Each year, the RCOG invites foundation trainees to tell us why they’ve chosen a career in O&G for the Why Obs and Gynae? prize.
This is a submission from Kimberley Gibson, an FY2 at Crosshouse Hospital, NHS Ayrshire and Arran.
Why obstetrics and gynaecology?
‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’1
First year of medical school consisted of a systems based approach to learning the anatomy and physiology of the functioning human body. This merely nurtured our naive biomedical perception of medicine. In our eyes the body was simply a machine and we were to be its mechanics. However these views were quickly challenged during our opening second year lecture “an introduction to public health”. The above definition of health was boldly projected onto the screen and was met with a puzzled silence.
During the rest of my medical school training I tried to bear this declaration in mind to reinforce my holistic approach to patient care. However in no block was this statement more relevant than in obstetrics and gynaecology. As a specialty it covers not only disea se management in the form of medicine and surgery but health promotion, ethics and counselling.
Labour ward 3a.m- The lady I had been monitoring with the midwife was about to become a mother. I say ‘lady’ because ‘patient’ is never a term used by the labour ward team- perhaps it projects negative connotations onto a natural and hopefully disease free process? However I’m sure no one would judge you for questioning the physical and mental well- being of a lady during labour. This woman was in pain, sweating profusely and screaming profanities at her partner. The midwife carefully monitored the ladies condition while providing much needed support and encouragement. Unfortunately her labour was not progressing adequately and the she was beginning to tire. At this point the obstetrician was called in. She efficiently assessed the clinical condition of mother and baby and after explaining the situation to the worried couple, consent was obtained to proceed to theatre. A flurry of activity followed within the labour suite as the team prepared for an emergency caesarean section. Swift clinical decision making, effective team communication and impressive surgical skills resulted in the delivery of a healthy baby girl and happy mother. It was one of the most exhilarating, enlightening and down-right frightening moments of my life and I have willingly jumped out of a plane! I felt such privilege to have been involved in caring for this woman, her baby and her partner at such a vulnerable stage in their lives.
The next four weeks of my block saw me at family planning, early pregnancy assessment, antenatal, GUM and gynaecology clinics, in theatre, on community midwife visits, on wards and in tutorials. This experience gave me a glimpse into the vast and diverse nature of obstetrics and gynaecology as an intriguing and evolving specialty, incorporating advanced technologies on a solid foundation of clinical skills.
During the block I developed an interest in the surgical management of patients with a focus on minimally invasive techniques. I explored this field further with a self proposed specialist study module in the diagnosis and management of ectopic pregnancy. During this project I followed the care pathway of women presenting with ectopic pregnancy, observed their operations and subsequent management. It was during the research for my written report that I became aware of the use of clinical guidelines within the field- such as the green topped guidelines from the Royal College of Obstetricians and Gynaecologists. It is evident that as a specialty obstetrics and gynaecology is always adapting and improving clinical care with use of evidence based guidelines. This is crucial in a modern and evolving medical climate.
During my elective at Mercy Woman’s Hospital in Melbourne I was able to explore the specialty further. It was here I gained a better appreciation of the medical aspects of care for both gynaecological conditions such as mennorhagia to high risk antenatal clinics for patients with chronic medical conditions, such as diabetes. It highlighted the need for a multi-disciplinary and in some cases multi-specialty approach. The block allowed me to shadow many members of the multi-disciplinary team and gain some understanding of their roles and responsibilities. This in turn led to an improved appreciation of the doctors’ role within the service. One particular case from my elective sticks in my mind as it highlights the difficulties which can arise from a language barrier. An elderly Hungarian woman came to an urogynaecology clinic where she continued to complain of vaginal discomfort despite being started on appropriate treatment. It wasn’t until further questioning with the aid of the interpreter we discovered why here symptoms had not improved- she had been taking her pessaries orally. With some reassurance and appropriate explanation she left more content with her management.
My impression is that, to its credit, obstetrics and gynaecology attracts an immense variety of people with different interests, skills and personalities. I have met many inspiring people during my training who have encouraged my love of the specialty and provided me with insight into the life I may later lead. I also appreciate the honest and personal discussions I have had regarding the negative aspects of the career. These appear to range from disdain for lengthy on-call commitments, fear of litigation and despair at managing patients with sheer disregard for their own health. Due to recent changes in working hours and structure of hospital out of hours services the impact of some of these issues may have lessened. Despite considering these challenges my motivation to pursue a career in the field has not wavered.
I feel maintaining a suitable work-life balance is a beneficial achievement in any career. After reading case profiles in publications such as ‘obstetrics and gynaecology your career in focus’ and attending the RCOG careers fair where enthusiastic speakers told their incredible stories with great passion, I believe obstetrics and gynaecology is a specialty in which this aim has the potential to be realised. This may be through flexible training, academic posts or time out of training for research.
During my career I hope to promote women’s health both in the UK and the developing world. I hope to be able to provide relevant and effective education, support and health care for communities in need. I feel training in obstetrics and gynaecology will allow me to develop the clinical, surgical and counselling skills necessary for this task. It will encourage my independent and collaborative decision making skills and expand my ability to adapt to varied clinical situations.
Overall I feel obstetrics and gynaecology will provide me with a challenging, varied and fulfilling career with many opportunities for both professional and personal development.
1. World Health Organisation. WHO definition of health. http://www.who.int/about/definition/en/print.html, 24 August 2010.