Uncategorized

Taking Risks: Getting Comfortable in an Uncomfortable Spot

It’s hard to believe it has been one year since I retired from medicine.

It was a big leap to make that decision and a scary one at that. However, if I have learned nothing else over this past year, the one thing that has proven itself over and over is the value in pushing myself into uncomfortable and unknown scenarios.

Fear of failure has held me back from opportunities in the past. I think most people can agree with this statement. We may make excuses for why we didn’t apply for a certain job, try a new fitness class, or learn how to invest. In addition, it’s easier to stay where we are in the comforting cocoon of understanding the “rules”. We know what to expect and what is expected of us. It makes us anxious to go into an unfamiliar setting.

My goals for 2018 will include pushing into more unknown but exciting endeavors. I may certainly fail, but I’ve learned to be ok with that.

Some positives from the past year:

1.  Writing

It was terrifying to put my first article on a public forum, but I attended a writing conference that pushed me to try it. Since I wrote that first piece, I have since started a blog (accumulated over 260 Regular Followers- thank you readers!), accepted a position as a Doximity Fellow (I am a contributor for this “Linked In” for physicians website), wrote a couple of guest posts for other websites, was interviewed for 2 different podcasts

http://www.doctormoneymatters.com/episode-17,

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(Link up today for “Doctor Money Matters” Podcast! This physician led podcast is more finance related, so if interested- please check it out- and follow his podcast!)   This is something new for me- pushing into an unknown again, hoping I don’t sound too foolish…

…. Lastly, I had had several interviews with reporters leading to quotes in articles published on Yahoo News, SELF, and STAT regarding topics important to me in health care. It still seems crazy to think that one year ago I had never written anything! Apparently “good things happen to people who write” as a wise person once told me.  If you ever thought about writing or have something to say, Go for it.

2.   Coaching a youth sports team.

Sure it may just be 4 year old girls soccer, but its harder than it looks to keep 4-year-olds entertained for an hour! Plus, I haven’t played soccer in over 20 years. This was a fun endeavor that both my daughter and I enjoyed immensely.

3.   Investing.

I jumped in head first, all while soaking up as much information as I could. It proved to be a lucky year to get involved. I would encourage other readers to learn about the stock market and get the courage to learn about something new, like personal finance. It can be quite empowering and beneficial to your ability to retire early if you so choose.

Some failures:

You may remember from my post back in May, soon after retiring You Retired From Medicine- Now What? ,where I where I discussed wanting to learn how to cook. I really did try but haven’t quite figured this one out. Perhaps its just a lack of passion but when it comes down to it, I really don’t like cooking. I have been unable to manage to make more than 1-2 homemade meals a week. We still tend to eat out way more often than we should, or my husband will sometimes cook. Until I can get 5 people on the same page about whether to eat steak/salmon and broccoli, as opposed to dinosaur chicken nuggets, I just don’t think it will happen.  So, macaroni and cheese/pizza/nuggets it is for now!

Plans for the future:  hold me accountable!

1. Continue my quest/love for travel. Scheduled for 2018 so far:
I’m a big believer in the value of experiences instead of things…

Orlando, FL (Disney World with the kids)
New York, NY (“Frozen” on Broadway with my oldest),
San Francisco (conference)
New Orleans (celebrating a friend’s 40th)
Boston (conference),
Punta Cana, Dominican Republic
Kiawah, SC
Outer banks, NC

2. Continue learning more about finances/investing.
On my book shelf:


3. Grow the blog
I will have a regular posting schedule in the future- expect more content!

4. Continue to speak my mind regarding Health Care in our country and topics of importance to both physicians and patients.

I’ve learned that the more risks you take, the easier it becomes. So, this year I will be pushing the limits even more. I am not sure what my life will look like 1 year from now, but if the dramatic change from last year is any indication of the unpredictable twits and turns life can take, I know one thing for sure- I have no idea where I will be.

I would love to hear what risks you are thinking of taking in 2018.  Any ideas?

hospital, OB GYN, physician

Working the Holidays: The Invisible Heroes of Healthcare

No one wants to be sick around the holidays, or go into labor during Christmas Eve Service.  We are constantly reminded that we have no control over these things as emergencies arise 365 days a year and thankfully, there is always a place to seek help and someone who is ready to be of assistance.

The holidays are what remind us of what is important in life.  They are a time for gathering with family and friends when the otherwise hurried pace of life doesn’t usually leave time for a home cooked meal with Mom, chatting with cousins, or playing in the snow with kids.

Unfortunately, some people have to miss these precious moments- their jobs require it.

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If you walk through a hospital during Christmas, you will notice it to be eerily quiet.  Only patients with true emergencies will be there, and health care workers will be ready.

You will see a phlebotomist with a Santa hat on striking up a conversation with a patient while skillfully drawing their blood.  You will see a nurse comforting a woman in labor and a surgeon closing the incision from an appendectomy.  You will see a cafeteria worker flipping burgers and humming a song while he works, providing the sustenance to keep the rest of the team going through their 12-24 hour holiday shifts.

They are all happy to have their jobs, but they are missing their families immensely during this time.  Few professions require the dedication to work during a time when everyone else is tending to the people that make their lives meaningful.

Alternatively, some health care workers may have volunteered to work.  Perhaps the holidays are a particularly difficult time as they are acutely reminded of the loss of a loved one and the memories forged on these holidays in the past.  Working may provide a necessary and welcome distraction.

Regardless of the reason these people are working over the holiday, they are providing a desperately needed service- a service to others at the expense of their own families.  These actions are what remind us all of the need to take care of each other.

Thank you to all of the janitorial staff, medical assistants, nurses, phlebotomists, ultrasound techs, and doctors (to name just a few) who keep America’s hospitals running and care for our patients over the holidays.

Merry Christmas and Happy Holidays!

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physician, Uncategorized

Do Patients Pay Less for Cheaper Care? Why the CVS/Aetna Deal Matters

On a recent trip to urgent care for my child, I began to more clearly see how the changes in medicine are affecting our patients and who is benefiting from the bottom line of what is occurring in the US health care system.

A minor injury to my 2 year old son had me waiting patiently to be seen at a local urgent care center.  Eventually, a nurse practitioner evaluated, correctly diagnosed, and successfully treated my son.  (I make it a habit not to treat my own children as I feel it more appropriate to be “mom” instead of “Dr. Jones” to my children in these types of situations).  I appreciate nurse practitioners and feel they provide a great service and are filling in gaps in areas of need, especially in this time of physician shortage.

My concern arose as I considered how this medical care visit was truly playing out financially.  I paid a copay with my insurance- no big deal, it was $30.  My insurance would be covering the majority of the visit.  However, ultimately the company running the urgent care facility would be charging the same rate to my insurance, and same copay to me, for my care regardless of whether I saw a physician or a nurse practitioner.  I even went as far as calling a billing specialist in membership services at my insurance company to ask if this was the case.  She indeed confirmed that there is not a separate charge for urgent care visits depending on the level of provider seen.

My question to anyone who has seen a nurse practitioner or other qualified individual, is your co-pay lower for the service? Do you receive a discount for not seeing the higher paid/more trained physician?  In my situation, there was no reduction of copay.  So, if they are collecting the same amount for the service provided despite a disparity in income level of the provider, who benefits from this profit?

The company running the urgent care center reaps all of the benefits of employing a health care provider with a lower salary than that of a physician.  Their smaller salary likely means more profit for the company.

Again, I am in no way against using mid-level providers, nurse practitioners, midwives, etc.  They are here to stay and provide an important role in healthcare moving forward.  However, my argument is that if a company is benefitting financially from hiring “cheaper” people to provide care to their patients they should at least be passing the savings on to the patients who are receiving the care.  Often, these companies are looking for the financial bottom line and what they can get away with to reap the most profit.  It is a primary responsibility of top administrators to make money for the company, and we can hardly blame them for successfully completing the role they were hired to fulfill.

Transparency is required in these situations.  The patient must know they are not seeing a physician- when they could be- for the same cost to themselves and their insurance company.   They should have the ability to demand physician care if desired.

A prime example how this business scenario is becoming the future of medicine can be seen in the recent proposed merger of CVS and Aetna. The companies involved are in a massive media campaign to make patients think this is to their benefit.  Please remember, these are businesses at the end of the day and their ultimate goal is to increase financial return to investors.  The basic facts are still at play- a drug store is buying an insurance company.

On Wall Street, the widely held belief behind this merger is that by teaming up, CVS and Aetna can have a fighting chance against the behemoth that is “Amazon”, as this online giant attempts to get into prescription drug sales.

Often, the patient is the one to suffer in situations such as this merger, as they will actually pay more and receive less choice.  It’s a monopoly and if your insurance is owned by a drug store company, guess which prescription you will likely receive?  The one on formulary at CVS of course!  So, if the prescription chosen to treat your condition is on formulary at CVS, there most certainly is less overall cost in the health care transaction.  So, does the patient pay less since their prescription costs less or a lower copay for seeing a mid-level provider in a “clinic” that is now part of the plan to have in CVS stores?

You guessed it, the company will profit each time a prescription is written for a drug under their formulary instead of one that isn’t.  The company will also profit each time a midlevel provider sees a patient instead of a physician.  Again, is this in the best interest of the patient?

One last piece of information to consider, the Aetna CEO will walk away with $500 million in cash and stock if this deal goes through.  This executive, who is not a physician, has much to gain from this merger.  I don’t begrudge anyone good fortune, but I also don’t believe the media should portray that the patients are the primary ones to benefit in a deal such as this.

Patients and physicians are no longer accepting the status quo and what everyone outside of health care is telling us is “in our best interest”.  We see and understand what is going on.  We are speaking up and demanding better.

OB GYN, Physician Training, retirement

Is it Ethical to Retire Early from a Career in Medicine?

Eight weeks after I delivered my 3rd child, I was diagnosed with a 4 cm lung mass.  Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer.  Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis, and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician.

Luckily, I soon found out my situation was not as grave as first expected.  A PET scan leaned toward benign diagnosis (or at least consolidated disease).  I could temporarily push aside the paralyzing fear of leaving my 3 young children with no mother and focus on getting rid of this mass that was causing pneumonia, difficulty breathing, coughing for 2+ years, and go ahead with scheduling the thoracotomy.  After resection of the mass which was densely adherent to my pericardial sac and phrenic nerve, I lost about a 1/3 of my left lung.  To my amazement, after my ICU stay I left breathing better than I had been in years.  Benign diagnosis was confirmed.

This experience made me reevaluate my life and it stopped my “hamster wheel” of life I had been running on at a dizzying speed.  I viewed this health scare as a second chance at life.  I didn’t take this lightly as it almost seemed unfair that I got this chance to live while others who have a lung mass often have it turn out to be one of the most fatal of cancers.  Having to face the prospect of this potentially devastating diagnosis changed the course of my life. I was able to view my career for what it was and had become.

 

I had planned to work in my medical career as a physician indefinitely, or at least well into my 60’s.  It had always been my passion to work in obstetrics and I love my patients and the bonds I build with their families. It was never my intention to leave early, and it didn’t factor into choices along the way for my career.  But here I was, ready to retire in my late 30’s after several years of increasing disillusionment with the health care environment.  Apparently, I just needed this wake-up call for a chance to realign my priorities.

Loss of physician autonomy, pressure to increase productivity as opposed to quality care, and placing cost effectiveness ahead of best medical practice were weighing heavy on me.  In addition, the litigious environment in the US has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.

I could no longer honestly tell myself that I was working so hard for the good of my patients, and I became cynical that my efforts were to the benefit of the financial bottom line of a health care system with its priorities out of sync with my own.  This is not specific to any health care employer, physician group, or hospital.  It is emblematic of the US healthcare system in general.  It is the reason I left medicine entirely and did not merely seek to work elsewhere. The problem is pervasive.

The decision to leave became a question of “why am I doing this, and for whom”?  I decided to retire early.

I have since learned that many feel this is not an appropriate thing to do in your late 30’s.  There is the argument that I owe a debt to society now that I have the skills acquired from all of those years of training. Or that the government paid for my residency salary and that I am indebted due to that.  Or that it is selfish to stop working to spend more time with my family.  There is the argument that it is not fair to leave my patients that I have been caring for over the years.
My response to the ethics of my decision to retire early: If you pay for the privilege of a medical degree and work hard to pay off this debt, should it be your decision if you want to continue to practice?  The government did pay my salary as a resident, which amounted to a little more than minimum wage for 4 years of 80 hour work weeks.  Do I owe something because of this?

As for leaving my patients, I actually do feel a little guilty about his one.  I love my patients.  I also struggle with no longer using my degree for clinical practice, something I worked so hard for.  We are already feeling the strain of physician shortages and this another thing that gives me pause.

In the end, the burden of practicing medicine in today’s environment no longer outweighed the positives for me.

Ironically, it’s my patients who hugged me and told me how happy they were for me to live the life I felt I needed to.  It’s my patients that spoke up (without me saying a word) about how the medical field has changed and that we are losing good doctors as the control of medicine is being handed to hospital administrators and politicians who are making choices about health care without a medical degree. It’s my patients that brought presents on my last days and thanked me for the care I did provide throughout my career instead of lament about what I “could” have done if I stayed longer.

It was a very personal and difficult decision for me to leave medicine and luckily, my colleagues who know me have been incredibly supportive.  On the other hand, one thing that has surprised me is the number of physicians contacting me who want out of healthcare but don’t know how, or can’t, get out.

How do we retain physicians? It is not by increasing salaries. Doctors aren’t in it for the money, we chose this profession to help people and save lives.  We do it by reforming the current health care environment and making this a profession that is sustainable.

Give medical decision making back to physicians.  Decrease the cost of health care by cutting out costly administrators and through tort reform.  This is the way to keep our best physicians and improve health care in our country for our patients.

Ultimately, is it ethical to retire early from a career in medicine? Or is it a bigger picture issue of how do physicians take back control of medicine so that we aren’t leaving at a time of shortage? This is a major concern for our country moving forward.

 

hpv, OB GYN, Parenting, vaccine

This Mom (and OB/GYN Doctor) Sounds Off on Whether Your Daughter Should Get the HPV Vaccine

My young daughter will be entering middle school in another year. However, she still likes coloring books. If she watches a scary movie, I have to lay with her in bed until she falls asleep.

She is still just a kid. Should I really be worried about HPV? Is this something you should consider for your daughter?

Most people know that the HPV virus is sexually transmitted. However, most people don’t think it could happen to their daughter. Unfortunately, more than 80% of the population has been exposed to the HPV virus during their lifetime. How is that possible?

Well, let’s assume your daughter has 1 lifetime sexual partner. Let’s pretend her future husband only had 1 girlfriend prior to meeting your daughter. However, maybe his previous girlfriend had 5 partners- and who knows how many exposures those 5 partners had.

Now it’s easy to see that you don’t have to be sexually promiscuous to be exposed to HPV. It could happen to anyone and often does. HPV is silent (there are often NO symptoms), and people don’t know they have it and therefore pass it on to others unknowingly.

As an ob-gyn doctor, I know about the HPV virus and have seen so many patients affected by this virus that can cause cervical cancer if left untreated. I have seen women die from cervical cancer caused by this virus. I have seen pregnant women who are newly diagnosed with cervical cancer have to decide whether to delay treatment or potentially risk their pregnancy by treating the disease.

Luckily, most of the time we can monitor the HPV virus through pap smears/hpv testing and never have to intervene as the body will often clear the virus on its own. Occasionally, treatment in the form of excisional procedures on the cervix are necessary to prevent progression to cervical cancer. If you have never seen a LEEP procedure done in the office, trust me, you want to spare your daughter from this if at all possible.

By the time a girl visits her ob-gyn’s office she may have already been exposed to HPV and we potentially missed an important opportunity to give the vaccine. This is due to the fact that we typically don’t see teens in the office unless they are having a problem, and we don’t start pap smear screening until age 21 (appropriately so).

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Pediatricians (and family practitioners) do a fantastic job of making sure our young girls are getting the vaccine when indicated. Currently, the vaccine can be given to girls between the ages of 9-26 years old. Most girls are vaccinated with the series at age 11 or 12. Remember, the point is to vaccinate far PRIOR to sexual activity. We don’t expect your 11 year old daughter to be sexually active.

On the other hand, I have had to do numerous procedures on patients in their 20’s who have precancerous lesions from the HPV virus. Most are shocked and terrified and don’t understand how this could have happened to them.

As a mother, I am just like any other parent who would do anything to prevent my child from suffering. I worry about risks and benefits of treatments (even preventative) and how they will affect my daughter. I feel lucky to have had the opportunity to truly understand the research and risks behind this vaccine through extensive training in obstetrics and gynecology.

It is empowering to have access to a vaccine that can actually prevent cancer.

So, while the physician in me appreciates and understands the research and clinical implications this vaccine portends, when I counsel patients I find the mother in me also weighing in.

Since I do have a young daughter who I would do anything to protect, I can assuredly say that she will be getting her HPV vaccine when she turns 11. I want to know that I did my job as her mother to protect her when she can’t yet understand how this may impact her life down the road.

 

Uncategorized

Holding the Knife for the First Time

As an intern in ob-gyn, one of the things you look forward to the most is getting to be the surgeon while an attending is your assistant for a cesarean delivery.  In some residency programs this doesn’t happen until your second year of training.

Most of the time you are honing skills on uneventful vaginal deliveries.  You are learning about labor progression, shoulder dystocia, inserting cervical ripening agents and performing “scut” work around the labor ward.

However, one a day an attending notices the work you have been putting in.  He also notes the great rapport you have with this particular patient.  He asks you if you would like to perform her necessary surgery and you say “yes!” before he has finished asking.  You put on the surgical gown and knee high scrub boots about 30 minutes too early in anticipation.

You nervously sneak away for a few minutes to review the steps in your mind for the surgery.  You have scrubbed into dozens of c-sections as a medical student, but that involved holding the suction and retractors.  This was much different- you would be holding the knife for the first time.  You feel ready, and have been practicing your surgical knots and know the steps.

After you talk with the patient and help her onto the operating table, you begin the prep work.  You check the fetal heartbeat one last time and then cleanse her abdomen with a solution to help prevent infection.  Next, you cover her body with a drape that has a large hole in the middle designed to allow access to just the pregnant abdomen.  The drape extends upward and you can no longer see her face behind the drape.  You now understand why this is a good thing.

The drape helps you mentally separate from the attachment you have with the patient.

Before the drape went up, you were sensing and feeling your patient’s expected anxiety about having a surgical procedure.  You were also feeling the excitement from both she and her husband about the fact that their baby was about to be born.  The drape moves your focus to only the task at hand.  You stop thinking about the emotions involved with this person, and instead direct all of your attention to safely performing this surgery.

You confidently call out “scalpel” for the first time and the scrub tech hands you the instrument.  Your hand is shaking just slightly as you press it against the skin.  However, you notice the tremor disappears as you carefully and deliberately make the large incision on her abdomen.   You have started and the steps of the surgery proceed like second nature.

When you make the incision on the uterus you are particularly careful.  All you can think is “don’t cut the baby”.  The fetal head is firmly pressed against the uterine wall which is particularly thin after a long, stalled labor.  You cut through the thin uterine muscle layer by layer until you see the scalp of the baby.  At this point you gently slide your hand over the baby’s head and deep into the pelvis.  You have never done this part before, but the attending calmly guides you to keep your wrist straight and pull the baby’s head through the incision.

It takes more strength than you anticipated as the head was socked deep in the pelvis of a laboring patient, but you do it successfully and the baby is screaming immediately on delivery.  You look down and excitedly announce “It’s a girl!” to the parents waiting anxiously behind the drape.  For the first time since the surgery started, you allow your emotions back in.  A rush of adrenaline runs through you as you relish and acknowledge the gravity of the moment of this baby’s birth.

Finishing the surgery, you sew the uterus and fascia carefully back together.  You notice the scrub tech impatiently looking at the clock and you are acutely aware it takes you more time than most seasoned surgeons since this is only your first case.  However, your attending doesn’t seem to mind your meticulous fashion so you proceed without worry.  Finally, you sew the skin to complete the case.  Your attending physician says “nice job” and shakes your hand firmly.

You don’t think there could be a better feeling than performing your first case solo…..

Until, you get to walk an intern through their own “first case” and experience the growth, excitement and gratitude through their eyes.