2012 ACM District II Reporters
Lori D. Homa, MD; David Kulak, MD; Jovana Lekovic-Bijelic, MD; Sarah Morocco, MD; Nwamaka M. Onwugbenu, MD
Nwamaka Onwugbenu, MD
Reports
Lori D. Homa, MD; David Kulak, MD; Jovana Lekovic-Bijelic, MD; Sarah Morocco, MD; Nwamaka M. Onwugbenu, MD
On May 5th in the San Diego Hotel Solamar, after months of excitement and many emails, we finally met the other ACOG junior fellow reporters. From districts across America, Japan and South America, residents descended upon San Diego for the National ACOG Annual Clinical Meeting. We met before the meeting began for our commencement dinner, where we were introduced to many members of the ACOG upper echelon and Rhonda Greene who single-handedly coordinates the entire program. We were delighted to be greeted and introduced to Dr. Sterling Williams and Dr. James Martin.
The next morning we had a breakfast meeting with a lecture from Dr. Patrice Weiss about emotional intelligence. The lecture showed that self awareness, self control, and social aptitude are better predictors of success than test scores and IQ. The rest of the day we were able to partake in different educational courses. One of the courses focused on REI topics. The first lecture on PCOS by Dr. Usadi was a comprehensive review from diagnosis, metabolic consequences, treatments with focus on CV and metabolic risks. The next lecture “Playing the Dice” by Dr. Mathews was a review of infertility treatments through the lens of cost effectiveness in a setting of limited resources, and general cost of different treatment choices. She reviewed the changes in treatments over the last 20 years and future trends. Dr. Seli gave the next lecture which was about endometriosis, medical and surgical treatment choices, and advice on best treatments modalities for patients desiring future fertility. The afternoon seminars started with Dr. Usadi’s lecture on recurrent pregnancy loss. The lecture on the work-up for this diagnosis was framed through the mneomonic TIME GAP (Thrombophilic, Immunologic, Microbiologic, Endocrinologic, Genetic, Anatomic, Psychologic) as a guide to the underlying causes of RPL. She reviewed multiple ACOG practice bulletins and the newest published and unpublished research to guide us in our future practice. I think all of us there agree that the lecture will be helpful in our future practice with such a complicated and multifaceted problem. Dr. Seli’s PM lecture brought it home for the District II members in the crowd, with a review of fibroid treatments. In addition to some of the more classic fibroid treatments he also reviewed some of the newer data on SPRMs and MRI HIFU.
Other courses attended by reporters focused more on practice management than on clinical education. One of these courses was “Women’s Health Practice of the Future: Information and Tools for Success.” This course promoted the role for electronic medical records and ways to promote quality, efficiency, and safety. This course was attended by practitioners as well as many office managers.
Other reporters attended a coding seminar entitled “Coding and Documentation for the Obstetrician Gynecologist,” attended mostly by practicing attending physicians in private practice or graduating residents about to join the practice. It was useful because it explained the principles in more detail than the lectures we had in the past in our program.
We then had a few hours to enjoy the warm San Diego weather before our evening activity: the ACOG welcome ceremony at the Hilton hotel. Although the weather was cold, it was a beautiful setting and a great networking event. Given the timing of the event at dinner, we appreciated the variety of different sliders.
The next day we rose with the sun, to start off our busy day with an early breakfast. We had a lecture from Dr. Montgomery on domestic violence and maternal morbidity. The lecture, although stark and disheartening, was a needed wake-up call or reminder for us to regularly and frequently screen for this very morbid and common occurrence. We greatly appreciated the personal stories which brought us much closer to the issue. We then moved to the convention center where we attended the presidential program that summarized the work of the preeclampsia work-group established last year. We had three lectures. The first summarized what we know about the pathophysiology. The second summarized the soon-to-be-released guidelines from the work group. Finally, we heard an emotional talk from preeclampsia survivor and executive director of Preeclampsia Foundation, Ms. Eleni Tsigas, with the message urging us to give all of our patients warning signs for preeclampsia. To finish the morning, we all then broke up for different educational lectures-one of them being a lecture on IUDs and implants from Dr. Espey, who reviewed the excellent safety and efficacy profiles of these methods. Another lecture during the same time was how to manage shoulder dystocia fearlessly and calmly. I found this lecture particularly useful, given my sparse prior experience with this intimidating obstetrical emergency. Still others attended a lecture on techniques in abdominal wound closure which presented an excellent overview of anatomy, physiology, and appropriate clinical practice.
That afternoon we had a series of lectures entitled “Life After Residency.” It started with a lecture about possible legal actions that can be taken against physicians. The lecture was reassuring in that it empowered us to be prepared and protected with excellent documentation. We next had a riveting lecture by Dr. Von Gruenigen about the potential of social media in the medical world. Our next lecture was about the potential pitfalls of social media. Finally, an excellent lecture on emotional and social consequences of adverse outcomes on OB/GYN physicians by Dr. Waldman. He urged practicing physicians to treat their colleagues and themselves kindly and gave useful advice on how to heal and recover after an inevitable adverse outcome. He also advised how the staff surrounding the event can help the healing. Dr. Waldman’s lecture motivated us to look into this issue further among our own co-residents who experienced adverse outcomes and initiate a support program at our own facilities. We plan to organize a movie screening for the rest of the residents to help educate about this issue. The evening concluded with a Junior Fellow and Medical Student Reception at the Hilton San Diego Bayfront Hotel.
Tuesday morning we enjoyed breakfast lectures from a panel of leaders in the medical world including leaders from the AMA, the junior fellows, and finally a lecture on leadership. The OBGYN reporters then joined the rest of the ACM members for an interesting session of “Stump the Professors.” The panel of judges was entertaining as well as brilliant, and the presentations were lighthearted and fun. This session was highly enjoyed by all. That afternoon we had an opportunity to tour the exhibit floor and see the abstracts and posters, which contained some very interesting research. The lecture on maternal morbidity was inspiring and attention grabbing with a guest appearance by Christy Turlington. That night at the Presidential Dinner we were able to get our adrenaline pumping again with flight simulators, zero-gravity upside down space module rides, and a 4D movie.
Our final day, Wednesday, started off slightly later in the morning with the closing ceremony. After the ceremony we had a final lecture on the history (and future?) of forceps. We found out that when forceps were first discovered they were a secret tool used by a family of male midwives in England, and once publicized they helped galvanize midwifery into a medical field with trained obstetric physicians. It was very interesting to see the evolution of forceps through the years.
At the conclusion of our experience, it is a difficult task to distill these four days into a meaningful message that we can “report back” to our fellow residents in New York. It was wonderful to see how and when the decisions are made that will further impact millions of women in our country. We feel a renewed sense of connection to our specialty after spending this time at the ACM. We regained important insight, sometimes easy to misplace in day-to-day residency life. Taking the time to hear from so many experts in our field was an amazing opportunity which afforded us some perspective on where the specialty is going, and what we want to focus on when we return. In terms of where our specialty is going, we are now equipped with the latest information and materials on topics like emerging subtypes of preeclampsia, the 2-hour GTT, and treating menopause with SERMs, and using social media to reach out to our patients. But a few motivating concepts will stay with us during our own professional development, and those came as much from the experience of the conference as the lectures themselves. One is the notion that emotional intelligence and leadership are skills that can be honed as we grow into roles with greater responsibilities. Another relates to Dr. Waldman’s call for providing support to our colleagues through the inevitable adverse outcomes that we will face. Perhaps most important is just the fact that we are all part of a community of like-minded physicians, and this is a rich resource to have as we move through our careers. These might be the harder concepts to bring back to our respective residencies, but they are the most impressionable.
Nwamaka Onwugbenu, MD
Attending the ACOG 2012 Conference as a ob/gyn reporter was a remarkable and memorable experience—one that I will endeavor to encourage my peers to continue to participate in. There are so many topics I can touch upon that made this conference incredibly insightful, but I would like to limit it to the lectures entitled “From Impetuous, to Imperious, to Impeccable: The Evolution of Emotional Intelligence” by Dr. Patrice Weiss and “Healing our own: Adverse Events in Ob-Gyn” by Dr. Richard Waldman. These outstanding lectures struck a chord – they brought to light issues and concerns that most residents feel or encounter but do not readily speak about in fear of being castigated.
As physicians, we all took the Hippocratic Oath, which includes the promise to ‘abstain from doing harm.’ This commitment is broad and encompasses doing no harm to our patients, our peers (including all other healthcare professionals and ancillary staff) and ourselves. We are focused on patients and their care to a fault – we forget that if the physician is not of sound mind and body, it will reflect poorly on how we practice the art of medicine. It saddens me that not enough effort or attention is allotted to addressing this issue during residency or in practice.
Dr. Patrice Weiss spoke about physicians acknowledging and enriching their emotional intelligence. Emotional intelligence was defined as recognizing MY own feelings and that of those around you. It is composed of five keys points: 1) self awareness, 2) self regulation, 3) motivation, 4) empathy and 5) social skills. Self awareness focuses on one’s self confidence and realistic self assessment. How does a resident develop a healthy sense of confidence? Does he or she rely on the appraisal from their peers or attendings or patients? What if the environment is not keen on affirming a job well done, then how does a physician in training learn to be confident instead of becoming arrogant. Our peers, our attending, our nurses need be cognizant that they every interaction either adds or subtracts from the development of a healthy self confidence. Self regulation is the ability to control or redirect disruptive impulses and mood; the propensity to suspend poor judgment. Every resident or attending has had a day when they are exhausted, hungry and irritable and has lashed out on the next person as a result transference. At times it feels that we lack the ability to regulate these impulses because we are constantly in state of high stress and we let our emotions direct our actions and thoughts. Dr. Weiss pointed out that we are the master of our mind and body and that we have to control these disruptive impulses—we have to be aware of what makes us ‘tick’ and disarm ourselves before we EXPLODE. Motivation is the passion to do work for reasons beyond money or status; having a strong desire to achieve. Empathy is the ability to understand the emotional make up of other people and reacting to other their emotional needs. Lastly, social skills are how one manages relationships and build networks; the ability to find common ground and build rapport. These are the fundamentals of what make an emotionally intelligent physician. Essentially, my argument is that there is a deficit in the evaluation of social and personal competence. There should not be a delay to address this issue -- must there be an incident, such as a resident acting inappropriately with a patient or a physician getting in a verbal altercation with a nurse, to facilitate the discussion of emotional intelligence?
Dr. Patrice Weiss’ lecture goes hand in hand with Dr. Waldman’s lecture entitled “Healing our Own: Adverse Events in Ob-Gyn.” One of the opening quotes in his lecture was “We can’t practice compassion with other people if we can’t treat ourselves kindly.” How hard can it be for us to treat ourselves kindly? If we have self competence, we can identify the people, place or things that make us happy or sad; we acknowledge our strengths and weakness and know when we have reached our limit so we know when to ask for HELP. The sad reality is that even though there are self aware physicians out there, they may bear the weight of their cross in silence because of the erroneous perception that there is no crying in medicine. Physicians are in a high stress environment and are expected to perform with unrealistic accuracy--it is this high expectations that make physician inconsolable when they become HUMAN and make an error. Why me? What did I do wrong? How could this happen? It’s all my FAULT! The once highly revered physician becomes a self-depreciating mess. So who will now provides this physician the support that he needs? His peers? The institution psychologist or psychiatrist? What if he perceives that he has no options? Brene Brown says, “If you put shame in a Petri dish, it needs three things to grow: secrecy, silence and judgment.” As the shame grows, physicians become a risk to themselves and to others. The recent statistics on physician suicide rates is staggering -- “approximately 400 doctors commit suicide yearly, which is equivalent to one entire medical school class.” We should not feel that self harm is an option. Physicians should not feel the obligation to appear healthy -- this stigmata needs to be eradicated. Emotions should be validated and concerns should be addressed. Doctors need to be encouraged to seek medical evaluation or treatment for their emotional health. An emotional healthy physician with a high emotional IQ would be more able to serve his or her patients optimally.
Drs. Weiss and Waldman gave lectures that presented the Physician as a human -- a complex being that has both emotional and intellectual components. There is so much focus on the acquisition of knowledge and keeping abreast with surgical and clinical skills that there is a lack of attention to the physician as a person and their emotional needs. The sad truth is that physicians are revered and placed on a high pedestal, but it only means that we fall from a higher distance and fall harder.