Sign Out: Destiny's child

October 1, 2004

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Sign Out

Insights and reflections from Contemporary OB/GYN Editorial Board members.

Destiny's Child

By Andrew Berchuck, MD

Just before I began a clerkship in obstetrics and gynecology in medical school, my sister Emily died suddenly, at age 19.

My naive illusions of a career in internal medicine had recently been shattered on the rocks of real life experience. The first blow came when my fantasies of roaming the wards making brilliant diagnoses such as pseudopseudohypoparathyroidism were swept away by the daily drudgery of congestive heart failure and diabetes. And the routine of ward rounds, attending rounds, teaching rounds, radiology rounds, and sign out rounds was numbing. Not enough action. I was squirming in my chair all day.

The timing of my obstetrics and gynecology rotation was fortuitous. I was in my element from day one, and the fast and furious pace kept my mind off Emily's death. Staying up all night recalled the energy and thrills of college. Instead of parties, there were scalp gases, deliveries, and then over to the floor for a fever work-up. Next, perhaps, came a descent to the emergency room to care for a woman having a miscarriage. Lulls in the action would invariably be filled by chitchat with colleagues over take-out food until the calm was shattered by the next crisis.

Yet I could not shake the sense that I was destined to be an internist. Ambivalence reigned as the match loomed in the fourth year of medical school. I interviewed for both medicine and ob/gyn residencies and did two acting internships to give internal medicine second and third chances. To no avail. The realization slowly sunk in that ob/gyn had always been my destiny, despite my preconceived notions to the contrary.

Twenty-five years later I occasionally borrow my wife's reading glasses (even though I don't really need them), and in hindsight, the decision to pursue ob/gyn—and specifically gynecologic oncology—looks like perfect vision! All areas of our specialty are action-oriented and require the ability to "multitask" as well as a hefty dose of common sense. The range of clinical and surgical activities encompassed by ob/gyn is incredibly broad and we clinicians practice a bit of medicine and psychiatry, too.

My decision to enter the match in ob/gyn ultimately was spurred, in large part, by the realization that I enjoyed working with other physicians and nurses who had gravitated toward the field. Ob/gyns would rather solve a problem than discuss it all day. We are bright and intellectual, but do not dwell excessively on minutiae. We are not afraid of hard work and almost always have fun in the process. In the operating room at Duke, we ask the medical students anatomy questions, interspersed with mock "serious" inquiries about which group is singing the classic rock song playing overhead.

Yet our field's popularity is waning. The first hint I got of this trend was when students no longer bothered to humor me by saying they "might" be interested in ob/gyn. This year many ob/gyn residency slots went unmatched. The non-patient-care specialties are most coveted, with their promise of favorable lifestyles. Ob/gyn has its issues, including long hours and outrageous malpractice premiums, but the fun and rewards have not changed and most practices are now structured to facilitate protected time.

I frequently regale medical students at the scrub sink with the story of my circuitous journey to ob/gyn. I advise them of the wisdom of choosing a specialty with your gut rather than your brain. And I warn them that their eventual destination may come as a surprise. In the face of the current low level of enthusiasm for ob/gyn, it is more imperative than ever that we convey enthusiasm for our work and strive to create positive educational environments like the one I grew up in. In my experience, that's the best way to attract medical students in search of a home.

DR. BERCHUCK is F. Bayard Carter Distinguished Professor of Obstetrics and Gynecology in the Division of Gynecologic Oncology at Duke University in Durham, N.C., and a member of the Contemporary OB/GYN Editorial Board. He is Principal Investigator of an Ovarian Cancer Program project entitled "Biological basis for chemoprevention of ovarian cancer," which is funded by the Department of Defense. In addition, he has recently served on the governing councils of both the Society of Gynecologic Oncologists and the Society for Gynecologic Investigation. He also heads the scientific advisory committee of the Ovarian Cancer Research Fund.

 

Andrew Berchuck. Sign Out: Destiny's child. Contemporary Ob/Gyn Oct. 1, 2004;49:104.