OBGYN - Introduction
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(Created page with '=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…') |
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*What do OB/GYN’s do? | *What do OB/GYN’s do? | ||
- | ==Brief History of Obstetrics | + | ==Brief History of Obstetrics== |
*Second oldest profession. | *Second oldest profession. | ||
*Started with midwives. | *Started with midwives. | ||
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*William Smellie: | *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. | + | **'''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.''' |
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**1510-1590 | **1510-1590 | ||
**Reintroduced podalic version (delivering feet first) | **Reintroduced podalic version (delivering feet first) | ||
- | **Recommended cesarean deliveries on the living | + | **'''Recommended cesarean deliveries on the living''' |
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**Student of Ambroise Pare | **Student of Ambroise Pare | ||
**Described a technique of breech extraction. | **Described a technique of breech extraction. | ||
- | **Used podalic version as a technique of delivery for placenta previa. | + | **'''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. | ***Placenta previa is when the placenta grows / attaches across the opening of the cervix which complicated delivery. | ||
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- | *Ignaz Philipp Semmelweiss | + | '''*Ignaz Philipp Semmelweiss |
**1818-1865 | **1818-1865 | ||
**Determined that hands could transmit infection. | **Determined that hands could transmit infection. | ||
**Instituted mandatory hand-washing before and after each patient. | **Instituted mandatory hand-washing before and after each patient. | ||
**Recognized germs decadeds before Lister and Pasteur. | **Recognized germs decadeds before Lister and Pasteur. | ||
- | **Got kicked out of hospital, practice, and country for his crazy ideas. | + | **Got kicked out of hospital, practice, and country for his crazy ideas.''' |
===Physicians in Obstetrics=== | ===Physicians in Obstetrics=== |
Current revision as of 19:42, 28 November 2011
Contents
|
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.