Friday, December 11, 2009

Fighting the Cynic Inside

I have always envisioned myself as becoming a doctor who would empathize with her patients. Regardless of they were, where they came from, or what they presented with, I always wanted to approach my patients with patience and compassion. Now, three weeks into my Night Float rotation, I am finding this vision much more challenging than I anticipated.

One of the wonderful aspects of my residency program is that our hospital runs its own Emergency Department for women of all ages, pregnant or non-pregnant, with any sort of acute OB or GYN issue. It is a high paced environment in which patients are rolling in with anything from labor, miscarriages, cancer complications, surgical complications, sepsis (aka widespread infection)… the list goes on and on. It makes for fantastic resident training.

On nights, when I am not in the delivery room or the OR, I am often found tending to these high acuity patients. After all, one would think that a person would have to be really sick to come into the ED at 1:00am, right? Ha. This is where the issue of my dwindling patience comes in. Let me introduce you to the 24yo non-pregnant female who came to see us last night. Her chief complaint? Vaginal SPOTTING between periods. In the setting of a history of irregular menses. I’m serious, this was a regular problem for her and she decided that one day of spotting was an emergency. She had gone through HALF of ONE pantyliner. Clearly not hemorrhaging. There are also the dozens of women each week who come into the Emergency Room after getting a positive home pregnancy test. I mean, really? You need to come in to the ED at 2:30am for a positive HPT?!? Oh, and the woman who “lost a tampon” in her vagina?

The icing on the cake was a patient I had the other night. She was a 20yo female who was pregnant with her THIRD child in the last THREE years. She had had ONE prenatal care visit during this pregnancy and not for lack of insurance or health care provider. She didn’t know her last period and as a result, we had no idea how far along she really was. Her chief complaint? She had come to the ED because she decided that she wanted a C-section that night. SHE decided. I was shocked.

I’ve seen many a bitter physician throughout my training - the sort that blame their patients for everything. I don’t ever want to become that person. Fighting cynicism, however, is an ongoing battle. Especially when you feel like there are so many patients who take advantage of our services.

Now I am educated enough to understand that our shabby health care system, with its limited access to primary care, is largely to blame. Our G-rated version of sex education has also left women so unfamiliar with their bodies that they run to a physician for the most minor issues. I also understand that WE were the ones who failed S.M. when we let her have two babies at our hospital and never set her up with reliable birth control. But remembering this is a struggle. I am resolved to doing it, to be the kind of doctor that I would want to go to. But it takes a conscious decision I make each and every day.


  1. So...since Implanon isn't actually known to harm pregnancies, could we just start popping them in prenatally in pts like that? (Kidding. Mostly.)

  2. Wow! I don't think it's just our healthcare system or our educators at fault for these women being absolutely clueless...there seems to be a lack of parenting too. We as parents need to instruct our children better. This just reaffirms that just because someone is physically capable of conceiving a child, it doesn't mean they are capable to be a role model or guide for life experiences...that's so sad.

  3. karen - i like the way you think ;)

  4. Kudos to you for keeping up the good fight! I'm a fan of "Depo for Welfare" - to get your check, you get your shot. (Hey, it's not taking away anyone's rights because welfare is an optional program.) Oh, and co-pays. Fifty cents for clinic, five bucks for the ER, and ten for the ambulance, sorry, cab-ulance (as we like to call it).

    And women definitely need to be better educated about their bodies at all socioeconomic levels!