Attitude

Our society and many individual teachers and patients are extending to you a priceless learning opportunity. They are giving of their time and knowledge, and taking some risk, to give you an educational experience of great value.

• Learn everything you can.
• Be pleasant to everyone
• Avoid anything that detracts from your learning experience or interferes with the most effective doctor-patient relationships.

Demeanor

You are working in a professional environment and you need to act professionally. Ask questions respectfully, and use a soft and pleasant tone of voice. Be kind to those around you.

Be confident, as it is contagious. When I was in the Navy, I was aboard a ship when we had a young woman sailor with a tender pelvic mass and high fever. We needed to evacuate her off the ship to a hospital. A helicopter met us at sea and hovered over the ship. The plan was to put her in a basket, connect the basket to a cable connected to the helicopter, and winch her up. It was very scary, and the patient was petrified. She had never flown in a helicopter, and this whole concept was so frightening, it was all she could do to hold herself together mentally.

Arriving with the helicopter was a Navy Flight Surgeon. He rode the cable down to the ship and came over to talk to this pretty sick and pretty nervous patient. He took off his helmet and had the broadest smile imaginable. He checked her over and then asked her, "Have you ever done this before?" She nervously shook her head no. "That's OK," he laughed. "I've done this a thousand times and never had a problem. You'll be fine."

As the corpsmen were making final preparations for hoisting her up into the helicopter, I whispered to him, "Is that true, you've done this a thousand times and never had a problem?" "Partly true. I've never had a problem, but this is the first time I've ever done it. I think it will be OK." He was a little frightened himself. The medical evacuation went fine and there were no problems.

I don't encourage misleading patients. Honesty is the best policy. But putting a positive spin on medical issues and beaming confidence to your patients will calm them, ease their mental pain, and usually leads to a better outcome. Be confident.

Dr. "G"

Dr. "G" is the one physician I met during medical school from whom I learned the most. This was not because he knew the most medicine. He didn't. He probably knew the least amount of medicine of anyone I met. But despite that limitation, I personally learned the most about medicine from him, than from any other physician. I did this by watching him make rounds.

Dr. "G" was a family practitioner. He trained during World War II when the curriculum was accelerated to accommodate the war effort. His medical school lasted 2 years rather than 4. His internship lasted 6 months rather than 12. Then, he was shipped off to a South Pacific island, where he attended the medical needs of 600 soldiers for two years. After the war, he returned to Chicago and started up his practice and never had any more formal training. He didn't really know a lot of medicine.

What he did know, was how to take care of patients, and he was a master of that art. He had a large practice and his patients loved him. Whenever one was sick, he knew just the right specialist to take care of the problem. While the specialist was busy curing the patient's medical problem, Dr. "G" was busy taking care of the patient.

Mrs. Jones was a 78 year old woman hospitalized with diabetes, gout, and borderline congestive heart failure. Dr. "G" would walk into her room, and:

• Sit on the bed next to her
• Hold her hand
• Look her in the eyes
• Smile
• Laugh
• Ask about her grandchildren
• Reminisce about the fun times they had when her husband, David, was still alive
• Gossip about her neighbor
• Inspect the flowers in the room and read some of the cards
• Talk about some recent news event
• Listen intently to her heart, and then declare, "Well, that doesn't sound so bad. I think you're getting better."

When he had spent about 15 minutes with Mrs. Jones, she was beaming. Previously, she was bent over, looking sick. When we left the room, she was sitting up brightly, smiling, and her breathing was better. The pallor in her cheeks was gone and she was thinking about getting up in the chair for a while. Dr. "G" made therapeutic rounds, and his patients did better than any of the other patients. 15 minutes with Dr. "G" was worth a whole nursing station full of specialists.

I don't underestimate the value of the specialists. They knew, I knew, and Dr. "G" knew who was making the right diagnoses, and providing the best treatment for Mrs. Jones' ailments. But the patients believed that Dr. "G" had cured them, and I believe there is some truth to that. I hope that as you grow into your profession, you will learn not only the best medicine, but also the doctor-patient skills of Dr. "G" so your patients will do as well as his.

Professional Attire

Generally, you will be more effective in providing health care to women if you dress professionally. In an emergency, it makes very little difference what you wear, but a great deal of difference the quality of care you provide. In non-emergency settings, dressing professionally:

1. Communicates to your patient that you are a professional.
2. Encourages your patient to relate to you on a professional basis, and
3. Provides the patient confidence that you can effectively treat their medical problem.

Professional clothing generally includes:

• Uniforms (clean and pressed)
• Laboratory coats
• Suits
• Sport coats
• Dress slacks
• Casual dress slacks
• Skirts
• Casual dresses
• Dress shirts, blouses, collared sports shirts, jewel-neck blouses
• Sweaters, vests
• Dress and casual shoes
• Scrub suits where appropriate
• Socks or hosiery

Professional clothing generally does not include:

• Open-toed shoes, sandals, tennis shoes, high heels greater than 3 inches, or any footwear that may interfere with performing your job.
• Denim (jeans, of any color or style)
• T-shirts
• Clothing with potentially offensive phrases, political statements, religious statements, or advertising.
• Sleeveless tops without a jacket
• Clothing that exposes the skin of the shoulders, back or stomach
• Shorts or miniskirts
• Low-cut tops
• Athletic clothes (sweatshirts, jogging suites)
• Faded, unclean or wrinkled clothing

Grooming and Hygiene

Your patients will typically respond better if they have confidence in your professional skills. Good grooming and personal hygiene are an important part of that professional image. This includes:

• Regular bathing and use of deodorants to eliminate body odor
• Cologne or perfume, if used at all, should be subtle
• Body piercing, other than ear rings, should be unnoticeable
• Hair, beards and mustaches should be neatly trimmed, clean, and in a natural color
• Fingernails should be trimmed, clean, and free of colored nail polish than can interfere with your visual check of cleanliness under the nails. Artificial nails should not be worn in surgical suites or critical care areas (ER, ICU, CCU, L&D, OR, RR, etc.)
• If your hands, face or clothing becomes soiled, go wash and change clothes. Don't talk to family members of a woman you have just delivered with blood and meconium on your scrub suit. Change to a clean scrub suit first.

Relationship with Patients

• Use a soft and gentle tone of voice
• Be sympathetic to the patient's problems
• Be respectful that they are allowing you to participate in their care, at some risk (at least perceived risk) to themselves.
• At this stage in your career, you should always have a mentor, chaperone, or other person present whenever you examine the breasts or genitals of a patient.
• Personal relationships that go beyond the normal doctor-patient relationship are usually a bad idea. Sexual relationships with patients are unethical, unprofessional, and in some circumstances illegal.

Relationship with Teachers

• Be respectful of your teachers and the time and effort they devote to your education.
• Remember that by supervising you, they are assuming some risks.
• Notify your teachers any time something goes wrong, has an unexpected outcome, or you think you may have made a mistake. All of these things can usually be easily fixed if dealt with early. If a mistake is learned about further down the clinical road, it may not be so easy to fix. Try not to make mistakes, but if you make one (and we all do...more of them when we are younger, fewer of them when we are older), let your teacher know about it immediately.
• Every teacher will be wrong about some things, but right about most things. With wisdom and clinical maturity, you will discover which is which.
• Value vast current knowledge as much as you value years of experience.
• Personal relationships that go beyond the normal student-teacher relationship are usually a bad idea. They may also be unethical and unprofessional. If you feel that any teacher is coercing you (threats, grades, passing the course, etc.) into an inappropriate relationship, go immediately to someone within the school you can trust and report it. This might be a Department Chairman, Dean, Provost, or other official. 

Relationship with other Students

• We often learn much from our colleagues. Things that seem simple to you may not be so simple to your classmate. Help each other.
• Medicine is an emotionally and physically demanding profession. Stresses can be high, and the stresses of daily life don't wait until you are finished with your education before they can overwhelm you. Mood disorders (depression, anxiety) affect health care professionals just as much (maybe more) than others. Watch your classmates for evidence of this (dysfunctional behavior, crying for no good reason, sleeplessness, overreactions of emotion) and help them out. We all need each other, and all need help from each other at one time or another. Friends are a blessing. Look out for them and protect them.

OB-GYN 101: Introductory Obstetrics & Gynecology
© 2003, 2004, 2005 Medical Education Division, Brookside Associates, Ltd.
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