Healing

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.

Generics

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.

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!"