the way), we just didn't feel *right* about depriving poor little CindyLou and Bean of a Christmas tree and decorations until the week before Christmas (think of the *children!), so we bought a tree for the rental, decorated it and the rental house (including the outside, of course!), undecorated, bought a new tree for the new house, and the decorated the new house once again. I cannot vouch for my mental stability, that bit of madness was unbelievably ill-advised. Regardless, despite several snags, we arrived safely and soundly in the new house before Christmas. Santa even found us and everything! Whew!

So now, I am digging out of boxes, cursing the paper clutter and all of the things that can't be thrown away, but do not yet have a "home." Paper clutter is my true nemesis. We all love the new house. It is so nice to be in a home that is truly "ours" from the very start. Cindy Lou's bedroom is bedecked in lavenders, pinks, and fairies. Bean's is bathed in blues, "Cars" characters, and, let's not forget, monster trucks. We are very happy here, which is good, because (hear this internets) I AM NEVER MOVING AGAIN! (I hope.)

Work is going well, getting back into full swing since the holidays. I find I have so much less to complain about these days. Likely because I am not much on the front lines any more (no more midnight phone calls about cough syrup selection), I am getting more sleep, and more weekends off to play and love on my sweet little family. I still have the occasional fist-clenching moments, like the two sisters, due a week apart. The younger went into labor first, even though the older was *due* first, and the older got so p*ssed off she *refused* to come to the hospital bedside to support her sister. I mean, *dammit* she *always* gets *her* way. (These are grown ass women we are talking about here, you wouldn't believe the adolescent machinations, mostly on the part of the older sister.) Younger sister's baby ended up having an unknown health problem after delivery, which would have made me feel like a criminal that I wasn't there for *my* sister during that time. Older sister's baby was born about a week later and was *perfect,* and I got the vague impression she was feeling quite smug and justified about that. Sad, sad, sad.

There was also the patient whose MIL jumped all over me when, after going to have a "for fun" ultrasound where the US tech said the cord *might* be around or near the baby's neck, I tried to explain that, if indeed the cord was around the neck, there was not a thing in the world I could do about it! I spent 30 minutes with the patient and her MIL, even obtained a (completely normal and beautifully reactive) NST. At the MIL's visit to my partner the next week (for her own medical care) she expressed to them how I just "rushed" them right through the appointment, and how her DIL needed "more TLC" from our practice. GAH! The unmitigated *gall* of that woman! I give up. Haven't seen her or DIL since, and I'm not crying about that one little bit.

So anyway, time marches on...double numbers are luck for me, so I think 2011 is going to be a good one. Maybe, just maybe, I can lose the rest of that weight, organize my life, de-clutter, become a great cook, run a marathon, found a charity organization, and still find the time to be the world's best wife, mother, and doctor. Hmmmmm, probably not! Good to be back, and I hope to write more in the coming year. Hope you are still out there and listening!

Crazy Life

October has a special place in my heart. The fall weather is my favorite, football is in full swing, and the school year is settling into a routine. This year, however, it is also my favorite because September is finally freaking over! In the past 4 weeks of call I have cared for, delivered, operated on, or diagnosed the following:

- A twin IUFD @ 18 weeks, followed by a retained placenta requiring a D&C.

- 3 post-partum hemorrhages, transfused a total of 9 units of blood between them, one of whom almost lost her uterus, but was saved by a B-Lynch stitch.

- An 11 pound shoulder dystocia (baby and mom were fine).

- A 30 week severe IUGR IUFD, barely able to be delivered vaginally due to a contracted pelvis.

- A multiparous unmedicated, "I'm physically here, but mentally I'm not," precipitous delivery followed by a shoulder dystocia, complete with tight nuchal cord x 2, baby with a very purple face, but no other sequelae.

- A newly diagnosed placenta previa, possible accreta at 28 weeks gestation.

- An 8 cm ectopic pregnancy.

- A cervical ectopic pregnancy.

- More preeclampsia than I have ever seen or care to see again.

- A full labor and delivery unit, laboring patients in triage, delivering in the ORs due to lack of beds.

- A 360 pound, 28 year old patient who had never seen a gynecologist with excessive bleeding and a 10 cm complex right ovarian mass.

It's been a rough month to say the least! Not to mention the day-to-day office grind, allergies, a sinus infection that won't go away, and a poor prognosis for a family member, recently diagnosed with recurrent, advanced malignancy. Every day I see something that makes me aware of how fragile our lives really are, and I am so thankful for all with which I have been blessed. So I am taking all that I've learned from the above experiences, gray hairs, angina, and all and pressing forward into October. It can only get better....right??

Little Wonders

I sat with my patient, a new mother, in the examination room. She was there for her first post-partum visit and we were discussing the events of the last few weeks. We chatted about breast feeding, birth control, lack of sleep, how annoying it is that men can sleep through *anything*, and then, I asked, as I always do, about how she was handling things emotionally. I always make it a point to screen for post-partum depression, many times, if you don't ask, they will not tell you how they are really feeling. This time, though she passed the screening for depression, she gave a laugh and said, "For the first time, I know why my mother is the way that she is." She went on to elaborate how she always made fun of how emotional her mother is, and now how she couldn't watch Kleenex commercials any more without bawling like a baby. It is so true. When we become parents we are forever changed, not only do we understand our parents better, but the way that we look at the whole world is different.

For me, it was the same. Before I became a mother, I loved to watch scary movies. The scarier the better. Imagine my surprise when, not long after Cindy Lou was born, and Mr. Whoo and I settled in to watch a horror flick when I realized that I had changed. I could not watch it, couldn't even get past the first 30 minutes. Why? Because there was a little girl child in it who was missing, and I couldn't handle thinking of a child (my child) being lost, scared, and alone. I never realized how many horror films use disturbing images of children before having a child of my own. It changed how I watch movies even now, far removed from the emotional lability of the immediate post-partum days. The same holds true for news stories involving children, footage of the 2004 tsunami devastated me, same for Katrina the summer after. The tears flow more freely now, happy, sad, and wistful. Most of all, music speaks to me, and often moves me to tears. There are certain songs I associate with different stages of my children's lives, and find myself tearing up just thinking of the lyrics. For Cindy Lou, it is "Baby Mine" and "Return to Pooh Corner." For Bean it is "Sweet Baby James" and "Little Wonders." Especially these lyrics:

"Our lives are made, in these small hours, these little wonders, these twists and turns of fate.
Time falls away, but these small hours, these small hours still remain."

So now I know how my mother felt when I was younger, when Cindy Lou turns to find me wiping away a happy tear or two and says, "Mommy, if you are happy, then why are you crying?" Perhaps it is because the transformative joy and wonder of having a part in creating these precious lives fills up our hearts until they break, just a little, from the magic of it all. How have your children changed the way you see the world?


***Cross Posted at Mothers in Medicine***

Aw, yeah!

Hi! Don't you love how I swear that I'm back to blogging and then don't post for two weeks? Time keeps slip-sliding away, but the main reason is that I was on *vacation.* Woo hoo, right? There were good, bad, and ugly parts, just like any old fashioned family vacation. The good: time with family, spending time in, near, and on the water, reading books (for fun!), eating good food, and having absolutely no responsibilities, pagers, emails, or Internet access. The bad: family overkill, NO AC in our rental (and 90 degree temps, if you know me, you know how disastrous this was), mosquitoes the size of my pinky finger (and a blue million mosquito bites), not really having anything to *do*, eating way too much good food, and no Internet access. The ugly: 23 hours in the car (each way!), with a 6 and almost 3 year-old. Yes, you read correctly, a total of 4 of my vacation days were spent driving in the car, with my whiny, don't- know-how-great-they-have-it children, slowly going insane. I believe that the first "Are we there yet?" came about 17 minutes into the trip, so yeah. Fun times.

The hilarious thing is, Mr. Whoo and I were crazy enough to make this trip about 5 years ago, with our just over one year old, and swore we would never do it again. HAHAHA! See how time dulls the sense of abject horror? Well, time, and over $400 per person for plane tickets. The first time around, CindyLou was just a little over one year old, and, while we had a DVD player (the makeshift kind that would hang in between the front seats and plugged into the cigarette lighter), CindyLou had the attention span of a gnat, and would only watch *one* of the many DVDs we had brought for her pacification, er, viewing pleasure. Any other of the videos made her bored, or scream, so we lucky people in the front seat got to listen to Ses.ame Stre.et "Sing Along" approximately 4872 times. The first couple of times, it was cute. We sang along with the songs and giggled at CindyLou's response. The next few times, we grinned and bore it. The next 100 times after that we started making up rude lyrics to the songs and commenting the actors "Mystery Science Theater 3000"-style. Any time after that, we just became hysterical and delirious. Seriously, this 30 minute video was the funniest sh*t we had ever heard. To this day we have quotations from that show (both real and altered) that we use in every day life, including a very enthusiastic "Aw, Yeah!" which came from an owl-type character in one of the songs. At the end of that trip, we (for some reason) kept the DVD, but did not watch it again for 5 whole years (mostly because we could recite it by rote)....until this trip.

We were a good 6 hours into the first day of traveling in the car, the novelty had worn off, and the kids were no longer interested in the snacks, our conversations, or the scenery. We were each "taking turns" choosing movies or music, when CindyLou and Bean just could not agree on a form of entertainment. The situation was devolving, and no amount of Capr.i S.un or Gold.fish could keep our offspring from complaining about one another when Mr. Whoo suddenly got this evil smile on his face, looked at me, and mouthed "Sing Along." My response? "Aw, YEAH!" So we played it. Bean was enthralled, CindyLou was still enthralled, and Mr. Whoo and I were laughing so hard we cried. The rest of the trip, we tried to engage the kids in the old standards such as the "Billboard Alphabet" game, the "License Plate" game, and "I Spy." We tried to give them a little taste of what it was like to travel back in the dark ages before DVD players, iPods, and Ninten.do DS. I'm not sure how much they appreciate it now, but hopefully, in time, they will. It is funny how the things that drive you the most insane are sometimes the best memories that you have. So family vacations, gotta love them. Now I am back in the fray, and just waiting for the next extraordinary happening in an ordinary day. Aw, yeah!

Summertime....

...and the living is, well, kinda crazy. Isn't that always the way? The more free time we seem to have, the more we fill it up with visits to the pool, spending time with grandparents, and trying to keep our kids from growing up so darn fast. I had to take a bit of a break from the blogosphere. I had gotten into a very bad habit of reading too many doctor-bashing blogs, and it was making me incredibly bitter and angry. Partially because of the blatant misinformation being bandied about, and partially because I know so many great, caring, and self-sacrificing people that are physicians, and to hear us all painted with such an ugly brush really p*sses me off. Not to mention how reading about how much people hate us out there was making me wonder why I was busting my *ss going above and beyond for people who didn't appreciate a d*mn thing that I did. So, I stepped away from the screen for a bit, and took the time to look around me.

In that time, life brought several patients my way that helped me to remember why my job is so important and yes, even still, appreciated. I did a 2 am emergency c-section on a woman who was actively abrupting at 35 weeks and helped save her life and her baby's life, as well. I helped two women, one with an early demise due to a fatal fetal anomaly, and one with a heartbreaking term demise to deliver and make it through the absolute worst days of their lives. I attended several "routine" deliveries and got to be a part of the happiest day in many women's lives (dreaded hospital setting and all). And I waited out a prolonged labor, complete with three hours of pushing and a pretty scary shoulder dystocia, and helped a first-time mother to deliver her healthy, 9 pound 15 ounce baby.

In the spaces in between, I got to celebrate CindyLou's 6th (!) birthday and her "graduation" from Kindergarten, enjoy some time with family and friends on the weekends that I have off, and I even successfully completed 2 weeks without eating any carbohydrates at all (and lost 6 more pounds, yay!) I think of this time last year, as we were preparing to make this move, and I was dreading July (as I always did, with OtherDoc's mega vacation looming in the foreground). This year we have vacations planned in July and Bean's 3rd (can you believe *that*?) birthday, and only 1 full weekend of call. I am finding my life again, and still getting to work in a field about which I am just as passionate, now with less burn-out! Whee! I also want to thank the sweet anon poster who asked that I not give up on the blog...don't worry! I may lose chunks of time in between posts, but I won't forget about you guys. I just have to find a way to make this blog funny again, and not so depressing and whiny! I will continue to fight the good fight for Ob/Gyns out there, and do my best to stop the rampant fear mongering by providing the example which contradicts the general blogosphere "rule." Good doctors do exist, we by far outnumber the "bad" ones, and we prove it every. single. day. Happy 1st day of summer, all! I am going to the pool. :)

Far from Fine

I am blessed. I have a great family, healthy children, a loving marriage, a career that I (mostly) love, and many good friends. But I still have things that I worry about, there are still things that are far from fine with me. Despite a 22 pound weight loss on my previously mentioned program (woo!), I am still obese and now that I am "graduated" from the program, I find the bad habits slipping back in and pounds creeping slowly back on. I eat when I am stressed. I am stressed a lot. Therefore (logic 101) I eat a lot. I wish I ate a lot of vegetables, or even a lot of fruit, but mostly I eat a lot of pasta. It must release some kind of serotonin, because it calms me like nothing else can (except wine, and I *really* don't want to go down that slippery slope, you know?)

I'm worried about our country's path, our future, my children's future. What the hell is going on with our politicians...all of them? Our government is so perverted from what our founding fathers originally envisioned. It is almost laughable, but worse, it is scary. I am scared to death about freedoms and rights that are being stolen from us right beneath our noses in the interest of some kind of unrealistic, Utopian "greater good." Many of my friends "get it," but there are also many that don't understand what I am saying or seeing, and it drives a wedge in these friendships.

I am worried about the future of my profession. I can see what is coming down the pike in the coming years. It is ugly and is going to get uglier, and I'm pretty sure that physicians had a hand in sealing the demise of our profession as we know it by being the types of people that physicians are...altruistic to a fault. While I'm doing what I can on a local level, I feel helpless to change the runaway freight train that is the bureaucracy surrounding what should be built on a case by case (patient to physician) basis.

So, I fret, and rage against the machine, and beat my head against the wall trying to get people to understand what they refuse to try to understand in both my personal and professional life, and I eat. I recognize that I am self-medicating...but what? Frustration? I'm not clinically depressed. I do have some anxiety and OCD tendencies, but nothing that has been interfering with my daily life. I am just using food as a crutch, instead of healthy sublimation like exercise, I am raising fork to mouth to push down my feelings, my fears. It isn't working for me. So today, after having pasta for breakfast after a particularly harrowing weekend call, I got off of my arse and went for a walk. The hardest step is the first step out the door. Right?

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**

"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. ;)

Answers for A

I recently received a comment on the blog posing the following questions. At first, I was going to just correspond via email, but I thought perhaps my readership could also jump in on answering these questions from "A," a 3rd year medical student considering Ob/Gyn. So, thank you in advance for your help!

Hi Dr. Whoo,

I have thoroughly enjoyed reading your blog and appreciate the time and effort you put into your posts to provide us readers with a glimpse of your life. I am currently an MS III with only 6 months left to decide on what to do with my medical career. My top 3 choices are OBGYN, Anesthesiology and Psychiatry. I loved my OB rotation and feel that the field is a perfect blend of medicine, surgery, procedures and primary care.

Hello, A! Thank you for the nice words about the blog, I am glad to be able to provide a glimpse of life in the world of Ob/Gyn. I agree that Ob/Gyn is a perfect blend of medicine, surgery, procedures, and primary care. It is a really great field, but it does have its limitations.

However, I am afraid to commit to the field for the following reasons:

-Work hours. I cannot get a straight answer from the academic faculty on what to expect after residency. Most of them have flat out discouraged me from choosing OB, telling me that I should just do one of my other 2 choices. Is it possible to find a job working 60-65 hours/week and still come out with a salary of $250-$300k in smaller cities in midwest or the south? I just want to be well-informed of what to expect before I take the plunge to ensure that I don't end up hating my career .

HAHAHAHAHAHAHA! Ahem, I mean, ah, not likely right off the bat, at any rate. I think you can get the salary you want with more work hours, or the work hours you want for a lower salary, but it would be rare to find the above combination just out of residency. My average work week (5 person group practice) is right about 60 hours with weekday call, 110 hours for weeks where I have weekend call. As an employed physician, I make less than $200,000. My pay will increase with each employed year until I am able to "buy-in" to the practice. After that, my income will increase (but a large portion of it will go back into buying into the practice). After about 5 years of "paying my dues," I will be able to set my ticket for income. It just takes some time.

At my previous job, I made over $250,000, worked in a rural, under served area with high Med.icaid, and only had 4 days off per month, so 168 hours the weeks that I worked weekends, 120 hour weeks the weeks when I had the weekend off. Trust me, it is far better to make less money and work less hours, especially now when O.b.ama.care looms on the horizon. (Plus, think of the taxes you will be paying on a higher salary, you may get to keep more of your money working for a lower income.) So, while I am sure you can find some places where low work hours and higher income combines, that would certainly not be the norm until you establish a practice.

-Liability. How stressful is this aspect of OB if I choose to move to a state with Tort Reform or low liability?

Liability, Tort Reform or not, is always stressful in OB. It will loom over your shoulder with every decision you make, especially with respect to managing labor and delivery. Even when you uphold the standard of care, you can still be sued for bad outcomes, and all it takes is one case to destroy you financially, personally, and professionally. Malpractice premiums are fairly exorbitant in the field, as well. You may not be able to cover your malpractice costs if you have a poor payer mix, meaning more volume, which leads to more chances of things going wrong. Vicious cycle. Most of the time, it is just like static noise in the background, other times you hear the alarm bells clanging. You get used to it, but it is always there.

-I am a male (a minority in the pool of OB applicants). I have been told that being a male would make it difficult for me to find a decent job because practices tend to prefer women OB's (hence males have to settle for worse locations, work hours and call schedules). How true is this?

Well, to be honest, I am not sure, since I am not a male. (Any male Ob/Gyns out there want to field this question?) I know that in many of the positions for which I interviewed, they were very interested in procuring a female physician. One field that you may consider, if you are so inclined, is the field of Urogynecology. I think it is a 3 year specialty after residency. It is a more surgery-heavy specialty, and, in my experience, still fairly male-dominated. You still get some procedures, good primary care and a lot of good surgeries, no babies, so less liability, and likely better hours and compensation overall. I hope that these answers helped somewhat, and I hope my readers are able to clarify further some points I am not able to elaborate upon. I truly wish you the best of luck with the rest of your training, and in whichever specialty you choose to pursue.