Doctor Shopping, the Life I Chose as an OB/GYN and the Over Medicalization of the Birth Process

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Today a patient and her husband came in to see me to determine if I was the right fit for her high-risk pregnancy. I find these situations awkward, as I am not a car salesman looking to sell you a car. Honestly, when patients come in for a consult I really do not care if they pick me as their doctor or not. I am not trying to be smug and I did not take offense when the husband commented on the waiting room being empty. I just stated the facts, ”I have fifteen patient slots a day, four exam rooms, I am not looking to get rich being a doctor so I only perform ten deliveries a month.”

My first priority is my family, I love spending time with my wife and kids. I do not have many individual outside interests, except the New York Yankees & Giants and a twice a year vacation to a tropical location where I do absolutely nothing but read Dirk Pitt novels and sleep until at least noon with my honey. As an Obstetrician, my job is to help people achieve a common goal, bring a healthy new baby into the world the way g-d intended.

I went on to explain to the couple, “I have been practicing OB/GYN, for fourteen years, starting my career in a twelve person group that went to four different hospitals. I could deliver as many as ten babies a day and not know one single family, but I made good money and only took call every 12 days.” Sounds like a sweet deal except for the fact I had no relationship with my patients, spent maybe five minutes talking to a return OB, maybe 30 minutes with a new patient and 15 minutes with an established patient.

Now I have my dream job, working in an office attached to the ONLY hospital I deliver at, Baylor Medical Center Frisco, with well-educated, considerate, sometimes a little Internet happy patients (you know who you are). Many of whom I consider my friends and often my neighbors. I have a great office staff, a nurse practitioner in Tara who will be able to take care of my patients when I go on vacation.

I have rededicated myself to personally lowering the national Cesarean Section rate one vaginal delivery at a time. I know every patient in the practice, how many doctors can say that? I have fixed medical problems other physicians have missed, just by listening to my patient tell their story. I get disgusted when I read charts on patients who had a C/S for breech presentation, preeclampsia, ‘the baby’s too big’ or the countless other b-ll sh-t reasons patients are given.

I practice medicine based on scientific fact, not whether it is getting close to dinnertime. Let me tell you a dirty little secret you will not see printed anywhere in OB literature, at least 90% of all emergency Cesarean Sections for fetal distress are caused by the ‘over medicalization’ of the birth process.

This is what happens every day all over this country:

  • You get too much Pitocin so the baby crashes because it could not get enough oxygen due to every 1-2 minute contraction intervals
  • Your electronic fetal heart monitor was over read as showing a baby in fetal distress (despite being born screaming with great APGARS),
  • Your blood pressure was dropped by your Epidural cutting off blood flow and oxygen to your uterus, and in turn your baby.

Why do you think babies born by Nurse Midwives or at Birth Centers have only a 10% chance of ending in Cesarean Section but at a hospital around here, it can be upwards of 50%? Just some food for thought.

Jonathan Weinstein, MD, FACOG

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