Obstetrics / Gynecology

When his high school biology teacher asked “NB” about his adult career plan and NB responded that he wanted to be a doctor, the biology teacher tried to discourage and redirect him: “You’re not college material and will never be admitted to med school so join the Navy and figure out another career from there.” NB accepted the challenge!

FAMILY BACKGROUND AND CAREER INFLUENCE

NB is one of three children, including his twin sister. His father had a hobbyist’s interest in science during his main career in advertising. When NB was 9 years old, his mother died of a doctor’s misdiagnosis, which was also the cause of death of one of NB’s grandparents. Looking back years later when thinking about factors which led to his eventual career in medicine, NB wonders whether those two premature deaths in his family an indirect influence were shaping his desire to help people by providing accurate medical advice and treatment. 

Following the death of NB’s mother, his father married again but was later divorced and married for a third time. Concurrent with his marital issues, NB’s father experienced difficulties and stressful times within his business world. NB now attributes his father’s inattention to provide academic guidance, to his father’s preoccupation with his own, stressful life. 

EARLY THOUGHTS OF AN ADULT CAREER

During one recalled conversation with his father when NB was a teenager, he told his father that he thought he would like to become a doctor. His father’s advice: “Well, then, you better get to work, or you’ll be looking down the end of a gasoline pump instead of a microscope.” 

SCHOOL DAYS

As a result of all unrest / chaos within his own life, NB’s father decided his children’s education would best be served within the structured world of private schools, though not at the same school for each child. Accordingly, NB was enrolled in a military prep style of school for his eighth and ninth grade school terms, where NB experienced “tough” discipline from the upperclassmen who enjoyed harassing new “cadets” under the guise of military discipline but NB did appreciate the enforced daily structure: all cadets are wakened at the same time to get out of bed, shower, get dressed and proceed through their highly regimented day. However, while not having the freedom to make personal decisions about when to do what, the structure did not motivate NB to study hard to become a good student. 

After two years of paying private school tuition without seeing an improvement in academic performance, NB’s father decided that his children might do just as well back in the local public school system. NB was glad as a 10th grader to be free of military discipline but the transition from private to public school did not by itself produce academic achievement; to the contrary, NB took advantage of his freedom from older students’ harassment, by turning his attention more to cute girls in class and playing drums in a band. 

Only one public high school teacher – for chemistry – took an interest in BN as a person, apparently sensing that as a new transfer into the 10th grade, NB didn’t share the same, long background with his classmates, who had mostly been together since kindergarten. As a result, NB worked hard and achieved an A in chemistry in order to not disappoint the teacher. 

COLLEGE

NB was required to meet with the high school guidance counselor, a nice lady who offered no suggestions, which he can now recall, regarding NB’s possible elective courses or post high school plans. But one infamous conversation with NB’s biology teacher will never be forgotten:

Bio Teacher: “Although you earned a B in my biology class, it was just barely above a C. I have reviewed the rest of your grades and other than chemistry, you have not demonstrated any academic abilities. You don’t even seem motivated to do well in the rest of your courses. I just don’t think you are college material so I suggest that the day after graduation, you enlist in the Navy and then take your service time to figure out what sort work you want to do.”

NB: “But I did get a B in your bio class and an A in chemistry so I think I can make it as a doctor.”

Bio teacher: “Not a chance. I was a straight A student and couldn’t get into med school, so you have no shot but even before med school, I don’t see you succeeding in college.”

NB: “I’m going to graduate from college and med school and will send you an invitation to my med school graduation!”

Bio teacher: “Good luck with that plan!” 

(Editor’s note – For many men and women, several years – or an entire career – of military service, is a good career option for such reasons, as serving your country, getting physically fit, learning discipline and leadership plus a possible civilian trade.)

NB then applied to six small, liberal arts colleges. Soon it appeared that the biology teacher had made an accurate prediction: NB was rejected by every school to which he had applied. 

NB considered his options: (A) continue applying to different colleges; or (B) join the Navy or one of the other military service branches; or (C) apply to a two year community college which likely had less academic standards for admission; or (D) use his drummer skills – having been voted by his high school classmates as “most talented male senior” – to join a band and pursue a career as a professional musician; or (E) try to find a job – any job – to support himself while he continued to consider what to do with his adult life. 

Fortunately, two things combined to give NB an opportunity to move forward in a good way: (1) while experiencing multiple college rejections, NB kept a positive attitude, believing he could be a successful adult if he could just find the right path to follow; and (2) his informal ‘friends network’ (including friends his age and adult friends of his father and step-mother) created an opportunity: when an adult friend heard that NB had not received any college acceptances, she recalled knowing someone who was a recruiter for a small, liberal arts college, several states away. She called her friend, who arranged for NB to be admitted on condition that he achieve at least a B average with no course failures. 

SELF ASSESSMENT IS HELPFUL – BUT ONLY IF REALISTIC

(Editor’s note – in Greek mythology, Icarus self-assessed that he could fly close to the sun. Icarus was able to get close but unfortunately, his wings were made of wax, which melted so his belief in his superpowers was not realistic; modern examples of unrealistic goals include hoping to become an emergency room physician or nurse but fainting at the sight of blood or wanting to be a civil engineer designing bridges but not a dedicated math student.)

NB accepted the challenge of his biology teacher’s pessimistic assessment! So NB eventually enrolled in college and worked hard to earn straight A’s for the first two years as a music major, which followed his passion and the recognition of NB’s artistic talent by his high school classmates. However, with two years of college and then an adult career still ahead, NB took some time to consider whether to proceed along the career path of a professional musician or switch to a different career path. First, he self-assessed the musician career path with the following considerations: 

* Talent level: am I adequate now and if not, is there realistic hope of improving my skills with enough dedication? Apparent music talent among 125 high school classmates may not merit the same degree of appreciation among a group of college classmates majoring in music. NB concluded that his actual talent was not at the same level as his similarly focused classmates. Before he assessed whether more practice and/or better music teachers could improve his performance, he pondered the next issue: 

* Lifestyle of a band drummer’s career: good now or eventually? Whether ultimately right or wrong, BN’s personal assessment was that too many professional musicians were drug addicted and/or not earning enough money to adequately support themselves. 

NB’s ability to realistically self-assess his own talents proved to be a very helpful personality trait. As an aspiring musician, NB realized that his talent level was below the talent level of his fellow music majors. As an aspiring physician, NB knew he could understand sophisticated science because he had already done so by performing at A and B level competence within a good high school’s biology and chemistry courses. Thus, he was able to rely on his own self confidence to disregard the advice of his high school biology teacher and proceed to college. 

Following his self-assessment which redirected his career path from music to science, NB enrolled in all the advanced science courses available at his university. Still a dedicated student and now with a new career goal, NB continued to achieve excellent grades in all his junior and senior year college courses. Medical school applications required the grad school equivalent of college ‘boards’ (either SAT or ACT): the “MCAT” exam, in which BN scored at the 100th percentile, leading to admission to every medical school to which he applied. 

“So now, Mr. Biology Teacher” asked NB to himself, “whose prediction turned out to be more accurate, yours or mine?!”

MEDICAL SCHOOL

NB’s dedication to learning his medical coursework was now fixed within his personality, as he worked hard and was rewarded with academic success. With graduation approaching, NB had to choose what type of medical practice would be both interesting and match his skills. Initially he considered psychiatry but then redirected his medical internship applications to internal medicine, which involved working in a clinic setting every two days, where NB was frustrated at not being able to cure enough (any?) patients with chronic (long term) diseases. 

Early epilogue – As NB was preparing to graduate from medical school, he had not forgotten his earlier promise to send an invitation to the ceremony to his high school biology teacher, who never responded.

Again, taking time to self-assess his interests and abilities for choosing a medical specialty now that he had graduated from medical school, NB joked to himself that he had “about a nine month attention span”…………. which coincidentally he realized was the same time period relevant to the combined specialties of obstetrics and gynecology (often referred to in abbreviated fashion as “OB – GYN”), involving the nine-month term from inception to birth. The OB part included surgery, which interested NB so combined with the ability to diagnose and treat medical issues at their early stages, NB could provide a much higher “cure” rate than dealing with long term diseases. So, NB had found his medical niche!

CAREER REQUIREMENTS BEYOND MEDICAL SCHOOL

A ‘basic’ career within the multiple specialties of the medical field requires 4 years of medical school, 1 year of specialty internship and 3 years of specialty residency (which may be a different specialty than the internship, as NB had opted to do). If the now licensed physician wishes to become “Board Certified” in a medical specialty, there are additional requirements: practice your specialty for at least two years and then present to the examining board, 100 of your cases for discussion as part of your oral exam, for which the pass rate is usually about 60%. 

FIRST CAREER JOB

(Editor’s note – As many of these Career Stories demonstrate, finding that first career job is often the result of what some refer to as “Luck” which – for purpose of these career stories – we define as follows: “Luck” = preparation meets opportunity.)

Following his pattern of giving careful thought to his future, NB sought advice from the chairman of the OB-GYN department of his medical school, to whom he posed a question: Since I would prefer a warm – but not necessarily hot place to live and work – what would be the best place to start out practicing my ob-gyn specialty? Without hesitating, NB’s mentor recommended an area with a climate matching NB’s parameter and then a specific city known for performing high-quality medical services within the ob-gyn specialty. 

Armed with his good academic record and personal recommendations from medical school professors and those with whom he had served as an intern, NB was able to promptly achieve several employment offers and select one ob-gyn practice to join with the prospect of soon becoming an equal business partner within a four MD practice. 

TYPICAL DAILY ACTIVITIES OF ONE OBSTETRICIAN / GYNECOLOGIST

NB worked as an ob-gyn within a medical practice (“practice” is used in the medical field as another word for “business”) consisting of 4 ob-gyns. The following are typical daily activities which of course cannot possibly all occur on the same day:

* Start the day early with ’rounds’ at the hospital; takes about 2 hours to visit each of your patients plus patients of other ob-gyns in your practice group, when you are ‘on call’

* Meet with 25 to 30 female patients each day 

* For each office visit, review their electronic chart and listen to the patient’s description of her current medical situation or problem

* Conduct a physical exam focusing on the current medical issue (e.g. new pregnancy or follow-up from a previously diagnosed infection) while remaining alert to potentially new medical issues which the patient has not yet realized

* Diagnose all discovered medical problems and prescribe related treatment such as a drug prescription, including alerting the patient to possible side-effects

* Recommend any future treatment needed, such as surgery or an office visit

* Update the patient’s medical chart to preserve current developments

* Receive a call from your answering service at 3 a.m. to proceed to the hospital to deliver a baby which you have already predicted will likely be a problem delivery due to the way the baby is positioned within the mother; (NB stopped counting the number of babies he helped to deliver, when the total reached 3,000!)

* Work all day and then proceed to the hospital to work with patients there for such issues as delivering their newborn baby; fortunately, NB loved his work enough to never let occasionally required, ‘odd’ hours bother him 

CAREER CHALLENGE – PERSONAL LIFE RELATIONSHIPS IN TRANSITION

(Editor’s note – Professional success in the practice of your trade and within your business relationships can proceed smoothly along one path while at home, your personal life is at the same time, ‘problematic’ due to various reasons such as serious illness for yourself or within your family or spousal incompatibility leading to separation and divorce. Some circumstances can be planned and controlled; others cannot be. But one thing is for sure – events within your personal life can significantly affect your career path.) 

While NB’s life as an OB-GYN was proceeding smoothly along two important fronts: (1) his increasing competence in diagnosing and treating medical problems plus his skills as a surgeon; and (2) calm and financially rewarding relationships with his ob-gyn practice partners, concurrently he was experiencing unrest on the personal side – his home life was in flux with a failed marriage and unhappiness regarding the residential area. 

Personal life resolution may never be satisfactorily resolved but at very least, an unstable situation at home needs to be dealt with so it doesn’t interfere with the important aspects of one’s career. NB brought peace to his personal life by obtaining a divorce from his wife and then he brought peace to his professional life by returning to a geographic area where he had enjoyed living and finding an opportunity to practice his medical specialty with nice and competent business partners. 

CAREER CHALLENGE – PATIENTS ASSUME PERFECT OUTCOMES

(Editor’s note – An old adage states: “To err is human, to forgive is divine.” However, while everyone knows perfection is rarely always achieved by themselves, doctor’s patients usually assume that there will be no medical error by their doctor; that only happens to someone else! 

And if a doctor errs, many patients will file a legal claim instead of offering divine forgiveness. 

Every licensed automobile driver knows that stopping for a red light is mandatory. Those who enter contracts are not supposed to breach their contractual duties. Soup manufacturers may be sued for selling contaminated soup. So, there are legal standards of acceptable conduct for everyone, as even U.S. Presidents are “not above the law” and may be impeached for misconduct. 

Fortunately, the legal standard of required medical care is not ‘perfection’ but only ‘conformity with community medical standards’ which ultimately a civil court jury has the responsibility to determine at the conclusion of a trial when a physician has been accused of ‘medical malpractice’ and has the opportunity to present defenses, including expert witness testimony. 

Since medical patients may decide to sue their physician even if the physician has provided excellent medical care but the patient was dissatisfied with the outcome, a potential career challenge for any physician are the effects of having to participate in a lawsuit, whether the physician is right or wrong: newspaper publicity which may be a headline announcing the lawsuit but less than a headline announcing a ‘not guilty’ verdict several years later, plus the time and attention devoted to having to defend yourself in court.) 

NB is pleased that during his decades long career as a physician, he was never sued for malpractice. 

CAREER CHALLENGE – DISAGREEING WITH A PATIENT’S REQUEST

This career story will not proceed “down the rabbit’s hole” of issues involving abortion, “legal” or otherwise. All that will be stated here is a frequent issue for ob. – gyns: whether to induce an early termination of the pregnancy (abortion) at the patient’s request or decline the request, where “harm” (however that may be defined) to the mother and/or to the child is medically forecast?  

Plastic surgeons surely face the same dilemma with less life-or-death consequences: can the dr. really make a 70 year old patient look 35 again?

Internal medicine / ‘family’ doctors must ask themselves whether continuing pain medication is in the best interest of a patient unwilling to try physical therapy. 

Critical care pulmonologists and trauma surgeons must deal with critically ill or injured patients and their families when it is clear to the physician that the patient will die soon without treatment but if ‘saved’ will never have a ‘quality of life’ possible thereafter. 

Examples of these medical dilemmas for physicians could go on and on. Suffice to say that some medical professionals are often on the front line of having to make life saving or life altering recommendations in the face of a patient’s or family’s wishes with which the physician disagrees. 

CAREER SATISFACTION

As an obstetrician / gynecologist specialist, NB appreciated:

* Being able to detect female medical issues during routine, annual exams, often before the patient experienced any symptoms and then providng the necessary treatment to effect a complete medical cure

* Bringing new children into the world by using his expertise; (NB confesses that many babies can be born without professional assistance, as evidenced by births occurring in cars while on the way to the hospital when mom ignored her labor signs for too long! So, he is glad to be the professional available to successfully save the life of the mother and child which would not have happened without his intervention.)

NB’S RECOMMENDATIONS FOR A HAPPY, SUCCESSFUL CAREER

* Hang out with smart kids who are goal oriented; avoid pessimistic ‘losers’

* Get to know your teachers to understand their teaching methods and so they understand you as a person

* Don’t skip class – study ‘hard’ to learn the subject and achieve good grades, which will be useful two ways: (1) you gain that knowledge; and (2) its a record of your dedication to learning which will open doors to further education and interesting careers

* If you proceed to college and are considering grad school after college, think twice about joining any social group (e.g. fraternity, sorority) which would distract you from being a serious student