From Iusmicm

Contents 1 Putting the “Guy” back in “Guynecology” and other OB/GYN stuff 1.1 Summary 1.2 Brief History of Obstetrics 1.2.1 Midwives 1.2.2 Men in Obstetrics 1.2.3 Physicians in Obstetrics 1.2.4 Gynecologic Surgery 1.2.5 Male Domination of Obstetrics and Gynecology 1.2.6 Women in Obstetrics and Gynecology 1.2.7 Gender Issues in OB/GYN 1.2.8 What do OB/GYN’s do? 1.2.9 What don’t OB/GYN’s do? 1.2.10 Myths and Legends 1.2.10.1 Medical Liability 1.2.10.2 Women want female OB/GYNs 1.2.10.3 Female OB/GYNs versus Male OB/GYNs 1.2.10.4 OB/GYN is happy medicine! 1.2.10.5 OB/GYN is UNhabppy medicine! 1.3 Miscellaneous

[edit] Putting the “Guy” back in “Guynecology” and other OB/GYN stuff

[edit] Summary

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

[edit] 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

[edit] 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.

[edit] 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.

[edit] 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%

[edit] 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.

[edit] 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."

[edit] 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.

[edit] 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.

[edit] What do OB/GYN’s do?

• Hands-on clinical experience every day including:
• Performing surgical procedures such as hysterectomy, laparoscopy, and urogynecologic surgery.
  • 1. 1 surgery is cataracts.
    2. 2 surgery is c-section.
    3. 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.

[edit] 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.

[edit] Myths and Legends

[edit] Medical Liability

• Huge Issue:
  • 1. 1 lawsuit: Failure to diagnose breast cancer.
    • Because there are so many people involved: family doc, ob/gyn, radiologist, surgeon, and pathologist
    1. 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.

[edit] 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.

[edit] 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.

[edit] 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.

[edit] 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.

[edit] 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.