Tag: obgyn

Do I ever really want to retire?

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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

Just gimme 20 min

Hi guys. Dr. Katz here. It has been a minute but my soapbox is begging me to climb back up so I’m gonna. There is just something I have to get off my chest.

The women’s health screening recommendations are trash lately. I mean, they completely suck. All this nonsense about spacing mammograms farther apart, forgetting about yourself after the age of 50, not needing an obgyn exam after having a hyst….all baloney and dangerous on top of that!

First of all, why would we ever recommend something that would decrease our awareness of our own bodies? How does that make any sense? How does that empower us or increase our chances of using our powers to evoke good in the world? I tell ya. It doesn’t. Those recommendations are based on statistics and costs, not people and patients. Those statististics and recommendations are based on how much it would cost to save the lives of 5 or 10 or 20 extra women. Well I say, what is the cost of a human life? Can you really put a cost on it? To me, every single life out there is precious and worth preserving. There is no cost too heavy to at least attempt to save it. For all these small numbers of difference in lives spared, I find these numbers to be at least ten times higher just in my practice. In the last month alone, I have had to give bad news to at least ten women that was preventable or at least treatable at a much earlier stage if someone had been looking. These women were not doing anything wrong. They were not being non compliant. They were just following these recommendations that their physicians were following. None of them even had symptoms serious enough to warrant their seeking medical help. That’s just how sneaky obgyn issues are!

I have something to say to these academicians who make these recommendations. When you are ready to sit down face to face to one of those patient whose diagnosis you missed and tell them how it was too costly to bother with them, then we can talk. If you can’t, and I suspect you can’t, then I am going to continue to ignore those recommendations and advise women to be seen on a yearly basis. You can’t even use insurance coverage as a reason because most insurances are still covering the yearly exam, even with no copay! Why are we wasting the opportunity to make good use of our awesome preventative resources? Why?

Bottom line. I am a fan of the yearly check-up. Just c’mon in will ya?

So people have been asking lately why I stopped delivering babies

Oh wow. This is a big deal question. Delivering babies was some of the most amazing, interesting, joyous, spontaneous, unique 25 years of my life. I loved doing it and still do. I was not one of those that ever rushed a patient because I had theater tickets. I realized that ob was not really a scheduled event. I can’t think of nearly anything else with that much infinite variety in terms of timing, experience and literally everything else. I knew before going in what the schedule would be like….tons of hours…missing outside stuff that was previously scheduled….sleepless nights….wrestling out of bed at 3 am to make a 30 second decision. You get what I’m saying. Some may call it gruelling. I called it fantastic. I knew what I was getting into and I wanted to be there.

I always made sure to make every experience special. Sometimes we sang. Sometimes we played music. Sometimes we laughed babies out. Sometimes I was in fact pulling women off the proverbial ceiling to regain back control and help them have an experience that they could look back on with joy and not regret.

I tried hard to remind patients not to stick to the strict birth plans because they were just a set up for disappointment. This is not me saying I didn’t think patient should have control over their own situations. Absolutely not. I am just saying that the labor and delivery experience is nothing if not a wild ride and if you go into it expecting something else, you will just make it tougher on yourself. There is nothing worse than setting yourself up for disappointment that a plan did not go a certain way and then that can potentially take away from your baby joy. Nope. I don’t recommend it.

I also was a big fan of the more natural experience. My goal was to be as hands off as was safe and let mom and baby guide the way. I was not the tons of ivs and epidurals and drugs for every patient. I had plenty of patients who had none of that and it was ok. Obviously if safety situations changed things could change as needed.

So, now that I have said all that, why would I stop doing it? It makes no sense right? It doesn’t sound like it does. Unfortunately it does makes sense. After my first cancer I lost of lot of that key stamina that’s required to really do a great job at OB. I wasn’t entirely confident that I still could jump up and do my job effectively at 3 am anymore. I just didn’t have the 100% anymore to do it. So, I realized that about myself and decided that if I felt like it was a potential risk to mom or baby, it was not worth still doing it. In OB, life and death things come up in seconds and you have to be ready. I wasn’t sure I could be ready all the time anymore. So, I made the very tough decision to give it up. I do feel sad about it still and I continue to take care of new obs up to 12 weeks in the office to get them started so there is till some interaction there. Bottom line is that if I am ever uncertain that I can do a job to the 110th percent, I won’t do it. Hope that answers everybody’s question.

Dr. Katz

What do you look for in an obgyn?

This question actually has multiple answers and is a more complicated process than selecting a primary care physician. The usual selection criteria apply of course: 1) Is the doctor in your network? 2) Are they local and easy to get to? 3) Does their availability(office hours) fit your availability? 4) Do they have good reviews? 5) Do you know anyone personally in your family or friend group that already sees them so that you can get firsthand feedback?

These are good to go by when attempting to select any physician, bearing in mind that reviews on google can be written by anyone anywhere, even if they have never been in the office in question. Having family feedback is good as well, provided that you know the whole story surrounding their comments. ( i.e Grandma Martha hates Dr. X, but also has multiple no show appointments and owes the office a lot of money that they are rightfully trying to collect) You see what I mean? Even the seemingly best source of information does not compare to your own personal experience.

Having clarified all that, I feel that selecting an obgyn adds yet an additional level in selection complexity. Finding the right obgyn means finding someone with a communication style and listening skills that make you feel comfortable enough to discuss some of your most personal and potentially embarrassing issues. I mean, you can’t go discussing your vagina and hormones with just anybody. Hopefully you are able to find somebody that listens and “gets you” at the same time.

This is the kind of thing I strive for the most….the listening part I mean. It is so so important. Many of the women that I see are frustrated because they have spent years dealing with unresolved issues because they either did not feel comfortable mentioning them to their previous physicians or they were dismissed. This should never happen. Every single patient deserves to be listened to and, in my opinion, if they have an issue that you are not prepared to deal with, they should be referred onward to someone that can. The patient should never have to suffer due to your lack of comfort or familiarity with their particular problem.

I received a compliment once from a patient that I did not understand at first, but now I consider it one of the best compliments I have ever gotten. She said that coming to my office was like coming to a girlfriend’s house. At first I thought, what the heck does she do at her girlfriend’s house? My face must have registered my confusion for a minute because she went on to explain what she meant. She meant that I was able to make her so comfortable at my office that she was able to disclose and discuss anything and everything that she wanted to. That is my job, my sacred mission, and what it’s all about. Have a great night everybody!

Dr. Katz