Editing OBGYN - Introduction

=Putting the “Guy” back in “Guynecology” and other OB/GYN stuff=

==Summary==
*Brief History of OB/GYN 
*Gender issues in ACOG. 
*What do OB/GYN’s do? 

==Brief History of Obstetrics===
*Second oldest profession. 
*Started with midwives.
**In french it is sage-femme meaning wise woman. 
*Most physicians considered it below their dignity.
**Roderigo a Castro (1594): Haec ars viros dedecet: This art is not suitable for men

===Midwives===
*Hippocrates instituted training for midwives in the 5th century B.C.
*Soranus was the leading authority AD 98-138 and wrote the guide for midwives.
*Loyse Bourgeois Boursier (female)
**1563-1636
**Married to a barber-surgeon.
**Wrote a textbook on midwifery.
**Was the midwife to the royal family for 27 years.


*Formal regulation in Western Europe began in the 1700’s.
*Academic courses taught in conjunction with the medical schools.
*Licensure controlled by the government.
*Mainly women as pupils.

===Men in Obstetrics===
*Barber-surgeons trained by midwives in the late 1600’s.
*In France called “sage-femmes en culottes” = "wise women in pants".
*In England they were called Man-midwives.
*John Blunt: “Such a man ought to be treated with as much indignity, as if he undertook to clear starch, hem a ruffle, or make a bed; yea, and with much greater; because in all these he is not called to handle the sacred parts of other men’s wives… man-midwifery is a personal, a domestic, and a national evil”.
*Not fully accepted until the 1800’s.
*Even the English Midwives attacked the man-midwives.
**“the delicate fist of a great horse god-mother of a he-midwife” describing the hands of William Smellie, an early OB/GYN.
**Elizabeth Nihell: “broken barbers, tailors, or even pork butchers...who, after passing half his life in stuffing sausages, is turned an intrepid physician and man-midwife...and what are those arms by which they maintain themselves, but those instruments, those weapons of death!”


*William Smellie: 
**the master of British Midwifery
**considered one of the most important obstetricians of all times and countries.
**Described the mechanism of labor, measured the diagonal conjugate of the pelvis, invented a number of instruments, an OB atlas and a 3 volume OB treatise.


*John Blunt: “the principal business of a midwife in natural labors...is only to press the palm of the left hand against the perinaeum during the birth....”


*Ambroise Pare
**1510-1590
**Reintroduced podalic version (delivering feet first)
**Recommended cesarean deliveries on the living


*Jacques Guillemeau:
**1550-1609
**Student of Ambroise Pare
**Described a technique of breech extraction.
**Used podalic version as a technique of delivery for placenta previa.
***Placenta previa is when the placenta grows / attaches across the opening of the cervix which complicated delivery.



*Francois Mauriceau
**1637-1709
**Textbook was translated into English, German, Dutch, Italian, Latin and Flemish.
**'''Antisyphilitic tx during pregnancy.'''
**Popularized the breech delivery of Guillemeau.
***Renamed the technique after himself.
***Now known as the Mauriceau maneuver. 


*Ignaz Philipp Semmelweiss
**1818-1865
**Determined that hands could transmit infection.
**Instituted mandatory hand-washing before and after each patient.
**Recognized germs decadeds before Lister and Pasteur.
**Got kicked out of hospital, practice, and country for his crazy ideas.

===Physicians in Obstetrics===
*Gradually obstetrics shifted into the male-dominated physician arena.
*Only physicians were allowed to use forceps.
*1909: NYC midwives delivered 40% of all infants.
*1932: Certified Nurse Midwives invented as licensed medical provider
*1963: Nat'lly, midwives delivered 0.3% of all births.
*1963: Southern Blacks, midwives delievered 20-40%

===Gynecologic Surgery===
*Minor Procedures were done for many centuries.
*Early gynecologic instruments from Hippocrates. 
*Cavallini took the uteri from pregnant dogs and sheep in 1768.
**Realized that “The uterus may be plucked out with impunity from the human body.”
**This was a new idea because people though the uterus moved around the body (and was in the head of the woman when she was "crazy" during her period).
*Inflammation of genitals treated with leeches to the cervix.
*1809: First successful oophorectomy by McDowell (father of abdominal surgery).
*1845: Successful repair of vesicovaginal fistula
**Sims was the physician who repaired the vesicovaginal fistula.
**Took him 40 tries on 3 of Sims' slaves.
**Realized he needed needed silver sutures.
*1855: Sims founded a hospital for women in NY.

===Male Domination of Obstetrics and Gynecology===
*From 1800’s to present the OB/GYN field was dominated by males.
*Florynce Kenedy: "There are very few jobs that actually require a penis or a vagina. All other jobs should be open to everybody."

===Women in Obstetrics and Gynecology===
*Mary Putnam Jacoby:
**6th woman to graduate from US medical school (Female Medical College of Pennsylvania).
**Married to Abraham Jacobi (Father of Pediatrics in US).
**First woman in the NY Academy of Medicine.
**Studied rest during menses.


*Emma Call:
**Graduated in 1873 from the U. of Michigan.
**Founder of New England Women’s Medical Society.
**First Female in Massachusetts Medical Society.
**'''Discovered Call-Exner bodies in granulosa cell tumors.'''


*Mary Amanda Dixon Jones:
**1828-1908
**The first person in America to propose and perform a total hysterectomy for myoma (a tumor of muscle tissue) of the uterus.
**Graduated in 1875 from Women’s Medical College of Pennsylvania.
**'''Graduated medical school at 47 years old.'''
**Published over fifty medical articles and was an associate editor of American Journal of Surgery and Gynecology.


*Marie E. Zakrzewska 
**1829 - 1902
**Originally a midwife in Europe but came to the US and studied medicine in the 1850s.
**Founded the New England Hospital for Women and Children in Boston in 1862.


*Georgia Rooks Dwelle:
**1884 - 1977
**Graduated with honors from Meharry Medical College in 1904.
**'''Received highest score on the Georgia State Medical Exam that year.'''
**Opened Georgia's first general hospital for African Americans, and its first obstetrical hospital for African American women.


===Gender Issues in OB/GYN===
*Fellows in OB/GYN
**17,000 Men
**10,000 Women
*Fellows are Board Certified (out of residency for  at least 2-3 years).
**'''So there are still more male OB/GYNs.'''


*More female medical students now.
*More men going into other specialties such as anesthesia and surgery.
*Men are not choosing medicine as a career.


===What do OB/GYN’s do?===
*Hands-on clinical experience every day including: 
*Performing surgical procedures such as hysterectomy, laparoscopy, and urogynecologic surgery.
**#1 surgery is cataracts.
**#2 surgery is c-section.
**#3 surgery is hysterectomy.
*Performing outpatient procedures such as dilation and curettage, colposcopy, and hysteroscopy.
*Diagnosing and treating gynecologic cancers
*Counseling patients on contraception, menopause, sexuality, prenatal diagnoses, and infertility.
*Providing ultrasound examinations.
*Working with leading-edge technologies such as in vitro fertilization.
*Providing high-risk pregnancy care.
*Managing patients in labor and delivery.
*Promoting women’s health issues.
*Participating in women’s health research.


*Medicine: Osteoporosis, Diabetes, Immunizations, etc.
*Surgery: Hysterectomy, Oophorectomy, Cancer and Incontinence surgeries.
*Radiology: Ultrasounds, CT.
*Dermatology: HPV, Rash, Vulvodynia.
*Pediatrics: Neonatal resuscitation, pediatric and adolescent gynecology.
*Emergency Medicine: Acute abdomen, miscarriage/hemorrhage, septic shock, ectopic pregnancies.
*Pathology: Cut on dead people (but only rarely). Make and review slides of vaginal discharge.
*Psychiatry: Depression in women, especially pregnant women.
*Genetics: Fetal diagnoses, Population studies.

===What don’t OB/GYN’s do?===
*Medicine: Round Forever
*Surgery: Yell and scream or torture young jedis.
*Radiology: Sit in dark caves all day.
*Dermatology: See 50-70 patients in a day.
*Pediatrics: Deal with snot-nosed parents and their children.
*Pathology: Never see a living patient.
*Emergency Medicine: Deal with the same drug-seeking, mentally ill individuals.
*Psychiatry: Constantly deal with the referals from the above mentioned ER patients.

===Myths and Legends===

====Medical Liability====
*Huge Issue: 
**#1 lawsuit: Failure to diagnose breast cancer.
***Because there are so many people involved: family doc, ob/gyn, radiologist, surgeon, and pathologist
**#2 lawsuit: Bad baby. 
*Lots of lawsuits in OB/GYN 
**76% have been sued one time. 
**57% have been sued two times. 
**41% have been sued three times. 
**29% have been sued four or more times. 
**30% have been sued for an event during residency. 
*'''Only 8.6% go to trial. 81% are won by the OB/GYN at trial.'''
*ACOG is working to reduce this—already have won several key reforms in really bad states such as Nevada and West Virginia.
**Zero matches in NV in previous years because no one even wanted to train there.
*Still having issues in Pennsylvania and Florida.
*Indiana law is fairly good at protecting the OB/GYN. 

====Women want female OB/GYNs====
*Several national studies have shown that 50% want a woman, 10% want a man, and 40% don’t care.
*2002 study out of Michigan State University asked women this same question, then had them rank the 16 most important qualities of a physician.
**Female gender was #14, Male gender was #16. 
**Top choices were “Doctor listens to me”, “Doctor explains things clearly”, “Doctor is respectful”, “Doctor is easy to talk to”, “Doctor is caring” and “Doctor understands women.”
*Patients were asked how they chose their current OB/GYN.
**23% because she is female.
**4% because he is male.
**73% gender was not a factor.
*'''Women want GOOD OB/GYNs'''
**Nearly three quarters of the women chose their OB/GYN based on factors other than gender.
*Several other studies have shown the same conclusions.


*Where does the myth perpetuate?
**PHYSICIANS!! 
*WE think that women place a higher importance on gender of their physician.
**Physician score 3.9 vs. patient score 2.7 for doctor is female.
**Physician score 2.7 vs. patient score 2.1 for doctor is male.


====Female OB/GYNs versus Male OB/GYNs====
*Female OBGYNs:
**Quit Obstetrics after 10 years or less. 
**More likely to work part-time. 
**Spend 10-20% more time per patient (so they see fewer patients overall).
**More likely to retire in late 50’s.


*Male OBGYNs:
**More likely to retire in late 60’s.
**More likely to subspecialize: MFM, REI, Urogyn, GynOnc.
**More likely to perform major and complicated surgery.


====OB/GYN is happy medicine!====
*This myth is TRUE!!
*No other doctor gets the same welcome at 3AM. 
*Everyone delivers eventually—even the crazy ones. 
*You can only take out the uterus once. 
*90% of women don’t need us to help them deliver. 

====OB/GYN is UNhabppy medicine!====
*We can make a difference in those 10%.
*We are with women and their families during their most sacred and difficult times.
*Most women LOVE their OB/GYN and if they don’t, they shop around until they do.

==Miscellaneous==
*How to join the American College of Obstetricians and Gynecologists
*Student membership is free!!
*Student@acog.org
*www.acog.org/goto/medstudents
*Membership@acog.org
*Access to the green journal and patient handouts online.
*Free registration to ACOG meetings.