Re: Who does what ...
From: David Rivera (cuurmudgeon@sbcglobal.net)
Sat Jun 11 16:22:28 2005
Semantics. Few might as well be none.
Yer so cute when yer angry....Anna, put down that gun!!!
"Anna Meenan, MD" <annam@uic.edu> wrote:
I believe that what Andrew said was that we'd be better off if there
were FEWER OB's. Wait, ;et me copy the exact quote:
\
I have felt in recent years tht society would be better off with fewer
obsteticians and more family physicians and midwives to deliver the
babies. Obstetrics is a dying art and FP and CNMW can certainly provide
the antepartum care and do the deliveries. A fraction of the OBs we
have now could do the c-sections and if need be any general surgeon
could do a c-section. IMHO andrew
FEWER obstetricians, not NO obstetricians.
Anna Meenan, MD, FAAFP
At Sat, 11 Jun 2005, David Rivera wrote:
>
>Look for Andrew Folley's note a few days ago. You probably have amuch better connection that I do right now.
>
>DAR
>
>"Anna Meenan, MD" wrote:
>Dave, find me even one note on this forum that declares the world would
>be better if there were NO obstetricians (except for the rare wacky
>troll note from before the forum required registration).
>
>Anna Meenan, MD, FAAFP
>
>At Thu, 9 Jun 2005, David Rivera wrote:
>>
>>Unscientific, maybe, but rooted in experience, especially with the younger set, and also with some of the comments in this forum. If you've done 3000 deliveries, I suspect you are from a different era when we had GPs and we did just fine.
>>
>>The stereotype of the obstetrician is a knife-happy SOB who does episiotomies on all women because he (invariably a he) loves inflicting pain and does Cesareans at the drop of a hat because he is either (a) late for the golf course or (b) has a Porche payment due. Even Katie Couric made reference to the golf course on the Today Show 11/30/04 (which raised the hackles in the ACOG forum)
>>
>> There have been several notes here about how the world would be better if there were no obstetricians and how midwives and family practitioners do a much better job because they are patient and view it as a"natural process" (So is an MI). Yeah, and some of my colleagues are idiots with superiority complexes as well-they have no excuse.
>>
>>My good friend and frequent adversary, Anna, and you, seem to believe if it weren't for family practice, people in the hinterlands wouldn't have anyone delivering their babies. Now, Anna hasn't practiced outside of a city of 150,000 her entire career. I travel around the country to small towns that have an OB and DONT have FPs doing deliveries.
>>
>>Ralph is right. A CNM did most of the colposcopies at the last job I did and I think she does a great job. My bitch with FPs is, in my experience, they are too caught up in not acting like obstetricians. I don't care if a family practitioner does deliveries as long as s/he knows his or her limits. Check back a few notes. I named one I worked with whom I trusted implicitly. (She was also married to another FP whom I didn't trust at all). If you are going to do it, do a damn good job.
>>
>>You and I both resent being stereotyped; that doesn't obviate the fact that the stereotypes exists and are rampant.
>>
>>DAR
>>
>>Henry Gregor wrote:
>>FHIW, this emotional stereotyping is not just uncivil, but scientfically (and I hope this point gains your attention and acquiescence, David) unsound. I remember years ago someone asking Ralph Richards just who should be doing colposcopies and I loved his answer. Paraphrasing here, but basically he said "Whoever has the interest, has pursured training, and has the demonstrated experience...that's not a specialist, that's a person who could be one of any number of specialty specific background."
>>
>>I estimate I have had 3000 + deliveries and they have been is mostly small locales...IMHO the country would be in a great bind if their weren't as many FP's and CNMW's out there as there are. For every tale of the FP wanting to wait two hours I bet I could offer a similar bonehead example of a FACOG with some similar inappropriate response. Not trying to send a flame here, but to denigrate large groups on individual performances is, as I said, not only uncivil, but unscrentific Dave. Your methods would not get you much of a grade if you ever apply them to a sociology class.
>>
>>Hank
>>
>>--
>>David Rivera wrote:
>>Yes, there are places where FPs do deliveries and that tends to drive their backups nuts. A couple years ago I called a young 'un because her patient's biophysicial profile was, to quote the tech, "Two, and that is being generous." FHR strip was flat. She was at the Y with her kid and wanted to know if we couldn't wait two hours to do a C section.
>>
>>My admonition to anyone in FP has always been: "If you are going to do this, know your limits and when to call for help. If you wait until it is too late, you are going to have one very P.O.'ed OB/GYN." There was another FP in the same town whom I trusted implicitly to do the right thing. She never let me down.
>>
>>I think most of the older guys did a decent job. My mother delivered her last kid at a D.O.s office in 1965 and everything went OK (except he musta had some dain bramage because he's the only Hispanic Muslim I've ever met.)
>>
>>Cheri Van Hoover wrote:
>>
>>David Rivera wrote:
>>
>>> MOI? Would moi be starting something? Actually, most little towns have
>>> obstetricians and most FPs have bailed out of delivering babies because
>>> their insurance premiums are too high and the stress of doing something
>>> part time isn't worth it.
>>
>>Here in East Jefferson County we have a population of about 20,000 (hard
>>to estimate because the county is strangely shaped with enormous
>>mountains completely separating the east and west portions of the
>>county, but most of the population is on the east).
>>http://www.ofm.wa.gov/localdata/jeff.htm
>>
>>There is one hospital, in Port Townsend (population about 8,000). It is
>>a Level 1, with about 125 beds. There is no dedicated labor and
>>delivery staff. All deliveries are done by 3 FPs, with general surgeons
>>brought in to do Cesarean section! ! s. There is one OB/GYN doctor in town,
>>but he does only GYN and consults with the FPs on higher risk
>>pregnancies. No deliveries. There is a group of Washington State
>>Licensed Midwives (not CNMs) which does home births only. Home births
>>are very popular here. I don't know how many births we have per year,
>>but it is very low. I would guess the hospital does only 15-20
>>births/month. Probably another 5-10 home births/month.
>>
>>>From what I hear, the FPs remain committed to doing births at our hospital.
>>
>>Cheri Van Hoover, CNM, MS
>>Faculty, Midwifery Institute at Philadelphia University
>>
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