Tag: doctor

Could someone please explain to me why the actual physical exam has gone so out of style?

The other day in doctor land, I was having a conversation with a fellow physician and was talking about the cardiovascular findings I found. They kind of snickered at me and said, “What? You still use your stethoscope? Mine is sitting in the corner collecting dust.” I was appalled and shocked at this answer. Yes I still use my stethoscope. Yes, I do have a vested interest in knowing if their heart and lungs are ok before I have them go under anesthesia. Umm, if I don’t think they could survive the surgery I shouldn’t do it correct? Isn’t that part of the whole picture? Aren’t I responsible for the whole person? You know what? I don’t even need an answer. I already know it’s the right thing to do.

I get it, for those of you out there that hate the physical exam. Sure, it’s invasive, especially the part that involves my specialty. Who wants to have to get naked for their doctor? I know it’s not a thrill for me either. But, without it, we can actually cause harm without realizing we are doing it. We can have the best intentions in the world and proceed accordingly and still fuck it up and hurt the person in the end. I am willing to bet that that person who did not want a physical exam would have no hesitation to come back and sue you if they got hurt. Let’s think about that just for a second from the cover your ass perspective. Does that convince you yet that we should do them? Or, how about, liability aspects aside, we should care enough that the whole person is in good shape with some certainty before we start making recommendations. Hmm. Sounds like a no brainer to me. I am going to forge ahead and keep doing complete exams with the option of a chaperone to be available if they want. Have a great day everybody!

Dr. Katz

You actually listened to me doctor!

This wonderful statement was said to me at a patient appointment the other day. These words both fill me with happiness and joy and sadness at the same time. I am thrilled to hear them, but I find it unsatisfying and somewhat sad that I was the first person to take this patient’s concerns seriously and even bother to address them. This patient had been to so many doctors and desperately attempted to ask so many questions, all for naught. She left every previous physician office with no answers and only more frustrations rather than solutions.

This is NOT how it is supposed to be folks! We are supposed to listen! We are supposed to be invested! We are supposed to love our job enough to do it well and to the fullest of our capability! We are not supposed to just barely show up as if we are forcing ourselves through drudgery or see so many patients in a day that we just file them through like some sort of herd. We need to listen. We need to provide individualized, thorough, compassionate care to every single patient that walks in the door. We need to let go of any preconceived notions that we may have heard elsewhere or told by someone else. We need to let go of any held on judgements based on previous experience. The only person that matters is that patient that walks in the door. Let’s get our crap together people and do the job that we were meant to do.

If you are a patient out there who has felt neglected, frustrated, and not listened to, please reach out until you find a physician that does listen. You are worth it!

Ponder this for a moment and have an amazing day.

Dr. Katz

Let me explain to you why I know about more than just the vagina.

I get asked or questioned all the time about how I seem to have knowledge about things that are not just about the pelvis. People say things like how do you know about that? Aren’t you just a lady doctor? Don’t you just care about the vagina? How do you know about anything else well enough to make recommendations about other health issues. I think that literally other physicians, internists, and family practitioners are somehow threatened or feel insecure about this.

Trust me, there are no worries here. Let me explain. I was fortunate enough to have completed my training in the 90s. During this time, Obgyn was temporarily reclassified as primary care. Therefore, during my residency, I got training in family practice, internal medicine, er, surgical ICU, in addition to my root Obgyn training. I am very grateful for this because it has allowed me to know more than just my specialty. I also make it my business to keep up on the latest in these other health issues as well. Do I portend to know more than a family practitioner? No. In addition to that there should be no worries about my taking over the care of your patient. I am well aware of my limitations and know exactly when to refer the patient back to you for further direction and care. I am now and have always been a physician who knows her boundaries and limits. I am also aware that we should all be members of the same patient team and should be willing to work together for the patient’s interest. That should always be our mutual goal. Have a great day everybody.

Dr. Katz

Get RID of post op restrictions? I think not.

As most of you may or may not know, I have to renew my board certification for obgyn on a yearly basis, often with a multitude of articles and modules that require completion and a series of tests to take. I think they think that it is a good reminder to stay invested and keep up to date. I personally feel that I am capable of that on my own without paying exorbitant fees, but oh well.

Anyway, I regret to say that it is rare that one of these required articles contains information that is either brand new to me or significantly useful. Most of the time I am looking at them and having to read them for credit and just go with that approach. Some of the articles I feel are downright potentially harmful. I need to tell you about one of them.

Most recently, I read an article in a very reputable journal suggesting that we abandon all post op restrictions. Post op restrictions are the what I feel is very necessary guidelines to maximally assure a good recovery after surgery. They include things like holding off from sexual activity for six weeks. No lifting, pushing, pulling anything over a full gallon of milk for six weeks and no driving for a car for at least one week. Yes, I know, it potentially sets a patient up for ultimate boredom and frustration. You are watching your house get dirty. You are watching your kids run amuck. You are missing out on your normally awesome cooking, etc.

However, having said that, I have found that, in my almost thirty years of experience, that these recommendations, while not popular, are the way to go. It is my way of helping to ensure a good recovery for my patients. So, I read this article, claiming that all these recommendations are anecdotal/heresay at best and have no scientific evidence or backing. This article also says that there is the same change in intrabdominal pressure with getting out of a chair as lifting something heavy. I am sorry, but that cannot possibly be true.

So, I started doubting myself. I thought maybe I am being too strict. Maybe these “experts”( that probably haven’t treated an actual patient in years) were right. So, I gave it a try. I gave up the post op recommendations for one set of surgeries for one day. You know what happened? Two of my patients ended up bleeding after wrestling with a dog or picking up their kids since they couldn’t stop….and one ended up back in surgery after tearing their vagina open. That was a definite turn off for me. I guess my anecdotal self realizes after thirty years that not all incisions are created equal. I can see that with a visible abdomen incision you might get a heads up if you are about to make a big mistake and tear your incision open. With a vaginal incision, there is nothing you can monitor visually and no good prior warning signals you have to to tip you off before it’s too late.

The bottom line is, I tried to follow this nonsensical potentially dangerous advice and it backfired almost immediately. So, we are officially BACK to the post op restrictions!

Dr. Katz

Tattoos

So, currently, I have like 7 tattoos. They are all beautiful. They are all significant. They are all very personal. I love every one of them and I love to gaze upon them every single day. Well, except for the one on my back. That is a little tougher to see…lol

Any way, I want to point out that I waited until I was 49 years old to get my first one. I had literally been pondering it for like 20 years. I had always been taught that tattoos were not ok. I was taught that only dangerous and scary people had them and they could not be trusted. I was definitely taught that no doctor had any business having them. So, I kind of agonized with my secret curiosity and fascination with them for literally over 20 years.

So, one day, I decided enough of what everyone else might think. I decided that I was going to take my daughter with me and get my first one. Ever the fan of a social experiment, I purposely showed up at the tattoo shop waving my blonde hair and wearing my pink scrubs. You could almost hear an audible sign of disgust and here we go with this crazy chick who is not going to make it through this. I snickered to myself and proceeded anyway and guess what?! Not only did I make it through my first one, but I went on and got 6 more over the next three years, only taking breaks for my cancer battles…lol

I am told that I was the only person my first artist actually enjoyed working on. He was a big consumate tough angry guy who actually looked forward to me coming in. Apparently the whole shop would breathe a sign of relief when they knew I was having an appointment. Well, that is a true compliment if I ever heard one.

After my guy retired, I found a new unown, completed unexpected artist. I noticed right away, despite her lack of experience, that she had an unprecedented talent in multiple different genres. I was hooked right away. I have been waiting for the last year through this most current battle, but I am already planning the next one with her.

Do you know what else? I was always told that there was no way that doctors should ever have tattoos. They were supposedly a potential cause for non-hiring or firing! Well, fortunately, I finally stopped worrying about that and got some anyway. I actually seemed to attract even more patients because my tattoos somehow made me more attainable as a person. Seems like it was a win all around.

So all you peeps out there with tats. I am a fan and I am right there with you!

Dr. Katz

No news is good news!

I hear this cheerful sentence from the vet and doctor’s offices all the time. They say it with a smile as if you are supposed to find it amazing and reassuring if you do not hear from them. You are supposed to rejoice at the lack of bad news, or any news whatsoever.

You know what I hear when they say that? I don’t need to take the time to reach out to you personally to let you know that you are ok. I have just saved myself a ton of time in my busy day. Nothing about this statement lets me know that they are actually concerned about me or my pet, or that I can actually be sure that they didn’t miss something and forgot to call? That could happen too ya know. How long do I wait before I know it really is no news is good news? Are we sure after a week, two weeks, a month? See where I am going with this?

You see, at my office we call, or if we can’t get through, we text or leave a message about every darn thing, good, bad, ugly, sideways, or fantastic. That way we almost eliminate the chance of missing anything and the patient or customer has no question in their minds that they are worth our time and investment in their care. So, what if the majority of the calls are just to say that something is normal. Awesome! Then you are also making sure that you are giving yourself little to no chance of missing the few abnormal or bad news ones. To me it’s a no brainer. Inform everyone about everything. You tend to miss less this way and it shows that you give a crap. Ok diatribe over for now. Have a great day everybody.

Dr. Katz

Please, just leave the pelvises to me.

closeup photography of pink rose flower

Hey there folks. Dr, Katz here. I have been an Obgyn for the last 28 years. I have delivered thousands of babies. I have performed thousands of surgeries. I have done thousands of paps. All of these things are essential parts of the specialty that I was specifically trained for. I was also fortunate enough to have gone through residency at a time where Obgyn was temporarily reclassified as primary care so I also have training in internal medicine, er, icu, pediatrics, and family medicine. As a result, I know how to diagnose things outside the scope of regular Obgyn practice, but, at the same time, I realize that I am not the expert in those areas so I know when to refer when necessary.

Sometimes, I feel like the same does not apply to obgyn care. There are a lot of family physicians and internists out there that still do the occasional pap when they have to or if the patient does not want to visit an actual obgyn.

Most of the time you get lucky and the pap would have been normal regardless so no harm done. But, then there are those other times when the patient has been getting “normal” paps for years by their family doctor and then they come and see me and actually have an invasive cancer that could have been caught earlier. Thank goodness these times are rare, but they happen nonetheless and are preventable.

To me, this says don’t dabble. You are potentially putting someone’s life at risk, even if unintentionally. I know that a lot of people think that doing a pap is a no brainer and that is the complete story as far as Obyn. I tell ya. It’s not true. There is an art to it from the performing of the procedure without harming the patient and actually knowing what you are looking at and being able to pick up on the subtlest of cues that something is off. Obgyn stuff is that sneaky. You usually don’t get any symptoms until something is already bad. Then, it can be too late. However, if you just stop into the Obgyn once a year, a lot of that is both preventable and/or treatable.

I know how to treat blood pressures and treat a multitude of various diseases, but I know I am not the expert so I refer appropriately. I think that every patient needs a primary care physician and an Obgyn because they both care for different necessary aspects of health. I think that both are necessary to achieve total health and well-being. I think we are different specialties for a reason. All I’m asking is, please leave the vaginas and the pelvises to me. I promise I won’t let you down.

Dr.Katz