Wednesday, October 6, 2010

The Lowly Gynaecologist

“ A Physician works at cerebral level, a Surgeon at spinal level and a Gynaecologist at Lumbrical level”

This was the sneering statement made by a Physician while we were in training.
For the non medical people, it implies that a Physician [post graduate in internal medicine] uses his brain, a surgeon his inherent skill, while a gynaecologist merely uses her hands without thinking or talent- the Lumbricals being muscles in the hand.
This patronising attitude towards us gynaecologists continues through our working lives.

With the Nobel prize for medicine being awarded this year to Professor Robert Edwards, the originator of the test tube baby and the first gynaecologist to win the award, all of us gynaecologists feel vindicated. It was balm on our bruised egos.
Thinking back, Gynaecologists have given several firsts to the world of medicine-

Professor Ian Donald, first thought of holding an ultrasound probe over the adbdomen of a pregnant woman and got images of the baby, thus starting the whole new field of sonography-which is indispensable in  diagnosis in almost every branch of medicine and even used in therapy.

Professor Kurt Semm also a gynaecologist, removed an appendix laparoscopically and then started doing hysterectomies setting the trend for endoscopic surgery. The surgeons followed with Laparoscopic cholecystectomies etc.

Prof. Camran Nezhat again a gynaecologist first used an endovision camera and monitor to do laparoscopic surgery while looking at a screen and not peeping through the telescope with one eye shut. Today extensive cancer surgeries are possible because of this one small step /giant leap.

Then there was the test tube baby- Louise Brown the brain child of Sir Robert Edwards and Patrick Steptoe. Gynaecologists all over the world adopted their methods successfully –leading to a whole new field of assisted reproduction. With this came advances in culture media, incubators, operative microscopes, sterile environments and led to development of stem cell research, tissue preservation and even cloning.

Prof Charles Koh, started doing endoscopic tuboplasty [for repair of the fallopian tubes] and opened up the field endoscopic microsurgery –useful even to cardio-vascular surgeons.

Besides these landmark developments by Gynaecologists, I feel a 'Doctor for Ladies' is different from other consultants in many ways-She has to be both Physician to treat various diseases in pregnancy, taking into account the effects on the mother and the baby; and Surgeon to operate on various pathologies of women. Besides gynaecologists need to have a fair knowledge of endocrinology, oncology and breast diseases. Plus she has to know about and use psychotherapy and also step in to sort out the social problems of her patients. Women she has delivered look to her for baby care tips and a basic knowledge of paediatrics is also in her domain. She also has to educate- girls starting puberty, women getting married, or trying to have a baby, sort out physical marital problems and help women age in comfort.

Gynaecologists are often primary care physicians for pregnant women and for those who are too embarrassed to see a male family doctor for an ailment of a personal nature.

To all derisive statements made towards us by doctors of other specialities, I would like to say we are not only your equal, we are first among equals.

Congratulations to Sir Robert Edwards for getting the highest honour for his work. Sir, you do us all proud.