My Evolution as Physician

I graduated from medical school in 2001.

It feels like yesterday and a million years ago.

After that, I did 4 years of OBGYN residency and 3 more years of fellowship in Reproductive Endocrinology and Infertility.

That’s a lot.

Since then, I’ve been practicing medicine full time.

“Practicing medicine.” Think about that term. It implies that medicine always keeps us striving and learning, while never being perfected.

During my time as a physician, I’ve evolved. As I should.

These are my subjective observations after nearly two decades in medicine.

What is different for me: 

I have experience under my belt. There are times in medicine where you can’t Fake It ‘til You Make It. I am Board Certified in OBGYN and my subspecialty, Reproductive Endocrinology and Infertility. I earned my stripes. More than 11 years into practicing my sub-specialty, I have seen a lot. When I quote you success rates about my practice, I am giving you facts about my practice. Mine. I have done thousands of egg retrievals and embryo transfers, not dozens or hundreds. Part of counseling patients is discussing the risks, benefits and alternatives to a procedure. We call this informed consent. Of course we do everything possible to minimize risks, recognize and treat any complications, but when you are doing something long enough and with sufficient volume, you will encounter complications and tough situations. I have. It’s humbling. But on the flip side, if you’re a patient, you want someone who can quickly and competently handle a problem, plus keep you out of trouble in the first place. 

I work harder than ever to build relationships with patients. I am genuinely interested in where you grew up, how you met your partner (if you have one) and what your ideal family looks like. The reality is that while many patients will be successful, some will not. Investing in the relationship along the way pays multiple dividends. I have some patients who did not achieve pregnancy yet still express deep gratitude for their care and have transitioned from patients to friends. 

I’ve aged into a new demographic. A whole generation of physicians has now come behind me. It is exciting to meet younger physicians or medical students who are the future of the field. They’re so bright and shiny! I love it. We’re in an age where women physicians get to be their authentic selves and I embrace it all. I love this army of Boss Lady Doctors.

With my darling co-fellow, circa 2005. Babies!

I delegate more. I get it. Patients want access to their doctors, and we should be there for our patients. Should I personally answer every patient’s routine question or call with a non-urgent lab result? Maybe. But with a robust practice, it is impossible to sustain or scale this over the long term. When your patient load is building and time is less limited, I wholeheartedly agree that every patient would prefer to speak directly to her doctor with every question, problem or concern. As you get busier and time becomes your most precious resource, you *must* find a way to divide and conquer tasks. This is true for life at home, as well. 

I am more skilled at having difficult conversations. My specialty requires a lot of them. Patients put their hopes, dreams and resources – emotional and financial – into our care and sometimes, it is not going to work out. It is never easy telling a patient that her eggs are not likely to create a baby. It is not easy telling a couple that none of their eggs fertilized in an IVF cycle and there are no embryos to transfer. While you should always bring your A Game to these conversations, I used to fear and dread them. Now I don’t. I might wish we were talking about something completely different, but I will be present for you and we will figure the next steps together. 

I thank patients for letting me take care of them. This is something I have done for a long time, and I mean it. Thank you for letting me in. Being a physician is a unique profession; we care for others at their most vulnerable and in the end, it is mutually satisfying. A word about thanking patients: do not do this if you cannot be sincere. This isn’t a place for phonies. A healthcare provider I saw once for an acute issue with my daughter asked at the end of the visit what he could do to ensure a five star rating if we received a patient satisfaction survey. That left a bad taste in my mouth. Don’t be that guy. 

I am better about recognizing when my tank is low. I’ve been burned out. Now I’m not. I’ve also come to think of my emotional reserve as a fuel tank: there are times when it is full and others where I am running on fumes. Now I’m better able to determine when I am down to my last quarter tank and then re-fueling prior to becoming completely dry. When I say “better,” I also do not mean perfect.  

I remain a work in progress. 

—————————————————–

What is the same: 

I will tell you “I’m sorry.” I’m sorry that your pregnancy test was negative. I’m sorry for your pregnancy loss. I’m sorry that you have to be my patient in the first place. I will acknowledge the Elephant in the Room. It isn’t a failing as a physician to say “I’m sorry.” Doctors aren’t gods, and I believe the “God Complex” stereotype is woefully outdated. I certainly don’t think of myself as anything other than deeply human, and part of being human is being honest and vulnerable with others. Saying “I’m sorry this happened to you” is often the humane thing to do.  

I understand how much this matters to you. It matters to me, too. Every negative pregnancy test is hard. The one thing I have told myself over and over is that the day a negative pregnancy test stops being hard, I should quit the field. There isn’t room for ambivalence. 

If you send me a birth announcement or a holiday card, I will save it. Not only will I keep it, I will look at it. Often. Especially on tough days. 

If I ever get to meet your baby, I will cry. Probably ugly cry. They will be happy tears, though. 

I stay curious.  

I am always learning.  

I remain a work in progress.  

To The Next Generation of Fancy Lady Doctors

I earned the nickname “Fancy Lady Doctor” in medical school, even before getting the official MD letters behind my name in 2001.

Despite being tongue-in-cheek at its core, the concept of the Fancy Lady Doctor – or FLD – resonated with my classmates.

Several of them started developing their own mini-groups of FLDs in residency programs across the country, but nowhere did it take off like in my own OBGYN residency program at the University of Colorado.

Friends, they still give out a “Fancy Lady Doctor” award at the annual end of the year residency banquet. I die with pride!

When I attended medical school in the late 1990s, there were a few attending physicians who qualified as FLDs, but not many. Ditto residency.

Don’t get me wrong, there were countless wonderful, smart and kind women who educated me, but not many were wearing heels in the OR at 3 A.M.

I have done this.

The culture of medicine has changed since then, too. More women than ever are entering medicine, and now that we are more than half of medical students – and emerging physicians – we can own the space in a way that our foresisters could not. I recognize the debt.

Back to the FLD scarcity in my training: This all changed when I was a third year resident and attended the 2003 annual meeting of the American Society of Reproductive Medicine, known as ASRM.

In the fertility world, the ASRM meeting is a big deal. Nearly 10,000 fertility professionals – doctors, nurses, embryologists, psychologists, scientists and more – meet to learn about cutting edge research and new techniques, tools or devices. There are opportunities to connect with old friends and colleagues, as well as industry leaders.

And there are parties.

Some of this has changed since my inaugural ASRM (it’s toned down a lot), but back then, I was blown away.

Everywhere I turned there was someone with near rock-star status in our field, walking around like a mere mortal. There were parties every night with multiple live bands, cocktails and embarrassingly extravagant displays of sushi. One party had enough jumbo shrimp and lobster tails to fill a bathtub.

And there were many, many FLDs.

Not only were these women smart, well-spoken and professionally accomplished, they looked great. They wore suits or dresses that fit perfectly. They had designer – real designer – shoes and bags. No knock-offs here. They had rings with diamonds large enough to choke a horse.

I had found my tribe.

Fast forward to now: Last week marked the 75th ASRM meeting in Philadelphia, PA. I went.

One day I wore these:

Holy Grail: Fabulous and comfortable.

And I was delighted to connect with a whole new generation of FLDs in my field.

While it’s a surprising position to discover I’ve aged enough that a whole generation has come up behind me – How did I get here? – I really, really like these women.

It makes me happy for the future of our speciality and for women physicians in general.

And, so, a final message to my younger FLD colleagues: Keep it going.

Be smart.

Be fabulous.

Be kind.

Be amazing physicians.

And remember: diamonds are always the perfect accessory.

Especially with scrubs.

Fancy Pants

When I saw that J. Crew was selling these pants, I almost broke my finger clicking “Buy Now.”

Fancy hot pink velvet pants? Sign me up!

But then I looked at the other images.

Ok, when this does not even look amazing on a 22 year old model, I can reasonably project that the rear view on a 46.75 year old Boss Lady Doctor will be less favorable.

One more shot:

I passed.

The search continues.

Six Years

Whoa.

I realized yesterday that I started this blog six years ago.

I didn’t know it at the time, but I was about to become deeply unhappy.

In the midst of impending turmoil, this was a creative outlet that gave me buoyancy when I was otherwise slowly drowning.

I was so cautious about not revealing too much about myself, lest my Big Brother Employer disapprove.

Now, I don’t give a s*it.

Figuratively and almost literally naked. Authentically Me!

In retrospect, it was physician burnout, the product of a toxic work environment that ultimately led me to take a risk, leave the perceived security of my “safe” job and venture into private practice.

It was the best decision I’ve ever made.

Six years later, I’m happier and more successful than ever.

I have autonomy. I have partners I love and trust. I work harder but mostly better. I’m a Kick Ass Doctor Lady Boss to nearly 60 people.

And I remain Fancy.

I strolled down Memory Lane for posts that resonated with me.

If you’re new here or curious, my personal Hits List includes:

https://fancyladydoctor.com/2013/10/06/we-really-need-to-solve-this-nanny-situation/

 
Why Do I Save Good Things?
 
Life Constantly Humbles Me
 
Raw discussion of my job transition.
 
Seriously great advice on How to Quit Your Job
 
Summiting.
This is still quite funny to me. Check out Courtney Love, aka my daughter.

Murray1

Thank you for your love and support. I appreciate it more than you know.

Saving Good Things

Do you save good things?

And by this, I mean do you consider some items so precious that you rarely use them, lest they get, well, used?

I do. And this is not a Good Thing.

Recently I realized that I hoard some of my nicest stuff, ostensibly protecting it from wear so that it will be (mostly) pristine when I want to use it. Which is often never.

This Prada bag is a great example.

bag

 

I bought this a couple of years ago with the idea that it’s a classic and an investment piece.

By “investment,” I also mean in my image and not in potential re-sale value.

This bag was supposed to say something about me: polished, luxe, sophisticated.

Of course I am often not any of those things, so it mostly continues to live in a box in my closet.

When I do take it out, it’s usually to go to a work event, like a conference, and then back the bag goes into its protective home.

I probably feel this way because I didn’t grow up with designer anything around our house and luxury items still sometimes feel irreplaceable if ruined despite consciously telling myself they’re Just Things.

To me, true decadence is having something nice and not really caring at all about it.

A former coworker used to sling around this giant Vuitton bag given to her by her boyfriend like it was a hobo’s bindle. She would carry (and spill) her lunch in it. Toss it in the corner of Labor and Delivery at our hospital. Drag it behind her. I couldn’t imagine ever being that carefree about something so spendy, but the more I think about it, maybe she had the right idea. It’s Just a Thing, and a practical one that’s meant to be used.

My weirdness for saving nice things also extends to travel.

I hate taking worn-out things on trips, so I practically have a whole separate wardrobe of things to wear on vacation.

There are swimsuit coverups and sandals that only see exotic beaches. Cashmere scarves and cardigans that are only meant for drafty airplane coverage. White tees that stay unworn so they can stay white. Delicate clutches for nights on the town. A Kate Spade wallet that I only use for foreign currency (!). You get the idea.

While it’s unlikely that I’ll ever get to my coworker’s carefree state of mind, I think acknowledging the problem is step one to solving it.

The tricky part is that I still am waiting for a personality transplant where I stop ruining everything I touch. Wish me luck.

What about you? Do you save your best stuff or use it with abandon?

 

 

 

 

 

 

 

This Naughty Dog

Now that I re-read it, the above title sounds a bit provocative, but I’m referring to a specific canine who is, in fact, quite ill-behaved.

Meet Penny.

Ostensibly, Penny is 25% Labrador retriever, 25% standard poodle and 50% miniature poodle.

Plausibly, she is 90% Fozzie Bear and 10% Junk Yard Dog.

Penny arrived on the rebound after an unfortunate incident involving our geriatric poodle, a sudden blinding rainstorm and the swimming pool in the house we had lived in for three days.

R.I.P. Frenchie

I’ll let you fill in the gaps, but this was a Trauma of the First Order for our kids, and suddenly a new dog seemed like an *amazing* idea.

My dear friend M. tipped me off about a breeder of impossibly cute doodle puppies, which is basically the Frankenstein version of mating anything with a poodle.

This girl caught my eye.

Can you even?

After an exhaustive application process including references, vetting, an essay about our family and submission of photos of our living space (I conveniently omitted the pool), we were (barely) approved to spend the tidy sum of $3k+ for this fur ball.

The breeder sent such detailed instructions (14 pages!) about puppy care, including an agreement that we must feed her specific food (purchased from her), how we were required to spay her within 6 months or pay a $5ooo fine, how we should address her when we picked the dog up (no eye contact, she will get in our car and sit in the passenger seat), how we needed a specific carrier to bring her home, etc, that I feared we would be disqualified at the 11th hour from dog ownership.

Much to my surprise, when I met at the appointed meeting spot (Parking Lot B – not A! – at the Gander Mountain in Rogers, MN, 8 AM SHARP!, near the grassy knoll), I was stunned to discover that it was not the 60-ish age breeder but a 20-something proxy who pulled up in a battered Subaru, popped the rear gate and dumped a 3 pound stuffed-toy-come-to-life in my arms, all within 15 seconds.

I fell in love.

Day 1
I swear this is not a “Silence of the Lambs” situation.
Stuffed labradoodle vs. Actual labradoodle

The kids had no idea this was coming, and to burst through the door of Fancy Pants Ranch Deux: Fancy Pants Ranchier and shout, “Who wants a puppy?” was a pinnacle of Doctor Mom Life.

We let the kids name her, and they reasonably determined “Penny” was a good fit. I concur.

We hadn’t had a puppy for 18 years, so the brutal reality of new parenthood struck hard.

I spent the summer of 2018 sleeping on a mattress, constantly touching the dog to see if she moved more than 1 mm, which would prompt complete awakening and a trip outdoors.

I learned quickly what is happening in our neighborhood at all hours of the night. (Spoiler: nothing).

Eventually she became more-or-less continent (my new rugs would say otherwise) and she began sleeping through the night.

But what she never stopped was CHEWING ALL THE STUFF.

To date, Penny has consumed 4 pairs of eyeglasses (including at least one lens, which prompts the question of “How is her colon intact?”, and I am SO MAD because that pair was my absolute favorite), the cushions from two leather chairs, countless shoes, the leg of a coffee table, dozens of eviscerated squeaky toys, 5 leashes, a tube of toothpaste, lip balms, LEGOs, and so many various Barbies and their accessories that she is easily the most prolific Barbie Serial Killer Of All Time.

I’m a good girl, I swear.

Yet.

I am her person.

I see her visually track me as I round the corner of the stairs.

She sleeps curled next to me.

She rests on my foot as I type.

She is so warm and fluffy.

I guess I am a dog person after all.