Sunday, February 3, 2008

Perfectly Said

A comment on OB/GYN really hit the nail on the head for me. From Agraphia:

I divorced my husband during the third year of obstetric residency, which was a second residency. My daughter and I hardly missed him by then. He never made it to her school functions, recitals, science fairs, ever. But, I think that was just him. He found time for things he wanted, like on the phone and hanging out rehashing the political garbage of residency with his “family” of residents. He was rarely home when he was there. He was chronically exhausted, mean, and self-focused. He became obsessed with malpractice issues and how to keep everyone from getting his money. I started the first residency “with him” and my focus was appreciating him when he was there, not bitching like I heard so many wives. Our lives were on hold all of the time … at age fourteen his daughter doesn’t know him and doesn’t want to. Nothing is more sad or tragic. I know it would be that way either way. The system of training, indoctrination, and expectations beyond what is humane is the cause. Why do people go along with it … and lose their loved ones/families? It is so unnecessary .. it is about control of money and litigation. He went from being disturbed about the way women and babies were treated and wanting to get a journalist to cover it in his first year, to becoming shut-down and numb so he would become stuck in the financial obligations that keep them there.

If the system would allow real midwifery, the load of the care needed could be divided between doctor, nurse, and midwife. A midwife is glad to be a woman’s primary caregiver and be there throughout, which is really important emotional support. Doctors have to be in the office doing monthly exams, available for surgery and births night and day. It’s crazy-making for everyone except the hospital coffers. If nurses and midwives helped play a part in the care of pregnant women, it would be acceptable for the doctor to just show up at the last minute, do the medical deeds and move on.

Of what service is the current system to women? They are forced to accept only the care of an OB, that when all is said and done is so inadequate and minimal. The tragedy from my perspective is seeing a man turn into someone so nasty to women. Why do we expect them to be all to everyone … so that end up tragically giving such poor quality to all?

The reasons that I feel surgery wasn’t for me drew along very similar concerns. Having a family, who doesn’t want you home, being completely consumed by your job and having nothing to do with people outside of the hospital are absurd events that many residents go through when entering demanding fields. To me, it’s just not worth it. I feel, and hopefully will always feel this way, is that there is no failure more complete and absolute than to fail as a parent.


Bostonian in NY said...

I have similar concerns, but not the wife & kids to drive it home like you. My PI's ex-wife is an OB/Gyn and it directly contributed to the downfall of their marriage.

Mel said...

"To me, it’s just not worth it."

I can't help but wonder where medicine would be if everybody harboured the same mentality.

Bostonian in NY said...

Give it time'll understand soon enough.

Medicine in the current US system will consume your life, and if you're not careful everyone's lives around you. We happily make the sacrifices of money and time to the persuit of serving other people as physicians. It's when you get to the point losing your relationships with family, loved ones and yourself because of the status quo expectations of your profession that really twists the knife and makes the choices tough.

Our current educational model is based on something designed in the 1800's by a bunch of single white male nerds who never considered the value of family above their professional calling. They're called residents because the training physicians actually lived in the hospital caring for the sick. When you try to fit a young, well-rounded family man into that mold something always ends up cracking.

Mel said...
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Mel said...

Personally, I've never been in a situation where I've had to weigh my academic or professional integrity against a personal relationship. Nonetheless, I doubt that the decision as to where my commitment lies would be a difficult one-- particularly as fewer concessions exist for women physicians attempting this balancing act between their profession and their biological compulsion to have kids...

Traditional gender roles still play a major part in marriage and relationships (loathe though I am to admit) and limiting one's professional life for family reasons is a concession that I'm unwilling to make as there's such a wild discrepency between male/female parenting roles.

Then again, I've yet to so much as start my medical degree so this is all uninformed speculation on my part, hah. On a related note, I found this a really interesting read.

MSG said...

It is definitely something that a lot of people don't understand - the desire to succeed at both your professional and family lives. There are careers in medicine that allow you to do both of those and there are careers that require you to give 100% to the job.

To me, medicine is just a job. It's not a calling, a devine right, or the end all be all of a life. It's just a job and I refuse to have my life characterized only by a couple letters following my name and a lifetime spent in the hospital.

I applaud those who will sacrifice their personal lives, but once you have a family...have children, it's no longer worthy of fanfare to abandon your other role.

Liana said...

mel, I honestly believe that medicine would be in a much better place if everyone harboured the same mentality.

Like MSG, I view medicine as a job. I find it very fulfilling and I endeavor to do it well, but I think you can accomplish that without sacrificing everything else. In fact, I would venture to say that most people cannot do medicine well without balance in their lives. If you're too busy working to eat and sleep well, to spend time with your loved ones or to pursue other interests, you'll burn out pretty damn quick.

When all is said and done, I doubt I'm going to be lying on my deathbed thinking "Dammit, I wish I'd done more dictations."

Canadianpsychres said...

I agree medicine is a awesome job! I couldn't imagine doing anything else-I love my work, the patients are interesting and challenging and at the end of the day I get to go home with the feeling that what I do matters to someone.

At the end of the day I also have the privilege of going home to spend time with my family who I love and I get to provide them with the comforts that I think they deserve.

Mel said...

"It's no longer worthy of fanfare to abandon your other role."

I'm stating the obvious but is fanfare alone enough to motivate specialisation in surgery? Surely the majority of surgeons aren't fuelled by such petty incentives. There are plenty of easier ways to bask in worship if that's what's topping one's agenda.

I agree that many fail to understand the need to succeed in both their personal and professional lives and I'll freely admit I'm one of them. In the inexperienced and overwhelmed eyes of a highschool graduate, the two are mutually exclusive.

Balance seems near impossible in a profession which (to some degree) enables and encourages OCPDs in its practitioners.

MSG said...

It is the nature of surgical training (amongst others) that does, in fact, hold those in high respect for whom their work is everything. I've seen surgeons talk reverently about a colleague who works all the time and, once, didn't see the house his wife bought until a week later. To me that's absurd, but the training surgeons, OB/GYNs, etc. receive ingrains a feeling that they are less of a doctor for trying to find balance outside of the hospital. Balance is a hard thing to find in medicine, but one-sidedness towards your job, no matter how great it is, does not lend itself towards a responsible individual.

Liana said...

I think the trend towards sacrificing your personal life for your professional life is slowly shifting, even in medicine (and even in surgery).

In med school, we had quite a few speakers talk to us about balance. We were encouraged to talk to counsellors if we were getting overwhelmed. When a close friend and classmate died, my school let me miss all of my clinical activities and then write the exam when I was ready. I remember being on elective and running into clinic late because the previous clinic hadn't finished on time. My supervisor asked me point blank: "Did you eat lunch?" I told him no, and he basically got someone to go out and buy me lunch and lectured me: "You're just starting medicine. Do not skip lunch. You can't be a good doctor if you don't take care of yourself."

In residency, nobody was applauded for coming in to work sick. They were sent home because they were a danger to patients. And our contract now has a 24-hour time limit on our call duties, with no more than 1:4 in-house call.

Maybe I should just post this on my own blog.

Zac said...

Funny you should post that comment, it really struck me as well... I think she summed up what I was trying to say very, very well. Keep up the good work, MSG :-)