View Full Version : Can Family Med docs do OB also???
08-23-2004, 06:50 PM
If I'm interested in delivering babies, would I need to do a residency in OBGYN? Or would it be possible to work in OB as a Family Med doctor? If I do the later, would I be able to do C-sections? would I have trouble getting OB patients? would I have to live in the boonies to get patients? Thanks for the help!
08-23-2004, 07:14 PM
Yes, you can definitely do OB as a family doctor. And yes, you can also do C-sections. Not only is this covered in FP residencies but you can also do an extra year of OB fellowship after those three years, and in that you can get really good at doing c-sxns etc. In terms of getting patients, understand that even in the boonies you will not be doing all ob. it will be just a part of your very broad and large practice. in the city, it depends which practice you join - I know FPs who definitely have a good OB load and go into the hospital for deliveries quite often - each person in the group is on call one day a week and they cover the deliveries that night. Other FPs in the city don't do OB anymore because of the practice they joined.
Bottom line, yes you can, you just have to choose the right residency program/fellowship and then the right practice. good luck!
08-23-2004, 08:29 PM
awesome! thanks so much for the thorough and helpful reply :)
08-24-2004, 08:00 AM
doing OB as an FP is also dependant on local politics. in my area, FP's do not do OB. it depends on the hospital credentialing policy as well. but, if there are lots of OB/Gyn's in the area, it will be tough to get many cases, or to be able to get privileges in the hospitals.
08-24-2004, 04:35 PM
don't forget to ask yourself "do I want to get sued?" once you start delivering babies, you are pretty much guaranteed 1-2 lawsuits per year, along with a huge jump in malpractice rates.
08-26-2004, 01:24 PM
don't forget to ask yourself "do I want to get sued?" ....
This made me burst out laughing..
It's so sad that the decision to go into a medical field or not can actually be taken down to a question like this and the question be accurate.. :laugh: :laugh:
08-27-2004, 02:23 AM
I find that most FP's can do OB work, but choose not to. They prefer to hand it over to an OB. Also, come litigation time, the pt can't turn around and say that they didn't get the best care from a specialist.
08-27-2004, 04:02 AM
By Patricia I. Carney, MD
Six years ago, I met a woman who would change my professional life. When we first met, she was a patient. For the past three years, she has been referred to as "the plaintiff." Somewhere along the way, I transformed from physician to "defendant."
Ms. V (she really did have a name back then) came to see me because of pain in her right lower abdomen. She brought an ultrasound report that showed a 5 cm irregularly shaped mass on her right ovary. Her most likely diagnosis was an endometrioma, but, considering that she was 42, I explained to her that we needed to remove it.
I knew Ms. V was upset, and I asked her to return to the office with her husband so that we could discuss everything. At that visit, we spoke for 30 minutes, and it's documented in the chart that we discussed laparoscopy vs laparotomy, cystectomy vs oophorectomy, risk of infection, bleeding, and injury to GI and GU organs, especially in light of two previous surgeries.
The patient adamantly wanted a laparoscopy over an open procedure because she needed to care for two small children at home. Before the surgery, I met with Ms. V a third time and dictated a lengthy preoperative note, again describing surgical risks as explained to the patient. I also noted that a laparotomy may be needed if the patient suffered any injury to surrounding organs during laparoscopy.
The surgery took place on a Friday morning. The chart proves I met with the patient yet again before the case. During the next two and a half hours, my partner and I dissected a large endometrioma from Ms. V's right ovary, tube, uterus, and rectosigmoid. We were extremely pleased with the way the case went.
I then made the biggest mistake of the entire case. I filled out the face sheet of the chart, but decided it was more important to get to the patients who had been waiting in the office for the past hour than to dictate the operative report.
I'll think twice before going out of town
It was unusual for me to go away for the weekend?I had two young children. But, ironically, the weekend of Ms. V.'s surgery, I did. When I returned on Sunday evening, I found a message on my answering machine telling me Ms. V. had been admitted to the hospital. I went there immediately, and later that night assisted the general surgeon on an exploratory laparotomy. It revealed a bowel perforation, and we did a resection and colostomy.
Before going back to talk with the family, the general surgeon stopped me in the elevator. He told me emphatically that this wasn't my fault, that I'm a good surgeon, and that if I do enough surgery, I will get complications. It took me several months before I truly believed those words.
I visited Ms. V in the hospital every day and did whatever I could to help her and her family deal with the social problems caused by her hospitalization. After much self-flagellation, I dictated the operative report as it should have been dictated on the date of the original surgery. Ms. V had her colostomy reversed a couple of months later.
On a personal level, I decided to leave private practice to return to academia, and I accepted a job 500 miles away. I also separated from my husband of 18 years, negotiated child custody, and became a single mother. Difficult stuff, but I consider myself a pretty tough cookie. I was about to be put to the test.
A lawsuit casts me as sacrificial lamb
Three years ago, on the day before the statute of limitations would have expired, Ms. V filed suit. She alleged that she hadn't received informed consent and that the surgery was performed in a negligent manner.
The attorney I hired is someone who's handled all of my professional legal work. He's one of the best local malpractice defense attorneys, something my insurance company agreed to. He told me not to worry, because they really didn't have a case. Then he told me what every malpractice attorney tells his client: "Don't discuss this case with anyone."
Two years went by. Then, on a Monday morning, the trial date arrived. I got my pre-trial instructions from my lawyer: Be pleasant, professional, don't react to anything that is said, don't nod your head; don't say a word while in the courthouse or in the two block area around the courthouse where jurors might be hanging out.
I thought, "And why don't I just stand on one foot and balance my briefcase on my head while we're at it?" But, of course, I complied.
The first order of business was pre-trial motions. By mid-morning, both my ex-partner and the hospital were dismissed from the suit for lack of evidence. I had to agree that any act of negligence on the part of my partner would be my responsibility. I felt like the sacrificial lamb.
The plaintiff's attorney called me as the second witness. I quickly realized that he had absolutely no interest in the "whole truth." "Doctor, during the deposition, did you say the operative report you dictated was true and accurate?" "Yes." "Knowing the final pathology, is the operative report true and accurate?" "No, but . . ." "Just answer the question. So, Doctor, isn't it correct then that you falsified information in the operative report?"
The plaintiff had one expert witness?a physician I'd worked with during residency. During his testimony, he identified an anatomical structure on my operative photographs as a fallopian tube, while five other physicians identified it as the colon. Under oath, he claimed to have privileges at one of the local hospitals when, in truth, he'd given up his privileges three years before. He stated my conduct fell below the standard of care because I'd lysed adhesions while removing an endometrioma, which was adherent to the uterus and sigmoid. He stated I had "no business" being near the bowel. He insinuated that the hospital pathologist lied on her pathology report simply because she and I worked at the same hospital.
08-27-2004, 04:04 AM
The medical case fell apart; character assassination began
On the day I finished my testimony, I lapsed for the first time into a profound sense of helplessness: From that point on, the jury would never hear another word I had to say. Call me a control freak?most physicians are?but I get extremely anxious when I feel I have no control over my own destiny.
A few days into the trial, probably after the plaintiff's expert self-destructed on the witness stand, the plaintiff's attorneys seemed to decide that they weren't going to win this case on the medical facts. Instead, they decided to destroy my character, my integrity, and my reputation. I was described as totally insensitive to my patient's needs. I was accused of forcing my patient to undergo unnecessary surgery against her will for the sole purpose of milking her for as much money as possible.
When I couldn't remember the details of a conversation that had taken place five years before, I was accused of stonewalling. When I could remember details, I was accused of lying. When my very explicit preoperative dictation on informed consent contradicted the plaintiff's five-year-old recollection, I was accused of falsifying medical records. The letter I wrote for my patient after surgery to help her sister get a visa to come care for the kids was offered as proof of my admission of guilt. I was not allowed to respond; I was not allowed to react.
During closing arguments, my attorney returned to the medical record. Step by step, he reviewed the chart and the opinions expressed by my experts. Page by page, he made it clear I had fully informed my patient and that her surgical care fell well within the applicable standards.
But when he was finished, I felt betrayed. Not once did he point out that the reason the operative report wasn't dictated immediately was because I had an office full of patients waiting for me. The jury was left to think that my only concern was to go away for the weekend. The jury was also left to think that the surgery was unnecessary and done only to bring me more money. According to my attorney, these issues weren't relevant to my defense. So long as these jurors understood the medicine and the legal question in dispute, it didn't matter what they thought of me as a physician?or as a human being.
It took the jury only a little over three hours to reach a verdict. Before I walked back into the courtroom, my lawyer took me aside. He told me that I was not to say a single word to the plaintiff or to her attorneys once the verdict was read. As we sat in the courtroom, we could hear the jury laughing in the jury room.
They appeared very relaxed as they filed into the courtroom for the last time. As the jury foreperson answered the questions for the verdict, I closed my eyes. The clerk repeated the verdict and then my attorney asked permission from the judge for us to leave the courtroom.
I never looked at the plaintiff or her attorneys; I never looked at the judge. During those moments as I walked out of the courtroom, I felt totally numb. And then I felt relieved. And then I felt angry.
Before this case, I'd never realized that we have a system of law where one person can stand up in a public forum and assassinate someone else's character without a single piece of substantiating evidence (known in legalese as "closing arguments"). He faces no consequences for doing this. He isn't even expected to apologize. We have a system of law that requires the witnesses to tell the whole truth, but then encourages attorneys to manipulate and hide that truth.
I know that most of my friends will tell me to "get over it." They'll tell me that I shouldn't worry about what the jury thinks of me?I'll never see these people again. They'll tell me that the only important thing is that I won.
Oh, did I forget to mention that? Maybe it's because I don't feel like I won; I feel like I have been violated. But one thing is different now. For my own mental well-being, and for the sake of other physicians who will encounter this system, I will no longer be silent.
Patricia Carney. Malpractice: Our system lives on personal attacks. Medical Economics May 7, 2004;81:41.