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.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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