Mrs. C was used to my quiet knock every morning at 6 a.m. She smiled as I turned on the overhead lights, but began to grimace when she realized that today was dressing-change day. The rustling packages of bandages in my overstuffed coat pockets had given it away. Mrs. C had stage four metastatic endometrial cancer; a malignancy of her uterus that was not responding well to chemotherapy and had ...

Read more...

I've waited to address this sensitive topic until after the midterm elections, when political slogans such as the phony "war on women" and trumped-up threats to religious liberty were discarded like so many campaign posters. It was curious to see the American Congress of Obstetricians and Gynecologists (ACOG) and Planned Parenthood attacking Republican Senate candidates for supporting over-the-counter birth control pills without a prescription -- a position that, if the pills ...

Read more...

We’ve come a long way, baby. Eighty five years ago (October 18, 1929) women were declared "persons" in Canada. On that day women in Canada became eligible to be appointed to the Canadian Senate, which up to that time, had been the sole dominion of men because women were not deemed "persons" under the law.  Five Alberta women, Emily Murphy, Irene Parlby, Louise McKinney, Henrietta Muir Edwards and Nellie Mcclung declared a ...

Read more...

shutterstock_194846810 Recently, reports surfaced that two Silicon-valley giants, Apple and Facebook, are covering elective ooycte cryopreservation, a.k.a. egg freezing, for its female employees.  Silicon Valley, like medicine, has a shortage of women at the top and it is presumed that this move will attract more women to enter -- and stay -- in the field of technology. As both a recent graduate of medical ...

Read more...

Martin Seligman, PhD, in his book Authentic Happiness, references a colleague, Mike Csikszentmihalyi, when discussing the concept of “flow.”  For Seligman and Csikszentmihalyi, flow is that feeling one gets when fully engaged or “in the zone” with an activity during which the passage of time seems suspended.  Often, the activity is aligned with one’s natural, signature strengths. For me, flow comes when I’m mountain biking: There are moments without thoughts, it’s just ...

Read more...

A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for episodic migraine without aura that first presented in high school and has persisted into the third trimester of her current pregnancy. The headache attacks occur two to four times monthly and last 12 to 24 hours. She experiences moderately severe pain, significant nausea, no vomiting, and ...

Read more...

To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger. The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In ...

Read more...

This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school. A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut ...

Read more...

The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is to ...

Read more...

Most Popular