Friday, May 23, 2008

Holiday weekend

As an obstetrician my most difficult days are holiday weekends on call. These typically begin with calls from patients who have been trying to go into labor all week. Patients who know their own OB will be off for the next three days and they can't bear the thought of delivering their baby without him. Some of these patients actually make it in to labor, usually after their physician has left town. When they labor, the obstetrician on call delivers the baby and the patient is happy feeling so much better in her un-pregnant state. In these cases the on call obstetrician will be the hero by virtue of the fact that she drew the short straw and was the one who remained.

Of course there are patients who don't go into labor, many of whom are miserable near the end of pregnancy. Some of these women need to call and explain how terrible they feel. If these calls are between the hours of 7 AM and 10 PM and my family has left out of town for my weekend on call, these needs are easily met. I do what I do most days. I listen to the complaints, many of which come under the heading of "discomforts of pregnancy." Included in this category are maladies like indigestion, swollen feet and ankles, heat rash, and insomnia. Asking a few pertinent questions to determine there is no emergent need for the patient to be seen, I give her reassurance about the normalcy of her pregnancy along with tried and true home remedies for alleviating these discomforts.

What I do not do well with are calls at 2 AM and especially those that begin, "I have had this problem for the last two weeks and ...." Hearing this my first thought is "Well if this has been a problem for two weeks, why on earth did you not call your physician, who knows you much better than I, during daylight, weekday office hours for his advice and treatment." I never verbalize this however.

If an symptom that prompts these emergency calls in the middle of the night has been present for more than twenty four hours, I usually begin with, "What about (name the symptom) has made you call me now." The answer will usually fall into one of two categories. The symptom has gotten worse. Or, the most likely reason, at night the patient has time to think more about this symptom and how long it may have been there. Her thinking is compounded by the fact that she found out yesterday her mother's youngest sister, was diagnosed with breast cancer and she fears that she may have the same.

Again, if this is not a true emergency, I try reassurance and a promise to get the patient into the office as soon as the schedule will allow. If there is a need for someone to be seen in the emergency room for a gynecology complaint the wait can be a long one. The number of true emergencies rises as the holiday weekend wears on. More traffic on the highways and lakes along with increased consumption of alcohol will put ER space at a premium.

So, as the holiday weekend approaches, I have stocked up on message pads. I have two books to read and a movie to watch if I am stuck at the hospital with laboring or emergency patients. I have been playing classical music since I arrived this morning. And I could be pleasantly surprised with opportunities to do yard work, rearrange the den furniture and walk the dog between hospital rounds, deliveries and phone calls.
Holiday weekendSocialTwist Tell-a-Friend

Thursday, May 22, 2008

Natural childbirth

I am always curious about the patient's expectations when she informs me that she desires a natural childbirth. For some women this simply means that they do not want a Cesarean section. Others want to labor and deliver completely unmedicated: no drugs, no epidural, no interventions of any sort. A patient once stated that for her natural childbirth would mean that she did not have time to put her make up on before leaving for the hospital. A few months ago I was a participant in a birthing experience that was natural by any definition.

The patient, her husband and their two children arrived at the hospital in the middle of a week day when the labor and delivery unit is typically the busiest. She had called him at work when her contractions were three minutes apart. This was their third baby. The second baby delivered within two hours of the first contraction. The dad, who I will call S, left his high profile job downtown to rush home. Shuffling his wife and kids into the family minivan he rushed the entire family unit to the hospital.

When I arrived in labor and delivery the entire family, including the two older children were in the labor room along with two labor nurses frantically trying to fill out all paper work. Monty Python may have taught us that a delivery cannot occur with out all the proper noise making equipment* but the modern legal profession and hospital administration has hammered into the nursing staff that no baby may safely arrive with any blanks on the admission form.

"She's 5 centimeters." Michelle the primary nurse assigned to care for the patient called out as I walked in the door.

S, still dressed in his three piece Brooks Brothers suit complete with tie in place, informed me that they did not know the gender of the baby. "When the baby delivers, don't tell us the baby's sex," he instructed. "I will cut the cord." Continuing his role as the one in charge he told me, "I will be the one to hand the baby to L." L, his wife, mother of the baby, was lying in bed panting through a contraction oblivious to our conversation.

Always sure of my role as "captain of the ship" (a phrase attorneys use, usually when something has gone wrong), I was not bothered by S's assertions. I have long given up a need to tell everyone I am making the decisions. When there is a crisis usually everyone wants me to make the decisions and they give me their attention quickly. Otherwise I do my job and hopefully help make the birth the joyful experience that it truly should be for all who are present.

As soon as I received my instructions from S, L's bag of waters broke in a huge gush of pea soup appearing fluid. This is called meconium stained fluid and means the baby has had a bowel movement in the bag of waters. By the color the meconium looked old meaning the bowel movement probably occurred sometime before the onset of labor. Not a problem by itself, meconium stained fluid is dangerous if the baby sucks this thick, irritating material into her lungs as she takes her first breath. Called meconium aspiration, this is a condition can result in the need for a ventilator, lung damage and even death in the newborn. To prevent the occurrence of meconium aspiration the obstetrician must use a delee, a suction device to suck out the baby's nose and mouth after the head is delivered but before the shoulders arrive. This feat requires a controlled, cooperative patient, a skilled obstetrician, a helpful husband and a nurse to assist. It seemed that at least two of these four were present.

This is when I noticed the double stroller. The kind where there is a seat in front and one behind. Four year old big sister sat in the front seat playing with her dolls and a two year old about to be big brother was behind her with one of those "board books," the type with the thick cardboard pages that are easy for toddlers to turn. Both kids seems to be fairly calm and satisfied for the moment. Turned away from all the action they were facing into the corner of the room.

Looking around again to make sure all the equipment ready, I noticed a cord blood collection kit. The patient expected me to get a bag full of the baby's umbilical cord blood, after the dad had cut the cord of course. Coming from the umbilical cord and the placenta after the baby no longer needed it, rich in embryonic stem cells, this blood would be cryoperserved in a cord blood bank in case any of the family needed a stem cell transplant.

L cried out, "I need to push!" Checking her cervix again, I confirmed that she was completely dilated and should being pushing. Delivery was imminent. As the green head crowned, the future big brother began to harass his sister sitting directly in front of him in the stroller. Watching the baby's head with one eye, I saw the stroller begin to gyrate out of the corner of my other eye. I ask the second nurse, still attending to paper work, to please check on the older siblings. S was fully focused on his wife and helping her breathe and push. For them, it was as if these other two kids did not exist.

Some how even with S's arms grabbing for the as yet undelivered baby, I managed to delee the baby's nose and mouth removing a great deal of meconium stained fluid from them. Satisfied that he would not aspirate the meconium, I delivered the rest of the baby and continued suctioning until he began to cry.

At this point over in the corner, the now big brother was taking advantage of the opportunity of being totally ignored. He whacked his big sister over the head with his book and she began to wail louder than the newborn. Again, the parents were totally oblivious to anything their older two children were doing. I again ask one of the nurses present to please break up the fight.

L was holding the baby on her abdomen, helping the nurse to dry him off and wrap him in warm blankets while S photographed them both. The two kids in the corner continued to fuss with each other fortunately now without bodily contact while I collected the umbilical cord blood and the second nurse did more paper work.

The placenta delivered and I began massaging L's fundus, the top of the uterus, to prevent hemorrhage. S looked directly at me and commanded, "Stop that! She won't be able to smile for the pictures." At this point my patience began to wane.

Stopping the fundal massage for a moment, I explained to both S and L, "Without fundal massage L, you will bleed." Finally having their attention I continued massaging, "After a third baby there could even be enough bleeding to require a blood transfusion. There will be time for pictures in a few minutes."

With the post partum uterine bleeding at a minimum, I cleaned up the delivery table and the middle of the room, carefully placing all the trash and linen in their proper containers. Covering L appropriately with sheets and blankets, I then invited S to take all the pictures he wanted as I walked over to the stroller and turned it around so that the two occupants could meet their new baby brother.

This delivery was about as natural as a birth could possibly be in a hospital setting today. One of the nurses informed me that the patient had been there all of nine minutes when the baby was born. At this point, I congratulated the couple excusing myself to do my portion of the paper work.

*from the movie "The Life of Brian."
Natural childbirthSocialTwist Tell-a-Friend

Wednesday, May 21, 2008

Job description

From before the moment of our first breath we are on the path to our last, our hearts beats a finite number. As physicians we are charged with preventing disease, curing disease, restoring patients to health. Our training makes anything less seem a failure. Yet, life is such that disease and death are inevitable.

For those who practice medicine a worthy goal is also alleviation of suffering. In doing so disease does not always have to be eradicated to make and keep a person whole.
Job descriptionSocialTwist Tell-a-Friend

Tuesday, May 20, 2008


"It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change." -Charles Darwin
AdaptationSocialTwist Tell-a-Friend

Monday, May 19, 2008

Makes me smile

If, on a Monday morning, you are wondering, "Is it possible to drive the boat, pull a skier, hold on to the dog and still take a picture?"

The answer is "Yes!"

So "Why then?" you ask,

"Is the dog climbing in the boat, too?"
Makes me smileSocialTwist Tell-a-Friend

Friday, May 16, 2008

Need for less speed

Veering away from medicine for a moment please direct your attention to the problem of rising gasoline prices. Does anyone remember when the speed limit was dropped to 55 miles per hour?

On my morning drive to work I have routinely used this tactic as a way to conserve fuel in my already fuel efficent Honda. This morning as I drove 55 on a freeway where the speed limit is 60 and many drive 70 miles per hour, a city bus roared by me going at least 65. Five miles down the road, still driving my self imposed speed limit of 55 I caught up to the city bus and all the sports utility vehicles that had rushed by several minutes before. Traffic had slowed at the interchange as we were entering downtown and we were all now traveling at a reduced rate of speed. I suspect that all of us arrived at our destinations similtaneously.

This fact caused me to remember a reduction in something other than fuel consumption when the speed limit was reduced to 55 miles per hour. We saved lives with a lower speed limit. There are those that will refute this fact. One item that gets in the way here is that cars are now safer with elaborate air bag systems in place to protect passengers. We really don't know how many lives we would save driving a bit slower in these safer cars.
Less cost, less loss, about the same arrival time. Do we need all this speed?
Need for less speedSocialTwist Tell-a-Friend

Thursday, May 15, 2008

Diagnositic dilemma

More than 17 years ago I made the diagnosis of my mother's lung cancer. This happened inadvertently on a trip home. I was seven months pregnant with my youngest child and it was to be my last excursion before I could no longer travel.
As my mother greeted me when I arrived her fingernails jumped out to me. They were clubbed. At first I didn't believe it but through dinner and as we cleaned up afterwards I couldn't take my eyes off of her hands. I would look away hoping that when I looked back they would somehow be different.

I knew the differential diagnoses for clubbing of the fingernails. There were many illnesses on the list that were not lung cancer. I also knew that with all her years of smoking, lung cancer was the most likely cause of the clubbing. Over the years the worst dilemmas I have encountered as a physician are all the illnesses I diagnose in those that are not my patients. It is especially difficult to manage the role of family member and physician simultaneously.

I suspect that my mother had not been feeling well but she was not one to complain. She even denied feeling ill when I began to question her about her health. She had not seen her primary care physician in several months confessing to me that she did not really like him. So much for my first idea of calling and making an appointment with my parent's local physician, telling him what I suspected so that I could resume my daughter role.

By the time my visit was over, I had convinced my mother to return with me to my home where I could get her into see physicians I knew. Both my parents felt very comfortable with this arrangement. I suspect they were very relieved and even wanted me in charge of my mother's care.

While my parents were comfortable, I was miserable. The radiologist called me personally while reading my mother's chest X-ray rather than talking to the internist with whom she had an appointment. This left me to deliver the diagnosis to my parents rather than going with them to hear someone else break the news.

One of my closest friends ask me how I felt about all of this. The truth was I had been waiting all my life for my mother to get lung cancer. Since elementary school I knew that smoking could lead to lung cancer. I was not surprised. I was angry. I was angry about many things but I believe that most of all I was angry that I made the diagnosis.

I loved medicine. I loved my mother. I wanted someone to give me the diagnosis gently, holding out some hope, comforting me in some way as well as comforting my parents. Giving all this up seemed unfair. It also seems selfish but at the time and even now I regreted being a physician.
Diagnositic dilemmaSocialTwist Tell-a-Friend

Wednesday, May 14, 2008

First visit

Early in my medical career, I was privileged to practice with a wonderful, witty physician who was well known and respected by physicians and patients alike. Much of my philosophy of medicine developed as we worked together.

The son of a prominent gynecologist and the grandson of a prominent Methodist minister, I am sure that Dr. S had his choice of careers. His college major was philosophy. Enjoying both people and science he followed his father's foot steps into medicine. After four years of medical school, a year of research and four years of residency he joined his father's group of obstetrician-gynecologists in private practice. The following is a story that he once told me about a new patient he saw in his first week in the office.

It often falls to the newest doctor in a practice to see the newest patients. Sometimes these patients are the ones with the worst problems. At other times they are simply the patients that will take more time. This was the case one day when the young Dr. S was given the chart of a 15 year old girl brought to the office by her mother for prolonged and heavy vaginal bleeding. The girl's mother was a patient of Dr. S's father.

Dr. S carefully went through the new patient history recording every detail. The young woman was shy but his calm, jovial manner soon had her smiling as the two of them engaged in a conversation about her medical history with her mother present. The young woman stated that she had never had sexual intercourse nor used tampons and at the mention of an examination she seemed very hesitant. Dr. S explained in detail how he would do a pelvic examination to determine the cause of her heavy and prolonged bleeding.

Concluding his explanation, Dr. S ask the young patient if she had any questions. Amazed at the idea of a pelvic examination, which obviously her mother had not explained to her before their arrival, the young woman's face became quizzical. "I just have one question." She leaned over almost as if to whisper so her mother would not hear. "Does your mother know what you do for a living?"

Dr. S, with I am sure a gleam in his eye, leaned a bit closer to her as he whispered back, "I think she must," came his quick reply. "You see my father does the same thing."
First visitSocialTwist Tell-a-Friend

Tuesday, May 13, 2008

Birth certificates

In the fall of 1980, on a cool October Friday night, I delivered the first baby of my medical career. As a third year medical student, I was one week into my second clinical rotation. For those who are old enough to be fans of the television series Dallas, the delivery occurred during the episode where the world was finding out that Sue Ellen shot J.R. That fact was part of the reason I got to do the delivery assisted only by the mother of the baby and the lowest ranking LVN in the labor suite at Jefferson Davis Hospital in Houston, Texas. Everyone else in the hospital was watching Dallas.

At the time that I delivered that baby boy, the birth certificate, an important document which is key to much in life, was filled out and signed by the physician who delivered the baby. That night filling out that document seemed almost as important as the delivery of the baby. I was as meticulous with this task too. The resident physician who was supervising me (from the TV room) was required to sign it. 1980 was back in the pre-electronic era of pen and paper. A blank at the bottom of the page was for the physician or midwife who "attended" the delivery to sign, attesting to the truth of the information contained on that page.

Since that night I have signed countless birth certificates. When I was a resident obstetrician the hospital would not issue your pay check if you had any incomplete charts or unsigned birth certificates. Many of my colleagues were caviler about both. They must have missed the lecture on vital statistics in medical school.

In addition to the date and the time of the birth along with the weight of the baby, the birth certificate contains a wealth of information. Facts such as the county and state where the child's mother and if she is married, her husband, were born. If the mother is unmarried at the time of birth, the father must sign the birth certificate himself to have his information included. Information about the mother's other pregnancies if there were any and whether or not the birth was one of multiple births such as twins or triplets. Also the mode of delivery: vaginal, operative vaginal (forceps) or Cesarean section is listed.

Today birth certificates, in Texas at least, are not signed by the person who attends the delivery. The birth certificate is a computer generated document filled out by a records clerk in the hospital. The information is provided by the mother and also taken from the hospital delivery record. This allows the birth certificate to be filed in a timely fashion. It also facilitates the issuing of a social security number for the newborn.

In this the electronic age, I appreciate the need for swiftness in the filing of the birth certificate, a vital document in establishing an identity. Yet, I am dismayed when I think about the human touch that has been lost. There is no review of the information recorded by a person who knows the mother and hopefully the father of the baby. There is no signature of someone who was present with these parents in that all important moment when this person, whose birth is being certified, made her entrance into the world.
Birth certificatesSocialTwist Tell-a-Friend

Sunday, May 11, 2008

Thought to remember

"Although the world is full of suffering, it is also full of the overcoming of it."
-Helen Keller
Thought to rememberSocialTwist Tell-a-Friend

Thursday, May 8, 2008

We have come along way and...

In beginning The local MD I left the gender box blank deciding to avoid the issues of being a woman in medicine. The advantages to being female in medicine are many. For instance in an illness most of us want to be cared for by our mother. The advantages in my specialty of obstetrics and gynecology are also obvious, not only do most woman want their mother when having a baby, they want someone who has had a similar experience and has lived to tell about it.

I never spent time dwelling on discrimination issues when it came to gender. Recently when interviewed by a medical publication, I was ask, "What has been the most difficult aspect of being a woman and practicing medicine?" I didn't even have to think about it. "Finding nice looking comfortable shoes." was my instant reply.

On July 1 it will be thirty years since I matriculated at Well Known College of Medicine . I was not one of the ground breakers since women had been in almost every medical school class for well over fifty years. Yet the women numbered only twenty seven in a class of 168. All but one of us graduated four years later. I have no idea how many are still practicing.

I never found it difficult being female in medical school. If anything because women stood out a bit more than most of the men we seemed to have more opportunities. The surgeons I worked with wrote me wonderful recommendations but only after finding out that I was entering what was considered an acceptable specialty for women. For my friend who wanted to pursue cardiothorasic surgery the attitude was different.

Having done reasonably well in medical school, I chose a residency where there was a great deal of competition for positions. The program that I ranked number one on my match list had a special history. Only five women had finished the program in more than forty years. Two of the last four females this program accepted left after the first year. When I interviewed with the program director he asked me two questions: "Is your husband willing to move to this city and when do you plan on starting your family?" Rather than file a lawsuit, I quietly answered that my husband was ecstatic at the prospects of moving and we really wanted to wait until after my residency to have children. The truth was that my husband would have to give up his job to move. Finding new employment would be difficult in the economic down turn the area was experiencing and we could not even afford to thing about having kids.

I was awarded a residency spot and spent the next four years as the only woman in a program with eleven men. In the end I was one of the guys. It is funny now that I look back on those years and realize that I did learn to think like the men. I also became very good friends with many of the nurses and the few female attending physicians, most of whom were anesthesiologists and pediatricians, who were on the hospital staff.

When I finished my residency, I joined a group of physicians, all men of course, at Big Name Medical Center. Practicing medicine with them went smoothly until my first child was born. Strange as it now sounds, that was really the first concession I made to my gender. I never guessed motherhood would become such an important part of who I am. I only planned to take three weeks off after N was born. I did return to work after three weeks bringing N to the office with me as I arranged my schedule to breast feed while hiring an additional person to care for him as I saw patients.

When my second child, B, was born, I realized the envy that my situation produced among my partners. One of the younger partners, who had children and a stay home wife, told several of my patients that I was trying to "have my cake and eat it too" as if working and motherhood should be incompatible. I was taking six weeks of unpaid leave to "have it all". I did not have it all but I was getting the best portion. Proof of that fact was a conversation my partner had with his young son one morning. Asked why he had to go to work all the time, my partner replied, "That is what Daddies do. Mommies stay home." "No!" His son replied, "When I grow up I will stay home with my kids and my wife can go to work!"

My time off was not only for recovery from childbirth. My mother was diagnosed with lung cancer one week before B was born. As an only child I became her primary caregiver too. She had surgery and then began radiation therapy. My only solace during this time was the chance to be a mother myself nursing my newborn and playing with my two year old.

Yes, I took six weeks off to have my baby and help my mother, but the partner who complained the loudest fractured his leg snow skiing. He was in a wheel chair and then on crutches for twelve weeks. During this time I took all of his call. The other partner had a rotator cuff injury (also skiing) and could not lift his right hand for several weeks. I preformed all of his surgeries and many of his deliveries for six weeks without compensation.

I am not sure to this day why I did these things but doing them felt much like caring for my children and my mother. These were tasks that needed to be done. I was the junior partner in the group so I did them. One gynecologist outside our group asked me, "How difficult is it to be 'the boy' when you are a girl?" If ask that now, I would reply, "I am not 'the boy.' I am simply doing what needs to be done." I was the caretaker of my immediate family and of the family made up of those with whom I practiced medicine.

While much has changed in medicine, there is still a huge gap in salaries between men and women. I believe this is due to differences in practice patterns. I limit the number of surgeries that I will do on any given day. I am no good after a certain number of hours in the operating room. It has been shown in several studies that women spend more time with each patient than our male colleagues. I believe that I and my female colleagues ask and answer many more questions when seeing patients. We are not as procedure oriented and try to fix more with medication or life style changes.

I could go on but I think the point is that men and women do things differently. There is not a right way and a wrong way, a good way and a bad way. There are just different ways. As I watch patients and friends who are in other professions I see that we all struggle with this gender diversity. I also see that because the population is made up of men and women, women and men are needed in all professions.

After all I am raising sons. I want them to enjoy meaningful work, to have an adequate income and to be able to send time with their families. I feel that women have come a long way and I hope that men feel they have come a long way also.
We have come along way and...SocialTwist Tell-a-Friend

Wednesday, May 7, 2008


I first met Kate when she was 32 years old and coming in for her yearly check up. I was new to practice and her previous gynecologist was retiring. Kate's real given name was Mary Katharyn. She could not give me any information about her medical history but I soon learned that she loved to go to the movies and that her favorite actor was Omar Sharif. She must have seen every movie that he made many times.

Kate was strikingly beautiful. Tall, slender, dark haired with a quick smile and dancing eyes. She had a dramatic way about her and she would even sing a few lines of a movie tune as she became caught up in telling me about a movie she had seen. Kate was on the dean's list her first semester of college. That was prior to the car accident which occurred just before her nineteenth birthday. Now she spent her days much as a four or five year old would under the almost constant supervision of one of her parents.

Kate's mother was a saint. The most patient person that I have ever met, she lovingly and tirelessly she cared for Kate year after year. She never complained even when I gave her permission to do so. Her constant concern was for Kate's well being.

I was thinking about Kate tonight when at dinner I used a trivet that she gave to me. A trivet is one of those little hot plate holders. This one is ceramic and covered with the image of a beautiful butterfly with multicolored wings. The day she brought it to me Kate went into great detail explaining how she choose the colors, painted the ceramic piece and then fired it in a kiln. Her eyes jumped as she described every detail of the creation.

I have not seen Kate or her mother in almost three years. When her father died, an older sister became the executor of his estate. Every thing changed. Their home was sold. I imagine that Kate is in some sort of care facility now. I do not even know if Mrs. E is still living.

Using the beautiful butterfly trivet is not the only time I am reminded of Kate. At the delivery of every healthy baby, when the parents breathe that sigh of relief that everything is alright, I think of Kate and her mother. I am reminded that there are no guarantees in life. As a parents most of us do the very best we know how hoping that the skills that we have will match the needs of our children.

*All names have been changed though those who worked with me may recognize the people as the stories are real.
Kate*SocialTwist Tell-a-Friend

Monday, May 5, 2008


Frequently the response when I tell someone I am an obstetrician is "What a wonderful job!" It is a wonderful job however not in the way most people who make that statement believe it to be. Here are reasons that I believe my job to be wonderful:

First, obstetrical patients are the most appreciative people on the planet. Even if all the obstetrician did was show up as the baby is being born (let's face it, in a large percentage of cases childbirth could happen without an obstetrician), the mother, the father, the grandparents all think that this child could not have made her way into the world without the assistance of the obstetrician. I generally stop to remind the parents (and myself) that their job is much more difficult and much more important than mine. I know. I have been a parent for over eighteen years.

Second, I like my job because when complications do arise during delivery or if it is a difficult pregnancy and the outcome is indeed a good one then I do feel as if I have contributed in making life better for all involved. In these cases the patient may not be as grateful. Perhaps it was not the story book pregnancy she imagined for herself. She and her family may have struggled through some difficult days or even months where she did not feel well, was confined to bed or hospitalized. If she has a healthy baby and she herself is well at the end of the process I will celebrate and then commiserate with the patient and her family for the next several years about how a truly awful pregnancy produced such a wonderful child.

Finally, when the outcome of the pregnancy is terrible, when the baby is born much too early, when he doesn't survive the neonatal period or she is stillborn, I have a chance to be with the family as they begin to heal from a terrible loss. I have learned in my more than twenty seven years of practicing medicine that I will never be able to make sense of these outcomes. I should not expect these people grieving the loss of their child, to make sense of this either. Until the baby is born, I am working as hard as I can to find ways to prolong the pregnancy or treat the condition threatening the baby's health. Once the baby has arrived my job is one of emotional support. If the baby is disabled or dies then the parents will still need care.

Healing comes on many levels at different times through a variety of sources. At times the physician plays a very active role deciding, prescribing, preforming. At other times it is just as important that the physician be present and be still.
HealingSocialTwist Tell-a-Friend

Saturday, May 3, 2008


Propagated by the pharmaceutical industry the term generic means common. Consumers have come to understand that a generic drug will be cheaper than the brand name medication. Patients have also come to understand that this generic prescription may not work as well as the branded alternative. Most let their pocket book make the choice accepting the fact that generic medications only have to provide 80% of the bioavaliability of the original product.

There are other ways that the practice of medicine opts for generics. In health care there is now generic care. Patients are frequently seen and treated by health care providers, not necessarily physicians, who care not for patients but for clients. The care itself is determined by algorithms, flow diagrams that have often been developed by insurance companies or governmental agencies based on research evidence. While evidence based medicine certainly has a role in patient care, it should not stand alone as the sole method of decision making in medicine.

Speaking with health care administrators (the business people who run hospitals, insurance companies, physician groups) one learns that the reason for these changes to physician surrogates and algorithms is to provide better health care and also to save money but not necessarily in that order.

Generic does mean common. Yet when people are ill, common in the last thing that they want. Most patients want uncommon care from uncommon caregivers that they know and trust. This trust is the hallmark of a good patient-physician relationship. This trust plays a vital role in healing. This trust is never generic.
GenericsSocialTwist Tell-a-Friend

Friday, May 2, 2008

Here goes!

"It's spring! The rest of you guys may not be ready but the days are getting longer, the grass greener, the sun brighter. It is time to get out of that rut and enjoy the world. Follow me!"
Here goes!SocialTwist Tell-a-Friend