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Fellow doctors, be courteous to Gynecologists

Obstetrics and Gynecology (OG) deals with reproductive health and diseases of the genital tract of women. Even though the doctors of OG have been doing a fantastic job in their field, they face a lot of teasing and taunts from fellow doctors due to various reasons. OG department is a pressure cooker where the resident doctors as well as the consultants appear equally frustrated due to workload and stress associated with work. Nevertheless, their role in bringing down the maternal and infant mortality rates is unmatchable. Despite having a great opportunity to contribute significantly to society, few medical students hesitate to opt for this subject for post-graduation as they have seen the medicolegal cases OG doctors face and the other departments making fun of the OG department for numerous reasons. In this article, I will try to explain the challenges that an OG doctor faces in our country.

Enormous workload

Image taken from Independent (UK)

One of my senior residents, who taught me a lot of OG during my undergraduate days, used to tell a lot of stories about her post-graduation days when she used to have lunch at 6 PM and dinner at 10 PM because of the workload she had to deal with. Later, when I joined for post-graduation in Pediatrics, I got ample opportunities to interact with OG colleges and I realized that whatever I heard about OG was true. Daily outpatient tally often crosses 700 and the clock would have hit 4 PM when they finish their out-patient clinic. Finishing evening ward rounds, paper works, and pre-operative preparation of patients before 8 PM is a herculean task. It is one of the most demanding PG branches in India and being a Gynecologist can take a toll on your personal life as well. Difficult times are not exclusive for resident doctors and even the junior consultants feel the heat.  Signing in as a consultant in a private hospital means that you are supposed to come at midnight also if the situation demands.

As they deal with shock and anemia quite often (because of placenta previa, ruptured ectopic pregnancies, etc.), they know about blood products and transfusion indications as well as anyone.

Miscomprehension by the patients and bystanders

Image taken from University of Toronto website

Even though pregnancy is not a disease per se, it is a process that can jeopardize the health of the woman in certain circumstances and unfortunately, our public never understands it. The common man may not agree with the doctor when the doctor explains the risk of complications in a high-risk pregnancy. Despite counseling multiple times, the bystanders may not realize the seriousness of the situation and if some adverse event happens, they put all the blame on doctors. Pregnancy-induced hypertension, eclampsia, uncontrolled diabetes mellitus, etc. are tricky conditions that can potentially cause life-threatening events during pregnancy or at the time of labor.  Although the cesarean section is a commonly performed surgery in any part of the world, dreadful complications can arise due to underlying detected or undetected diseases of the patient. 

In India, especially in Kerala, the maternity and pediatric services have improved leaps and bounds in the past two decades and that has resulted in significant reduction of infant and maternal mortality rates. However, even if the obstetricians try their level best, poor outcomes can occur in some pregnancies like cerebral palsy or malformations in the baby. If a malformation is detected after delivery which went unnoticed in the antenatal period, the innocent OG doctor will be at the receiving end. In reality, congenital anomalies can go undetected even if the scans are performed by an expert radiologist.

I have seen patients getting admitted with hemoglobin of 3g/dL and features of heart failure due to antepartum hemorrhage and even in those cases, the doctor will be held responsible if the patient succumbs to death.

Bullying from other departments

Image taken from The New York Times

Agree or not, the OG department is the most ridiculed department by the other doctors. The foremost reason for that is the huge number of cross consultations they sent and, indeed, some of those consultations are unnecessary. One episode of a mild headache is not an indication even for an Internal Medicine consultation, let alone Neurology.  However, one of the reasons for such a practice, from what I understand, is the huge number of litigations they face. Maternal death, be it due to any cause, will make the doctor visit court at least twice. As the health of the mother is a very sensitive issue, no OG doctor will take the risk and they try to make their side safe by cross-department consultation even for trivial complaints. One of the consultants in my current workplace once told me that, judges at court ask questions like “Why didn’t you show the patient to a Neurologist even when you had the facility as the patient had a headache?” even if the patient died due to heart failure. The ordeal of having to give evidence at court will demoralize the doctors and they resort to defensive medicine.

95% of OG department doctors are females and that is another reason for the bullying from other departments, especially from male doctors. Male chauvinistic attitude is deep rooted in our society and ripples of that superiority complex are visible in medical sector also. I have personally seen an anesthesiologist (who was my senior) passing a comment, “OG is run by ladies, so chaos is a rule there.”

The current scenario can be improved to a certain extent if more focus is given to infrastructure and manpower development. Public awareness regarding the complications of pregnancies needs to be done so that there won’t be miscomprehension between the treating doctor and the patient’s bystanders.

Dear fellow doctors, be courteous to OG doctors when you receive a call for consultation next time. They are also fighting their own battle and they are more prone to legal issues than us. 

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Dr. Sarath aka Tiny Physician is a pediatrics resident doctor, currently working at Government Medical College, Thiruvananthapuram. He writes about health & medicine, and football.

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