First day of Ob/Gyn

[Metfan2987]

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I just had my first day of Ob/Gyn and it was weird. I was miserable because this is my first rotation and I really have no clue at all what is going on in L&D. The residents are all so busy and I feel like I'm just following them around and clinging on any small task I am able to do. Its like, I feel like most of the time there the residents spend on the computer writing notes or just keeping the records straight. I felt really bored and annoyed.

Anybody else feel the same way?

 

[turkeyjerky]

yeah, that's pretty much par for the course. It will get better though, trust me. Won't ever be as great as people have led you to believe, but it will be better than it seems right now.

 

[Rollo]

Yeah I'm on rotation #2 and first few days of this rotation and my rotation last month, I was pretty much shadowing and trying to stay out of people's ways. You have to get used to your surroundings and people you will be working with first. Then you will start to get comfortable seeing patients on your own, following them, and talking about your patients with the residents.

It gets better, my friend. Don't worry.

 

[Perrotfish]

I just had my first day of Ob/Gyn and it was weird. I was miserable because this is my first rotation and I really have no clue at all what is going on in L&D. The residents are all so busy and I feel like I'm just following them around and clinging on any small task I am able to do. Its like, I feel like most of the time there the residents spend on the computer writing notes or just keeping the records straight. I felt really bored and annoyed.

Anybody else feel the same way?

I did OB at a private hospital (thankfully it was my last rotation). In 6 weeks at that hospital I never did a procedure (other than hold a retractor), I was barely spoken to, I never did an admit and almost never presented patients on rounds. It's not par for the course and it's low yield to say the least. However on a service like Ob/Gyn where there isn't really one attending in charge of the team it's an easy pattern for residents to fall into. There are other, more educational rotations coming. Until then try not to offend anyone and carry around lots of reading material. The good new is that other than medicine and maybe Peds, I don't think you'll ever learn as much from just reading as on OB, so lots of reading time isn't really a terrible thing for your education. Honestly without doing a lot of reading there's only so much you can really do on L&D anyway.

 

[sineapse]

I just had my first day of Ob/Gyn and it was weird. I was miserable because this is my first rotation and I really have no clue at all what is going on in L&D. The residents are all so busy and I feel like I'm just following them around and clinging on any small task I am able to do. Its like, I feel like most of the time there the residents spend on the computer writing notes or just keeping the records straight. I felt really bored and annoyed.

Welcome to clinical medicine.

 

[vicinihil]

Try talking to the residents about what they are doing. Obviously you have to be somewhat knowledgeable about L&D and don't ask questions like why are they mg'ing her.

Try to make yourself useful. The personality in OB is pretty neurotic so I think if you offer to do the menial tasks like you have been you'll do great.

Tips I found to make myself useful is to follow patients and do mag checks without being prompted. Also, show the residents you did them by going 10 minutes before the 2 hour mark so when you're done and before the resident goes him or herself, you can walk with them and tell them what you found, etc. Another useful thing to do is triage. No resident likes to see triage esp if its just Braxton Hicks. So go in there, ask the 4 questions, get out. If the patient is hispanic, grab the blue phone and go at it.

 

[finns86]

OB/GYN was one of my most difficult rotations due to the time requirements (took 30 hour shifts when on call) and the subject material (not really any OB/GYN preparation in the first two years of medical school).

I would however point out that this is July. Meaning that all the interns where medical students just a few months ago. I know that I wouldn't be doing much teaching if it was my first month ever of having the responsibilities of a physician. Also, the senior resident's priority is making competent interns not helping you honor/learn unfortunately.

 

[Metfan2987]

OB/GYN was one of my most difficult rotations due to the time requirements (took 30 hour shifts when on call) and the subject material (not really any OB/GYN preparation in the first two years of medical school).

I would however point out that this is July. Meaning that all the interns where medical students just a few months ago. I know that I wouldn't be doing much teaching if it was my first month ever of having the responsibilities of a physician. Also, the senior resident's priority is making competent interns not helping you honor/learn unfortunately.

I completely understand that. Its getting a little better as time goes along but not good altogether. I guess all I can say is good thing I have no interest in going into the field at all. Oh my god...I feel sooo bad for the intern, she is ridiculously stressed out at all times, and it seems like she never has a second off. Wow.

 

[45408]

I second the sympathy for the interns. When I was an M3, I didn't really appreciate how clueless they were for the first week or two. Once I did, I was kind of depressed when I realized that I would be in their shoes in two short years. They start to pick up speed pretty quickly with their volume of hours, but they just came off a pretty long vacation (end of M4 + a few months off). The M4s will be a much better resource for the first few weeks of July, especially since they know where everything is and how the system works. Plus, they need to be doing procedures. I'm just starting PGY-2, and even I won't be giving up things like central lines and chest tubes to the med students, sorry.

 

[Metfan2987]

I second the sympathy for the interns. When I was an M3, I didn't really appreciate how clueless they were for the first week or two. Once I did, I was kind of depressed when I realized that I would be in their shoes in two short years. They start to pick up speed pretty quickly with their volume of hours, but they just came off a pretty long vacation (end of M4 + a few months off). The M4s will be a much better resource for the first few weeks of July, especially since they know where everything is and how the system works. Plus, they need to be doing procedures. I'm just starting PGY-2, and even I won't be giving up things like central lines and chest tubes to the med students, sorry.

Yeah I never even thought of it like that. I'm honestly not upset at all with the intern I know how stresses she is right now and how she needs to (a) learn and (b) keep up. I'm more upset with the PGY-3 I follow during the day and how she shows absolutely know desire to teach me at all. And she scuts the hell out of me. I feel like the guiding principle should be that scutting is not an unacceptable thing as long as you also teach your student. If you don't teach me, you don't get to scut me. I'm considering just saying no to her the next time she asks me to bring charts from department to department. I'm not a f'n slave, I'm there to learn.

 

[han14tra]

I'm also doing my OB rotation first. L&D is boring because all you do is sit there and wait for the women to dilate to 10cm, and go offer them some ice chips or a blanket. Then, when they do deliver, the intern or resident always jumps right in leaving you to stare over their shoulder. If you're lucky, they let you deliver the placenta.

I've made my experience better by going over to the triage area. I'm basically functioning as an intern now. I see patients on my own, perform transvaginal ultrasounds, do FFNs, check fetal heart rates or fetal positioning using the transabdominal ultrasound, and do cervical checks. Then, I enter all the information into the computer, come up with a plan, and go present to the attending. Try to figure out who is the most overworked person there (usually the intern) and try to make their life easier. If they are entering info into the computer, say "hey, do you want me to go do the next patient's H&P and enter it into the computer for you?"

 

[Metfan2987]

Wanted to bump it up to discuss my 2 weeks on L&D.

Theres one major lesson I haven taken home from these past 2 weeks: The medical-legal environment reeeally is the major culprit right now in the deterioration of the doctor-patient relationship. What I have seen in the past 2 weeks is absolutely disgusting and does not do the great field of medicine justice. Doctors spend most of their time covering their paperwork bases and making sure they can't get sued over some bull****, and it SERIOUSLY compromises quality and efficiency of care. These doctors probably spend about 1-2% of their time during the day with patients. Before I was on the floor I really thought of that dogma as overkill, but it is soo true and soo easy to fix. I won't just sit an accept it, when I practice I don't want to be in an environment that absolutely kills the reason I wanted to go into this field: patient interaction and being able to make people in pain comfortable. It seems like women who come in with contractions that are painful leave in more distress than when they came in.

Talk about medicare cuts all you want...thats like putting a bandaid a knife wound...before we fix the economy of medicine, we NEED to do something about the correct practice of it. The only way to do that is to take away the culture of defensive medicine the goes on right now.

 

[olemissbabydoc]

Seeing some of the OB horror stories makes me ever more grateful for my teaching institution. Not having lots of fellowship programs means that the residents generally work directly with the attendings and we (M3's and new M4's) can kind of function as 'interns'. I got tons of experience on L&D (5 SVDs, 5 C/S scrub-ins) in two weeks and loved every minute of it.

OTOH, I LOATHED gynonc, and wasn't the biggest fan of general gyn or urogyn. But the specialty definitely isn't off the map.

Hope you have better luck on your next rotation, OP!

 

[sineapse]

I won't just sit an accept it

These doctors probably spend about 1-2% of their time during the day with patients.

Sure you won't...

Doctors don't spend a lot of time with the patient, true. Should have been a nurse if you wanted extended patient contact.

 

[shantster]

Sure you won't...

Doctors don't spend a lot of time with the patient, true. Should have been a nurse if you wanted extended patient contact.

Oh yes. I tried explaining this to my boyfriend when I was on my Medicine AI. He thought that I was working with patients all day and couldn't understand this concept. On call days I would spend ~1-1.5 hour in direct patient contact with admitting 3 patients and seeing my old patients. On non call days that would be ~30 minutes, including walking from place to place since our patients were all on different wings of the hospital and talking to the nurse if I had a question or she had a question for me. The rest of my day was spent either on the phone, on the computer, doing paperwork, finding the case manager to figure out where the person was going and what forms she needed, discussing with the resident and attending. If you want to spend more time with patients, you'll be working very very long days so that you can still get the rest of your work done. Plus for patients that you are just waiting on labs to come back, consults to see them, therapies to start working, what exactly are you going to do with them?

 

[ArcGurren]

Sure you won't...

Doctors don't spend a lot of time with the patient, true. Should have been a nurse if you wanted extended patient contact.

This is one of the reasons I like surgery and am starting to get annoyed with academic programs.

Most of the day is spent in a form of purely academic masturbation. First, talk about the patients a bit more. Then, go in and do a 5 minute physical and ask awkwardly if they're okay. Then leave. Then write stuff for half an hour. Then round for 3 hours and get pimped/watch residents get pimped on random crap. Then go sit in conferences and rounds for 2-3 more hours. Then sit around finishing up notes and refreshing lab values and attempting to read. Then leave in the afternoon. I'd say I spend like 10 minutes out of the day total doing actual patient care (though in all fairness I'm only looking after 1 patient right now, load is pretty low).

I get that it's a teaching hospital and that we're there to learn stuff, but a lot of it is sheer and utter nonsense. I liked outpatient much more where we meet with each patient for 15 minutes at least and get to do stuff for them. At least by the end of the day I'd feel like I'd accomplished something. Inpatient is only really fun IMO when there's cool cases to follow.

 

[sineapse]

This is one of the reasons I like surgery and am starting to get annoyed with academic programs.

Most of the day is spent in a form of purely academic masturbation. First, talk about the patients a bit more. Then, go in and do a 5 minute physical and ask awkwardly if they're okay. Then leave. Then write stuff for half an hour. Then round for 3 hours and get pimped/watch residents get pimped on random crap. Then go sit in conferences and rounds for 2-3 more hours. Then sit around finishing up notes and refreshing lab values and attempting to read. Then leave in the afternoon. I'd say I spend like 10 minutes out of the day total doing actual patient care (though in all fairness I'm only looking after 1 patient right now, load is pretty low).

I get that it's a teaching hospital and that we're there to learn stuff, but a lot of it is sheer and utter nonsense. I liked outpatient much more where we meet with each patient for 15 minutes at least and get to do stuff for them. At least by the end of the day I'd feel like I'd accomplished something. Inpatient is only really fun IMO when there's cool cases to follow.

Umad? Best bit about inpatient medicine is not having patients whine about their achy left buttock or whatever for hours without an escape route! At least you can leave the room on the ward!

But I think as a med student, inpatient stuff can be extremely boring. All you do is follow the team around and not do much patient care. Different story for the house officer though, having like 15 patients to care for keeps you extremely busy.

 

[Metfan2987]

ur missing the point of my rant. I'm not saying that when I work in residency I'm going to go against the grain and really make my spirit spread like a wildfire...I'm saying real underlying changes need to be made to the culture of the practice for the health economy to ever have a chance of improving. Its unrealistic in its current paradigm.

 

[ArcGurren]

Umad? Best bit about inpatient medicine is not having patients whine about their achy left buttock or whatever for hours without an escape route! At least you can leave the room on the ward!

But I think as a med student, inpatient stuff can be extremely boring. All you do is follow the team around and not do much patient care. Different story for the house officer though, having like 15 patients to care for keeps you extremely busy.

I'm the kind of person who, if I'm just sitting around bored for hours with residents who don't even really like to talk to you or teach you or even just chat about movies with you, I'll end up falling closer and closer to sleeping.

We actually do quite a lot of patient care at my teaching hospital, and the med students for the most part play a pretty big part in the recovery and followup of most of the patients. I suppose it is better on residency. I just really hate rounding for hours and hours.