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Photo by Dainis Graveris on Unsplash

What does ‘at risk’ mean? And why is assessing risk and acting based on that assessment so difficult?

I have been a physician for almost 25 years. In that time, information has become available in an instant, especially medical information. So many websites are available for people to access, yet I still spend the better part of my day explaining to patients what the statistics mean when we talk about risk. Putting these risks in perspective seems like a good idea.

The most common conversation in my practice is about risk for breast cancer. I am a gynecologist, so all my patients are women. Breast cancer is the topic that scares people the most. One number sticks in everyone’s head from some TV commercial: ‘A woman’s risk to be diagnosed with breast cancer is one in eight.’ What do those numbers really mean? If eight women are in a room, one is bound to have breast cancer? Of course not. That particular statistic means if a woman lives to age 80, then at 80, her risk is one in eight that she will have developed breast cancer by that time. That is, one of those eight women who reach age 80 will have had breast cancer. …


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My Book: Life Before Covid

I am exhausted. Every day I return to my home, shed my scrubs, place my chunky Crocs in a pail with bleach, and wipe my hospital ID badge with an alcohol swab before I enter my house. It is automatic, and yet sometimes I almost forget. Sometimes I am almost too tired to follow the routine. But I do it, because I am exposed and my family is inside. I cannot bear the thought of putting them at any more risk than I already am. So I do it. …


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I have been delivering babies for many years. I have delivered them in small community hospitals, and large university settings. I have even delivered one in the emergency room and one in a parking lot. The last few months of delivering obstetric care have felt as though I am a stranger in a strange land. It has changed the way I have had to deliver care, how I think about delivering care, and even how I care.

In the beginning of this crisis, before anyone knew what was to come, we first thought the Corona virus was somehow not affecting our community. That false notion led to us working and behaving as we always had in the delivery room: no masks or protective equipment during most deliveries, (patients needed to see our faces!) lots of provider-to-patient touching (with and without gloves), and lots of breathing, pushing and spewing of bodily fluids in close quarters. I’m surprised there were not more infections of all kinds resulting from these practices. When the number of cases of Covid-19 started rising and California made new rules for everyone, we began to believe that everyone may be infected, and most were asymptomatic carriers. The rules in the delivery room changed drastically and we all started wearing personal protective equipment all the time. Sadly and out of necessity, this completely changed the culture of the delivery room. No hugging, no high five celebrations when the baby finally came out; no family in the room and no visitors. My relationship and my eye contact with my patients became even more vitally important, and I told more than one patient, “Don’t worry, I will be there with you, even if no one else can be.” They understood the safety issue, but the tears still flowed. Birth plans BC (before Covid) consisted of pages of dreamy desires for the day of delivery. Women would list out many things that were important to their delivery experience, and we would discuss them at their third trimester visits. Birth plans AC (after Covid) changed drastically, and I’ll never forget the one that a patient handed me that had one sentence on the page stating “My main desire from my birth experience is_________” on which she had written “TO NOT DIE.”


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Rupturing uterus

One Saturday night, on an otherwise pretty quiet on-call weekend, I was woken from sleep @ 4:00 AM by the piercing sound of my phone ringing (which, as usual, was placed strategically next to my head). “Hello. It’s Dr Levy”, I answered, trying to sound like she had not just woken me from a coma. “It’s Anna, from labor and delivery. An ambulance pulled up a few minutes ago, and a patient, 38 weeks pregnant came in, with severe left lower quadrant pain.” “OK, any other history?” I answered. “Yes, she’s had 2 prior C sections, and just woke up with severe pain and called the ambulance.” (she said this sounding a little annoyed — was it at me? At my questions? At the patient? At the use of ambulances? I couldn’t tell). “The pain is all the way around to her left flank. So maybe it’s a kidney stone?” …


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Unsplash.com

I have never really believed that a physician has had to be personally diagnosed with the medical conditions that they evaluate and treat their patients for in order to be effective practitioners. If that were the case, a Cardiologist could not be effective unless he had some kind of heart condition, and a Gastroenterologist would have to have some stomach or bowel issue to have appropriate empathy for her patients.

As an Obstetrician and Gynecologist, I have begun to wonder if I am not a better and more effective physician specifically because I have experienced many of the things I evaluate and treat in my patients. When a patient tells me about her menstrual cramps, contraceptive side effects, or her pregnancy-related symptoms and fears, I often find it hard NOT to utter the words, “Yes…I know exactly what you mean…”, being readily truthful in my revelation. …


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Photo by NeONBRAND on Unsplash

One of the most common questions I hear in my medical practice is “What can you do that will re-ignite my libido?” This is not a question that I can answer at the end of a visit for preventative care, or when someone has come in for a Pap smear, or a refill on her birth control. It is a complex and important topic that deserves its own visit, discussed in an un-rushed and informative way. One of the reasons I discuss libido so often in my office is because I bring it up with every patient I see. …


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I often have patients come in to my office after I have ordered some tests, to discuss their results, and to review their future plan of care. Last week, a young lady (35) came in to discuss her journey with fertility. She and her husband had been married 2 years, and had been trying “ever since” to get pregnant. Immediately my opinion of her as being a “young” lady shifted a bit, because in the world of pregnancy and fertility, 35 is actually the beginning of what is considered “old”, or, in medical terms, even “elderly”.

When I do fertility management, I have a very definite set of ideas and a care plan that I would like to implement with my patients, of course with the end goal of a safe and healthy pregnancy. So who is fertile? What is “trying”? How do we move from “I want to be pregnant” to “I AM pregnant”? It’s actually not all that complicated. There are many parts to the fertility puzzle, and I feel it is my job to help my patients put it all together. …


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There is so much talk in the news these days about America’s health care system. It is a huge topic for the 2020 presidential race; specifically everyone’s talking about whether we should maintain our private health insurance system, trash it in favor of a government “Medicare for all” system, or use some sort of hybrid system incorporating both private and public health insurance options. One would think that as a physician and the owner of a small private solo medical practice that I would not be in favor of a Universal Health Care plan for everyone, since it would essentially have doctors either being paid a salary or would not allow doctors to be paid more for “doing more”. …


SHOULD WE CARE ABOUT THE C SECTION RATE?

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Photo by Patricia Prudente, Unsplash

I have been practicing Obstetrics for over 20 years. I have worked in small and large private practices, and in public health clinics. I have worked in two states, on two coasts. I have worked in a total of seven different hospitals. In all of these places, in all of these years, I have heard one repeated “battle cry” — “We need to lower the C Section Rate!!” It seems that for some reason this is a very important goal for everyone working in the field of Obstetrics.

WHY? Why is it so important that we lower the C Section rate, and how did it get to be something that people think is too high in the first place? And who can — or should be doing something to bring the rate down? …


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I have owned and run a small ObGyn private practice in Northern California for the past five years. It has been mostly a good experience, sometimes a surprising experience, and now, it is becoming what I am starting to realize is probably, and unfortunately a non-sustainable experience.

I did not go into this venture totally blind. I knew I was an intelligent person, a good doctor, and cared deeply about my patients. I was not under the false impression that those qualities alone would somehow result in a wildly successful medical practice. …

About

Rebecca Levy-Gantt

An Ob Gyn physician in Napa California, who has been practicing for 20 years. Also a writer (blogger, memoirist, advisor, humorist). Author of Womb With A View

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