Laura A. Katz MD, a board-certified obgyn talks about life, women's health, motherhood and the "sensitive subjects."
I am a board-certified obgyn and aesthetics specialist, a mother and a wife. I have been in solo practice for over 20 years. I am also a musician and a beginner tapper. My colleagues and friends thought that I should start blogging to share my thoughts with the world. Here's to hoping that my blog will make you laugh, make you think, and sprinkle in some helpful info in between.
I just heard about the unexpected death of an amazing human today and it really got my wheels spinning. It made me take a step back and re-evaluate my own processing of the world around me lately and really embrace the amount of time that I have wasted with misdirected anger, emotions and the occasional dose of self-pity. I need to stop. It shouldn’t take news like this to shake me out of my own festival of wallowing. I should already know that, whatever potentially exaggerated feelings that I have about what my own life struggles, there is always something worse out there that someone else is going through. I am not saying that I spend an exorbitant amount of time feeling sorry for myself or anything, but really any time is too much time now that I think about it. Have I had some shitty things going on lately? Check. Have I had financial issues like everyone else? Have I had any health issues? Check. But, for all that, I have plenty of things to be grateful for too. I still have a job. I am still above ground. I have great kids and a great husband. I work hard and I get to see the positive effects on patients, etc etc. Like I have said many times over, I need to follow my own advice and break the proverbial chains that tie me to negativity like some sort of prisoner. All they do is hold me back and keep me from recognizing anything good when it happens. So, I am going to make myself a promise and grab those bolt cutters with both hands and make way for positivity. Who’s with me?
Greetings from Michigan, where the shutdowns are back, viral cases are surging, morale is down and the economy is heaving along, the best that it can. Whew! That is both a mouthful and yet another heavy set of burdens for us to bear. What are we going to do? What can we do?…that we aren’t doing already? How are they deciding what to shut down? which schools to close? In the midst of the new resurgence of information overload, in combination with the overwhelming sense of loss of control, everything starts to merge together and nothing really makes sense anymore. With a sense of frustration and a deep need for answers and assertion of control, we start pointing fingers and making enemies and burning bridges right and left. We forget what’s really important anymore because we are so distracted by our unhappiness, our loss of freedoms, and our fog of depression that never seems to lift anymore. What we don’t realize, is that by launching our own attacks and tossing aside what’s familiar and devaluing those around us, we are just perpetuating our own isolation further. We are actually making things worse! If it is community that we truly crave, why fight amongst ourselves and elevate our level of pettiness to historic levels? What is that really doing? How is that supposed to make us feel any better? I have news for you: it isn’t and it won’t. So….stop already! Please! I get that it completely sucks to not be able to see the people you want to see all the time. I get it that we can’t frolic at concerts right now and family gatherings have become but a blip in the rearview. Businesses are struggling and people are at risk of losing their livelihood. I know. I am one of them. Big stuff is at stake. It all seems out of proportion to the actual death rate of this virus, but you and I both now, that we are not privy to all of the information. Therefore I have to believe that the “experts” aren’t just trying to screw us. I just can’t go on thinking like that. I am not talking about being lemmings or sheep, but, we just can’t afford to give in to hate and despair like we are. Nothing good will come of it. I am still hopeful that it is not forever. One thing IS clear in my mind: I know for sure that any of my own potential methods for self-destruction will not make things get any better any faster. I know how hard it is to be positive right now. I am struggling just like everybody else, but you will not see me giving up just yet and I am hoping against hope that you will join me.
These are more than just cool lyrics, beloved by millions since 1968. Mick Jagger slipped us some deep wisdom without us even noticing, which makes the lyrics as simultaneously clever as they are timeless. What is he really saying? I think he is referring to the fact that so many of us endlessly pursue goals and aspirations that will ultimately leave us unhappy, unsatisfied, or just aren’t right for us. We do this because we often become so singly focused on unattainable goals or at least ones that are a poor fit that we cannot metaphorically see what’s right in front of us that might actually give us more satisfaction and make us happier. I don’t really think that he is talking about settling per se. I think he is saying that we need to be able to realize what is actually best for us, despite our current perceptions, wants, and outside input. This is the only way that we can be truly happy. Thanks Mick. That is some good food for thought. Have a great day everybody.
Being a good doctor has been especially tough lately. It seems like there are so many obstacles to being able to provide quality care without completely sacrificing your own mental and physical health. Fortunately for me, I consider myself to be very strong of mind and body and my love for my patients and my job still far outweighs all the negative impact of the obstacles. I am very grateful for that, but, some are not so lucky.
You ask yourself, what kind of obstacles could doctors really have? Don’t they have it made? I mean, don’t they just make a ton of money off of the rest of us and live these amazing extravagant lives? Don’t they just get to direct us like sheep with all of their recommendations, procedures, and prescriptions etc? I hate to burst your bubble, but it is not like that at all, at least not for me.
Did you know that the rate of physician burnout is set to hit and all time high this year? The final numbers are not in yet, but it doesn’t look good. On top of that, Ob Gyn as a specialty has the fourth highest rate of burnout among all the specialties. 46% of Ob Gyn physicians report feeling burnout. So, what is burnout anyway? Physician burnout is classified as a psychological syndrome that is a prolonged response to chronic occupational stressors. Heh? What? It means that the stresses of the job potentially get so overwhelming and so stressful that you kind of break down and just don’t want to do it anymore. Yikes! Sounds awful doesn’t it? I mean anything with the word burn in it can’t be good right?
So, what are the symptoms of burnout? 1) Feeling tired and drained all the time is one of them. 2) Fatigue that does not budge no matter how much sleep you get is another. 3) Feeling sick all the time is yet another. 4) Changes in appetite or sleeping habits 5) Drop in libido or sexual desire 6) frequent back pain, muscle aches, headaches with no other apparent cause.
What do physicians have to be so stressed out about you ask? There are a ton of potential stressors. Let’s start off with the fact that your incredibly high medical school loans offset by the lower average salaries for most physicians means that your debt is not paid off until you are nearing 50. How about the fact that reimbursements for physicians, particularly in my specialty continue to drop, regardless of manhours spent or level of difficulty to the point that I find myself wondering if I am going to be the one paying to do procedures on patients instead of the patients…lol. Let’s think about the hours for a minute. For me, a solo practicing obgyn, I am essentially on call 24 hours a day and 7 days a week. My ability to do anything with my family completely depends on what is happening with patients. I find myself getting coverage if I decide to go to the bathroom in a town that’s greater than 30 miles away, much less if I am going on an actual vacation. I just can’t risk missing a call. For those of you with 9 to 5 jobs, most of you get to be done when you go home. I am never really done. I am always responsible for my patients. I am not complaining. I chose this life and this specialty. I am just clarifying.
Another stressor is the fact that there has been a huge breakdown in the concept of the doctor patient team relationship. Patients are now viewed as consumers rather than patients and as such, this wave of consumer-oriented thinking has brought a wave of bossy, entitled, demanding behavior that is often hard to stomach. I am extremely fortunate that I do not have a lot of these patients, but when I do, it is very exhausting. I have spent too much time invested in my education and have worked too hard and too long to have patients shake their finger at me, dictating their own care without listening as if I am their secretary or sales rep, rather than their doctor. It’s just not right.
One of the biggest stressors is the fact that doctors, even with all of their training and medical knowledge, do not really have the final say in what they can recommend for patients. The insurance companies do. The expenses do. The patient’s ability to pay does. I cannot tell you how many thousands of times in the last 25 years that I have had to change the optimum management, prescription, procedure, etc for a patient because of insurance and cost. Most of the time, my poor patients have to go through multiple treatment failures, medication side effects, extra office visits, etc before I am allowed to finally do the right thing for them because of some insurance criteria. To make it worse, most of them do not understand that I am not the one dictating these delays. They are under the impression that I am just “nickel and diming” them. Nothing could be further from the truth, yet I bear the brunt of their frustration and mine anyway.
Last but not least, let’s touch on the impact of COVID 19 for a minute. Wow talk about a stressor! Now we have to worry about exposure, like the rest of the world. We can’t hug our patients, hold their hand or comfort them in any way except with words, which is just not enough for some patients. If you thought insurance companies were bad about dictating care, they have nothing on COVID. We are being told when we can do procedures. I didn’t operate for months. We are being told what care is essential and what care isn’t. (Apparently vaginas fell in the isn’t category for awhile, unless a baby was coming out.) Our businesses are shut down and employees are sent home because there weren’t enough patients to keep them. Employees are afraid to come to work even when we have enough patients. We are told to do virtual consults instead of bringing patients to the office. How exactly are you supposed to do that with ObGyn patients? Hold their vaginas up to the screen? Generalization and conformity rules over sense and applicability. Even now when we are allowed to see patients, fear keeps most of them home anyway, crippling my ability to adequately care for them. I can say 100 times that it has never been safer to go to the office with all the precautions and prescreening, but I cannot force them to come in.
Long story short, physician burnout is a real thing. It affects nearly half the physicians in a lot of different specialties, and obgyn is no exception. I just want everyone to keep in mind that we doctors realize that everyone is struggling right now, but we need you to realize that we are right there with you.
I am basically a positive person and I try my best to exude that energy into the world the best that I can. I try to be a force for good not evil. I try to look at the bright side and find the silver lining no matter how well hidden. I have made it my personal mission to try to lift others up, especially during these stressful times in the last several months.
Don’t let me fool you. I know I make it look easy sometimes, but these efforts take significant mental and sometimes physical energy, more than I really have to spend if I am being completely honest. The rewards of making others feel good are amazing and I get a great deal of satisfaction from it. I wouldn’t trade my efforts for anything. However, I know that I need to work on embracing the idea that it’s ok to set some of my energy aside for myself. I have to realize that it is not my sole responsibility to uplift the world if no one else is going to. I have trouble convincing myself that it isn’t just a selfish gesture to make time for my needs when I have them. I have trouble realizing that, if I don’t take time for myself, I won’t have anything left to give to others. You would think that putting that spin on it would help me justify spending time on myself, but it doesn’t. I seem to categorize myself more as a caregiver for others than an independent individual with needs and wants. I actually feel a little guilty when I do something for myself. I get the same kind of guilty feeling when I have to say no to someone.
I am pretty sure that I am not alone in this kind of thinking. A lot of us have trouble with the concept of self care. But why? Why do we feel guilty? What’s wrong with saying no and setting boundaries? What’s wrong with some self preservation? I think the key is to not confuse self preservation with selfishness. We need to strike a balance between what we do for ourselves and what we do for others. Otherwise, we run the risk of having nothing left to give and no arms strong enough to lift. Have a great day everyone.
Remember how we were always taught that Sunday is a day of rest? You were supposed to rest and gather your mojo to prepare you for the rest of the week with no hard labor or rushing around. You were supposed to slow down, make time for reflection or worship and just…be. I have to confess, that concept has completely gone to the wayside for me for many years now. Sunday has become the catch all day for everything that I didn’t get to throughout the rest of the week: grocery shopping, running errands, cleaning, going through the email back log, etc. I treat it as if Sunday somehow contains more hours than the rest of the week, at least in relation to the unrealistic expectations I have of what I can accomplish. That way I am sure to be disappointed no matter what happens. I am not sure how it happened exactly. I think it crept up on me slowly through the years. There is no rest to be had on Sunday. It has just become impossible. But, is that really healthy? Don’t we all need some down time? Isn’t that an essential part of self-care, the biblical recommendations not withstanding?
In fact, down time IS an essential part of self care. We need a day to reflect, regather our thoughts, and actually rest. A day of rest is important physiologically to help your body replace the energy stores in your muscle cells so that your battery can be fully recharged for your next workout. A day of rest allows for some mechanical repair from your previous exercise. A day of rest is important psychologically because it allows us to slow our minds down from the daily, emotionally exhausting grind. When we unplug from our relentless, preplanned day to day activities, we can actually stop to enjoy our surroundings, take a momentary deep breath and do something just for ourselves for no reason and mentally prepare for the rest of the week. I am reminded of the words of Matthew Kelly, author of Resisting Happiness: “Don’t waste a single Sunday. If you don’t waste Sundays, you will be less likely to waste Mondays, Tuesdays, and Wednesdays.” The bottom line is, sometimes you gotta brake now, so you don’t break later when you don’t mean to. Happy Sunday everybody!
You’re gonna find your way to heaven is a rough and rocky road
If you don’t stop and smell the roses along the way.–Mac Davis
Stop and smell the roses. It’s a powerful statement that really has nothing to do with flowers. It means take a minute and pause to recognize the beauty of the world around you. How many of us actually take the time to do just that? How many of us consciously stop ourselves in the middle of rushing about our daily lives to just take note of our surroundings and appreciate them? Not too many I bet. I know that I don’t do it often enough. I think most of us spend the majority of our time running in multiple directions at once, marveling at our multitasking skills, and then find ourselves wondering hours or days later where our time actually went and have trouble actually remembering what we really accomplished. Time flies past us without a glance and we have nothing to show for it. The truth worth of an experience is measured in it’s memories. If we are moving too fast, we won’t have any. It’s time to slow down a little.
What am I talking about? I am talking about gynecological care guidelines. Most recent guidelines from the USPSTF recommend pap smears every three years from ages 21 to 65 if using just the pap smear or every 5 years between 30 and 65 if using the pap smear and HPV testing. These recommendations are based on epidemiological data and costs. The few issues that may be caught before the age of 21 and after the age of 65 are too few and far between to be considered economical to screen for.
I have a problem with this in both the translational sense and the practical sense. With regard to the translational sense, these recommendations have the tendency to confuse adult women based upon terminology. Most women equate getting their pap and their annual check up as one and the same. They are not! In my office, the pap smear is about a 10 second clip of what I do. It is just one small piece of the puzzle. The real meat and bones is in the head to toe exam that I offer which allows me to check for anything that could be wrong in all body parts. You see when you tell most women they don’t need a pap but every three years, if at all, they think sweet! I am off the hook for any gynecologic exams for three years at a time and they don’t come in at all. In the practical sense, this lack of clarification is both irresponsible and potentially deadly. Obgyn is blessed to have some of the best preventative tools in the business but we become crippled by these recommendations because the patients don’t show up. Add to that the fact that insurance companies jump on the bandwagon and start trying to refuse to cover paps/annuals and these women are potentially really screwed. In the practical sense,, the thing is that most gyn conditions do not present with symptoms until the condition is pretty advanced. A little itch on the vulva could actually be a vulvar cancer. A little feeling of fullness in the abdomen could actually be an ovarian tumor. But, unless someone is looking(i.e me), the patient doesn’t know, the condition goes unrecognized and the situation goes from simple and treatable to serious and deadly. In addition, I would challenge the academicians that sit behind the desks and formulate these recommendations to sit down with the patients whose diagnosis you missed and explain to them how it’s ok because the cost/returns ratio was just not in their favor to justify screening. I am not sure that quoting guidelines will help the patient or the family feel any better either.
The bottom line is that I am a fan of the annual exam, whether or not the pap is performed. It is definitely the most bang for your buck way to be watchful for your patients. It really goes back to the OPPOSITE of the old adage: what you don’t know or can’t see CAN hurt you! Have a great day everybody!