Team XX

This past week, I have been working with Dr. Olmo, one of two physicians that comprise the OB/GYN team at the Belau National Hospital. Despite the small population size of Palau (and thus the low number of annual births), the two OBs are spread pretty thin with all of their responsibilities in the hospital, especially when one goes on vacation or sick leave.

They have a different clinic every day starting at 8am (theoretically) that is dedicated to a certain group of patients. The only exception to this is Thursday morning which is set aside for elective surgeries. Often, the clinic doesn't start exactly on time because the physicians are seeing other patients that have been admitted to the medicine ward or L&D overnight. Mondays and Tuesday mornings are set aside for GYN patients. During these visits, they see women for their annual exams, follow-ups for abnormal paps, or for abnormal symptoms like bleeding or discharge. Tuesday afternoon is dedicated to post-partum visits during which they examine women who delivered 2 or 6 weeks ago and discuss contraception planning and breastfeeding. Wednesday mornings they see high risk prenatal patients - women with gestational diabetes, preeclampsia, a history of miscarriages, etc. Wednesday and Thursday afternoons are for regular prenatal visits, and Friday mornings are dedicated to women who have scheduled their first prenatal visit for the pregnancy.

At any point during the day (i.e. during clinic), the physicians can be paged for emergency admissions, surgeries, or deliveries. Luckily, I haven't seen this too often during my week, but I can easily imagine how that must completely throw off their schedule. It is also very difficult for them because other employees such as the clinic nurses or OR techs do not comprehend the scope of their responsibilities. The world of these ancillary employees is centered around their one responsibility (the clinic, the OR, etc.), so they do not understand why the OBs might be late or why it is absolutely imperative that things start on time if they are available (particularly the surgeries). I have heard many stories over the week in which the OB shows up to the OR for her scheduled elective surgery only to find that the patient has not been wheeled back and the OR nurses/techs are hanging out eating breakfast. The cascade then begins - the surgery starts and finishes late, the OB is late to clinic, the clinic nurse pages her overhead with patients waiting, and so on. What a difference a larger group of physicians (especially residents) make when running a clinic and L&D ward!

As you can imagine, their days are pretty busy and I have used this week to work on my speed with patients, particularly during annual exams, while maintaining comprehensiveness. Lots of pap smears, Leopold maneuvers, and recording of fetal heart rates. Surprisingly, I'm not sick of it at all.....I guess that's a good sign for residency!