Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "obstetrics"

"Hands and knees is my favorite position…much less risk of tear."

"Just get in there."

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"I just put my fingers in the vagina and drive."

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"Women may feel that it is not working in this position. They might not be getting the push they need. They may also say this feels amazing and this is the right position."

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Asker queenstales Asks:
hi I am interested in FM with Ob any thoughts? also do you plan on doing a fellowship ?
wayfaringmd wayfaringmd Said:

If you’re interested in doing OB after residency, it would probably be best to go to an OB-heavy residency program (especially one that teaches C-sections, not one that promises that you can get the experience if you work for it —in my experience, that’s usually a lie). The delivery requirements for family med residents has been significantly reduced this year, so if you go to a program that doesn’t have an OB track or that isn’t very OB focused, then you probably won’t get adequate training to practice prenatal care once you graduate.

I’ve thought about doing an OB fellowship, but there aren’t very many in my area of the country, and I’m not super keen on the idea of moving across the country for a year. If I had gone to a program that offered a fellowship, I’d definitely be up for it. My program was trying to get one off the ground, but it got put on hold because they started a different fellowship. 

Asker Anonymous Asks:
I am considering becoming an ob/gyn, however I believe that women should be able to birth in whatever way the like/feel most comfortable (within reason). I'm thankful for the medicine and technology we have today for birth. I also believe in natural birthing and the body's natural abilities. I feel like some women are being forced to birth on a schedule or receive interventions they don't want. Are my views on birthing to conflicting with modern obstetrics to the point where I'd be frustrated?
wayfaringmd wayfaringmd Said:

So I guess I got the same question that TNQD got, except a shorter version. Ummm… if you make it through medical school to an OB/GYN residency with your current views intact, then yes, there might be some conflict. 

As a family doc who only does low-risk obstetrics, I agree that women often get C-sections and inductions when they don’t need them. The official recommendations for having patience and not rushing into inductions and C-sections in OB/GYN are getting stronger and stronger, but we family docs still sometimes butt heads with the private OBs that schedule C-sections for “misery of pregnancy” and stupid crap like that.  But I also know from years of studying that there are good, solid, evidence-based reasons to do these procedures in certain circumstances. Sometimes the body’s “natural abilities” fail. We still see tons of women and babies die or suffer major complications because of this, abroad and even in the US. The whole reason we started intervening in labor was to help more moms and babies survive childbirth. That’s the goal, right?

There is an important distinction to be made here: we often recommend procedures and medications to patients that they don’t necessarily want. We recommend these interventions because we have evidence that shows that they are for the patient’s benefit, not because we want to inconvenience the patient. But I would agree that we shouldn’t be recommending unnecessary procedures just to get us home earlier or pad our pocketbooks. If you want to do OB work, you have to be okay with having to come in to work at weird hours. Babies like being born at 2am better than on a schedule. 

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Do you think you could maybe comment a bit on OB/GYN vs. family medicine as well?
wayfaringmd wayfaringmd Said:

OB/GYN is all hoo-has all the time.

Family is all the other parts plus hoo-has. 

OB is half surgery/procedures, half outpatient care.

Traditional outpatient family medicine is about 90-95% non-procedural. Except for the few family docs still out there who perform C-sections. 

OB is a 4 year residency. Family medicine is 3.

OB/GYN is a lot more than delivering babies. It includes infertility care, contraception management, urogynecology, maternal-fetal medicine, reproductive endocrinology, GYN oncology, managing dysfunctional bleeding and STIs, hysterectomies,  and tons more. 

Family docs overlap some of this, as we manage contraception, STIs, dysfunctional bleeding (non-surgical), basic gynecology, and low-risk obstetrical care. 

When 2 followers message you and ask “what the heck is a G6?”

My bad guys. Lemme explain.

OB docs like to shorten absolutely everything. They have a system for abbreviating a woman’s whole pregnancy history. It’s called the GPAT system. G is Gravida, meaning total number of pregnancies. P is para, meaning number of live children the woman has. A is abortus, for number of pregnancies that did not result in a live birth. T is for term, for number of pregnancies that went to a full term delivery. You can learn a lot from a woman’s Gs and Ps. 

Let’s practice, shall we? My mother is a G4P2A2T2. She’s been pregnant 4 times, had 2 babies (both of which were term deliveries), and 2 miscarriages. If the Ps and As don’t add up to the Gs, the patient is pregnant, as in G5P3A1. Or If the Ps +As are greater than the Gs, the patient had a multiple birth, as in G3P4A0.

To confuse things even more, we can abbreviate the Gs and Ps to just a G with numbers, so my mother would be a G4222. 

Make sense?

In our OB rounds, we’d open with a short statement about each patient from which you could gather a ton of information. It went a little like this:

This is a 27 year old G4P3A1 at 37 and 4  POD #1 s/p C/S. She is +/immune/NR, desires a circ. Breast and bottle. Depo. 

To translate: This 27 year old girl has had 4 pregnancies, 3 kids, and 1 abortion. She is at 37 weeks, 4 days gestation. Today is post-op day 1 after a C-Section. Her Rh type is positive, she’s rubella immune, and her RPR test for syphillis was non-reactive. She desires a circumcision for the baby. She will breast and bottle feed and will be using depo shots for birth control.

Now you see why we abbreviate.  

Reblogging for future reference. My hands are larger than the average human, so the whole fingertip/2 fingers/3 fingers etc method is sort of lost on me. I always guess smaller than it actually is. So the visual aids here may be helpful for me. 

Reblogging for future reference. My hands are larger than the average human, so the whole fingertip/2 fingers/3 fingers etc method is sort of lost on me. I always guess smaller than it actually is. So the visual aids here may be helpful for me. 

(via missmdisme)