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. 

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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.

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.

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

Podcasts I’m Listening To Now

My excessive commuting is fast coming to an end (Hooray!), but I’ve had lots of time – and thousands of miles – in the past six months to drive, contemplate life, fret over uncertainty, worry about Anything and Everything, plan vacations and listen to podcasts.

Lots and lots of podcasts.

Here are some suggestions, if you’re so inclined:

  • This American Life. I’ve been a fan since its inception. Still am. Always will be. This is the standard bearer for me by which all other podcasts are judged.
  • S-Town. The entire run of this Southern Gothic story dropped at once, and basically everyone freaked out and made this the Number One podcast in the Universe. Confession: for the first three episodes, I thought this was an extremely well-crafted fictional narrative, but when I figured out it was true, I lost my mind and gobbled up the rest. The storytelling here is incredible. I can’t even begin to describe what this is about: clock repair, hedge mazes, small town Southern life. You’ll have to trust me that this is so worth your time.
  • Crimetown. This first season is all about Providence, Rhode Island, and its corrupt politicians and mafia kingpins, both of which ruled the city for decades.   Any fan of works like “The Sopranos” or “Goodfellas” will love Crimetown.
  • Up and Vanished. Oh, boy. This one is addictive. This podcast starts out investigating a cold case murder of a teacher in a small town in Georgia, and in the course of the podcast, the case gets solved in real time. Watching this unfold week by week has been riveting. You can still catch up.
  • Matt and Doree’s Eggcellent Adventure: An IVF Journey. Well, I’m biased because this is what I do for a living, hence my initial binge and current weekly listening session. Matt and Doree are a likable California couple trying to have a baby via science. Hearing about IVF from a patient’s perspective has been humbling.
  • The Dinner Party Download. Guests vary, but the formula is the same: corny jokes, craft cocktail recipes, celebrity interviews and answers to modern etiquette quandaries.
  • Fresh Air.  Terry Gross is a master interviewer. An unfulfilled dream of mine would be to have dinner with Terry and have her find me witty and charming, with both of us leaving as fast friends. While this is never going to happen, a girl can dream. Full disclosure: I download all the episodes but only listen to about half, usually when the guests seem appealing. This is probably a mistake, because Terry Gross can make any interview fascinating. Tip: there is a weekend show with the week’s best clips if you want to cut to the chase.
  • Wait, Wait! Don’t Tell Me. Usually I catch this gameshow live on NPR, but when I don’t, I listen to the week’s podcast.
  • The Moth. Tagline: The art and craft of storytelling. Sometimes I laugh. Often I cry. The stories are that good. Another unfulfilled dream: have a story good enough to share at one of their events.
  • Mortified. Cringeworthy and awesome. Adults read their real childhood diary entries onstage, unedited and in their awkward adolescent glory. I’ve almost driven off the road choking with laughter, so be careful.

 

Summer Camp

Last week, Spouse and I took a leap of faith and sent Trixie off to camp.

For three weeks, one of which is spent doing a canoe trip that involves setting up tents, portaging and crossing the U.S. border into Canada.

She’s eight years old.

One more thing about that canoe trip: the guides purposefully steer the girls into headwinds and cheer when it rains under the premise that adversity builds character.

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I already love this camp.

“This American Life” recently replayed a 1998 episode (it’s held up remarkably well) entitled “Notes on Camp,”which explains the rituals, memories and strong emotions of kids who’ve grown up attending the same camp every summer. I highly recommend a listen; it would make almost anyone yearn for a type of childhood that most of us don’t get to experience.

The thing I love most about Trixie’s camp is that it’s an all female environment, from the campers to the counselors to the cooks to the camp director. The emphasis is on building strength, confidence and character, something I am 100% behind and I think is best accomplished in this exact setting.

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Trixie is already strong and confident, but the world can be tough on girls and even the strongest wings will have to fly through some storms.

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My friend M’s daughter is also attending this session. This is her second year at camp (she’s older than Trixie) and M. described last year’s experience as transformative for her daughter. I am hoping for the same.

My biggest wish: Trixie attends every summer and ultimately builds memories, friendships and qualities that last a lifetime.

I have so many dreams and hopes for This Girl.

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How To Quit Your Job (A Work of Fiction)

Memo: How TO QUIT YOUR JOB

 

  • First, don an amazing outfit; I mean a truly spectacular one. Wear lipstick. You’re going to want to look good for this.
  • Do it in person and in writing. On the morning of the day you quit, request a brief meeting with your boss, and say it is time sensitive. In the meeting, say that you are resigning. Be pleasant but neutral. Practice this ahead of time in order to actually be pleasant and neutral when it matters.
  • Accompany your verbal notice with a written one. Keep this extremely brief; state you are resigning and give your suggested final day at this workplace. If you are leaving but not entirely happy with the departure, it’s ok to NOT fill the page with words thanking your current employer for making conditions so bad that you are leaving. That would be inauthentic, and that is something you are not. However …
  • Be gracious. Wish your colleagues the best in the future. Even if you don’t feel that way right now, it’s a classy gesture.
  • If offered an exit interview, YOU MUST RESIST the temptation to Put It All Out There. Spoiler alert: they don’t care what you really think at this point, and odds are nothing is going to change from what you say. Save your catharsis for your friends.
  • Refrain from using the phrase “with mixed emotions” to describe any aspect of your departure. This is trite, overused and makes you look both inarticulate and unimaginative.
  • Know that they will talk sh*t about you. They just will. You don’t need to like this fact, but you do need to know it. You see, other people are going to watch you walk away and that might force them to put a mirror to themselves and their own lives, and they may not like what they see. So for some it will be easier to trash you, call you a fool, shake their heads and say that you never belonged here in the first place. Secret: some of them will actually be jealous because you are doing something they wish they could do. Some may be inspired to follow your lead and exit. Some will be happy for you, and they are called your friends.
  • Time it strategically for your benefits. This is a practical one: some companies have benefits programs where if you work a few days out of a month, your benefits will continue until the end of the month. It may feel tidier to quit on July 31st versus August 3rd, but those extra days may mean a significant financial difference, especially if you have to pay for COBRA coverage.
  • In you can swing it, throw your own going away party and pay for the booze! This way you can invite who you want, focusing on the people you like, and there has to be at least someone you still like there. Avoid an awkward lunch party in the conference room at all costs.
  • Also, if possible, give yourself a bridge between finishing one job and starting another. Honor and enjoy the time off, because as adults we rarely get to do this. Go to a tropical island if you can, because your new job may require some significant nose-to-the-grindstone time before you earn/can afford another vacation.
  • Be Brave. Know that you are strong and will be Even More Amazing in your next iteration.

P.S. This is a work of fiction.

A New Opportunity (a.k.a. Difficult Decisions, the Pursuit of Happiness and the Opportunity of a Lifetime)

Today was the last day of my job.

It was a position I held for over eight years, and for much of that time, I thought it would be a forever job, one where I would start and end my specialty medical career.

The reasons behind the decision are complicated and too personal to share in their entirety, but initially I faced this change with deep sadness. I still partially feel this way.

To focus on the (amazing, wonderful) positive: I am about to embark on a very exciting new chapter.

A colleague and friend who I respect and love asked me to partner with her in joining an established private practice in a nearby city.

This is a Once in a Lifetime opportunity, and in the end, it is also one I could not pass up.

I want to be able to craft a medical practice that represents me in every aspect, from the little things like the magazines in the lobby (artsy, diverse), to the art on the walls (hip, real), to offering patients a beverage while they wait (sparkling water, anyone?), to the big things like making every patient feel understood and cared for during the good times and the bad. Another pro: I can dress more creatively without the restrictive wardrobe rules of my old job (all suits, all the time).

The most important factor: I can authentically be myself, always.

I’m excited to begin.

On the flip side, people may wonder why I’m leaving a position I loved. That’s harder to justify.

For most of the time I was in my former job, I truly, deeply loved it. I lived and breathed the work and gave my all to the institution. I was so proud to be a physician there.

A few weeks ago I was interviewed for a public radio news show about fertility treatment. The other guest was Belle Boggs, who wrote “The Art of Waiting: On Fertility, Medicine and Motherhood,” an eloquent memoir about being a fertility patient. The conversation was stimulating and one of the best I’ve had in a long time. At the conclusion of the hour, the show’s host told me that throughout the program, the phone lines had been jammed with current and former patients of mine who were calling to say what an excellent doctor I was.

My voice cracked when I thanked her for telling me. 

It’s almost impossible to leave that behind, even though I’m sure there will be new stories and new patients.

(Sidenote: I hesitated to include that anecdote in this post, because if read the wrong way it sounds really boastful and ugly. I don’t mean it to; it was a very surprising moment to me and one where instead of feeling swollen with pride, I actually felt quite stunned and humbled. In the end I decided to keep it because it illustrates the bittersweetness of my current situation).

In all parts of my life, I’ve pledged to be authentically myself, and it would be inauthentic at this time not to mention that the reason I was receptive to the opportunity to join a private practice with my friend involved turmoil within my own department. After a few years of this, my immediate colleagues and I were very unhappy. Despite passionate discussions and attempts at change, it became apparent that the status quo would be upheld.

I felt like I could continue to be unhappy in my current iteration or try to live authentically and forge a new path. I chose the latter.

While I still have framed some of this story with sadness, the overwhelming sentiments I feel are Happiness and Excitement for the future.

I now see this opportunity for what it is: a gift.

To the clinical and nursing staff I’ve worked with, patients I’ve been honored to care for and my physician friends, please know I love you. Thank you for letting me be a part of your life and be able to practice a medical specialty that I deeply love. It is a privilege.