Reflections: This Time Last Year
>> Thursday, May 30, 2013
As I sit here typing this, days from moving across the country to California for residency, I must reflect on my last 2 rotations of M3 year this time last year. It's certainly been a crazy ride, this whole med school thing . . .
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Obstetrics/Gynecology: Watchers Over Birth
Obstetrics/gynecology ("ob/gyn" for short) is an interesting field because it's really two separate fields united over a single common cause: women's health. The two halves are, as you might have guessed, obstetrics and gynecology.
Obstetrics: from the Latin word obstare which means "to stand by." Ob focuses on pregnancy from conception to delivery, almost literally "waiting" for the moment of childbirth. It's the more "medicine" side of ob/gyn from routine health maintenance to prenatal visits to labor and delivery. I have only two personal criticisms regarding ob - 1.) it provides really focused care and can ignore more general health issues unless it will directly affect pregnancy, 2.) it provides excellent care of the fetus until delivery, and then the newborn is handed off rather quickly. That said, being able to attend a childbirth and catch a baby is one of the greatest privileges a med student can have - to literally be the first person to hold a newborn.
Gynecology: focuses on women's reproductive health. Gyn is the more surgical side of ob/gyn. There are a lot of surgical procedures that can be done (e.g. hysterectomies, ovarian cyst removal, etc). It's often criticized by general surgeons (rightly or wrongly) because gynecologists don't get much (any?) training on surgery outside the pelvis and bad things can happen should they find themselves accidentally in the abdomen.
It's this dichotomy between ob and gyn that I find fascinating. Some people gravitate more towards ob and others more towards gyn. The other fascinating thing about ob/gyn is that it's now overwhelmingly dominated by women. A male ob/gyn is a rarity, but I must say (from my limited observations), they tend to be more understanding and gentler with their pelvic exams. My hypothesis is that, because men don't have vaginas and such, they tread more cautiously to avoid discomfort (and also try harder to earn women's trust). On the flip side, women know their own anatomy better and I've seen female residents been "rougher" with patients because they can "handle it." But what do I know?
-----Neurology/Psychiatry: Troubled Minds
Neurology/psychiatry ("neuro/psych" for short here) are actually two different specialties entirely and unlike ob/gyn, aren't slapped together despite both focusing on the brain and the mind. Regardless, this rotation tends to be combined for this reason.
Neurology: focuses on the more anatomic dysfunctions of the brain. I rotated through the neurovascular team (aka, stroke team) and it was actually pretty interesting. Strokes are not uncommon and can be very devastating if not treated promptly. For much of neurology, once damage to the brain is done, it's irreversible. Treatment mostly focuses on either stabilization or trying to stop/slow progressive damage and disease. That said, stroke was nice because if treated during the first few hours, the symptoms can sometimes be completely reversible. I also found neurology to be "too academic" for me - lots of discussions about the injury and potential treatments, and not enough that can be actually done (yet).
Psychiatry: focuses on mental illnesses and diseases. Psych was fascinating. My site director told us something I should never forget: "Remember to treat the person and not the disease. There is a person inside there and you must treat him/her, not his/her mental illness." That really struck home because it emphasizes that these patients, too often stigmatized by society, are worth helping and saving.
I was fortunate to rotate through a site that saw the whole gamut of psych - from child/adolescent to eating disorders to adult to drug abuse/rehab. The child/adolescent cases are the most heart-wrenching. Many of these kids come from unfavorable backgrounds and their mental illnesses are often a result of their environment in combination with a "more fragile" mental constitution. I've seen some of these kids make great progress and develop coping strategies and mental resilience. I've also seen other kids who returned quickly because their home environment is so bad that being in an inpatient mental facility is better.
As my preceptor once said, "Our goal is to help these kids re-balance their mental set-points so they can function and be more resilient." Too bad hugging wasn't allowed (much less a physical exam), because some of these patients (child or adult) just need some attention, tolerance, and someone to believe in them.
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