Surgery News - August 2007 - (Page 14)

PRACTICE TRENDS exam, so if you plan on having a couple of pregnancies and want to take 6 weeks off with each one, you might not be able to finish your surgical residency on time.” With all the time-bound milestones a surgical resident must meet, family planning is a tough nut to crack. “It’s not like, ‘What would be the best time for us [to get pregnant]?’” Dr. Turner said. “It’s more of a case of ‘When would be the least bad time?’ Those are decisions that, in my opinion, would rarely enter the mind of a male surgeon.” The competitive nature of a surgical residency also plays a part, she said. “There can be resentment from your colleagues who have to take up the slack when you’re on maternity leave, or from your program’s faculty regarding your decision.” As a result, women may feel increased pressure both before they leave and after they return. “You have to be at the top of your game. You can’t give anyone any ammunition.” That pressure, plus the need to save all possible leave days for after the baby comes, can mean literally working right up to the last moment of pregnancy. “I was at work at 7:00 and went into labor at 11:00,” she recalled. Like Dr. Tawheed, Dr. Turner relies on her extended family for support. “I have a very supportive husband, and I live near my parents and his parents as well. I could never do what I do without all these people who allow it to work.” Dr. Turner completed her residency before the 80-hour workweek was approved. Since then, she has observed changes in both attitudes and programs, which are becoming more family friendly. These changes benefit men as well, she said. “In the current generation of young adults, both men and women identify lifestyle issues as much higher on their list of priorities than surgeons did 15 or 20 years ago. You were just not finding people who were concerned about making their kid’s ballet recital back then. Now, men and women are much more cognizant of time spent with family and outside of medicine.” Dr. Patricia Bergen, president of the Association for Women Surgeons, agrees. “At one time, programs would frankly discourage you from having children and made your working environment very difficult if you did. Now we know this is a part of life, and programs are adapting to handle it. The serious resentment that we used to see is gradually being replaced with a matter-of-fact attitude like ‘Well, this person is going to be out for a while, and how can we deal with it?’ ” Most institutions still have far to go, said Dr. Bergen, a general surgeon at the University of Texas at Dallas and an ACS Fellow. “Most programs don’t offer maternity leave—you have to take sick leave and vacation. You can get family medical leave, but of course it’s unpaid,” she explained. Attitudes in Europe are also much improved from the days when the terms “family” and “surgical resident” seemed mutually exclusive, Dr. Mettler said. “They used to say you could be a good surgeon and a bad mother, or a good mother and a bad surgeon. I think that is changing.” ■ SURGERY NEWS • A U G U S T 2 0 0 7 Childbearing Proves Challenging Obstacles • from page 1 she declared her interest in surgery in medical school, Dr. Tawheed didn’t exactly receive her professor’s resounding support. “He stressed that surgery is a man’s demanding job, and I had to understand the reality that a woman surgeon would encounter a lot of challenges that could make her change her career,” she said. She later discovered the true reason behind her professor’s cautionary tale: His own wife had had to switch from gynecologic surgery to laboratory research. “I was actually worried about his advice, but because I am a practically minded person who likes to see instant results days was difficult enough because my male colleagues did not let me operate.” Early on, Dr. Mettler said, part of a surgical assistant’s job during vaginal surgery was to position the patient by holding her legs on his shoulders. “When it was my turn to assist, they simply did not accept me.” Furthermore, her mentor threw surgical instruments at her when he was dissatisfied. “He would not have dared to do that to my male counterparts,” she said. She said she was only accepted as a surgeon after having published extensively, whereas her male colleagues were allowed to perform surgery from the time they entered university. Patient prejudices were also problematic. “My patients preferred a tall, goodlooking, physically strong man,” she said. “There was no recognition that you can be actually a better surgeon with small hands.” She experienced this same attitude during the 3 years in which she practiced in South America early in her career. “In the big cities, patients did not want a woman to do their surgery. But in the jungles of Peru, it was completely different. There, whoever was skillful enough to do the job was accepted.” Such notions are less common in Germany today, Dr. Mettler said. But Dr. Ornella Sizzi, a pediatric hematologist and laparoscopic surgeon at Villa Valeria Hospital, Rome, experiences them quite often. “Patients in Italy have a perception that a female physician is only good for obstetrics, gynecology, contraception, and menopause. They also believe that only a big, physically strong male is really capable of doing effective surgery.” Italian media help perpetuate the myth, she said. “Our most popular TV shows are soap operas with doctors who all fit that description.” Dr. Sizzi recalls that as a student, the first time she assisted in a gynecologic procedure, her professor noticed her small hands and said, “What do you think you can do with these hands? You do not have hands, you have stumps!” Yet by the end of her residency, she excelled at surgery. As a petite blonde, Dr. Sizzi feels that her looks sometimes add to the problem. “One little girl who I operated on said to her mother, when I entered the room, ‘Oh, look! There’s the Barbie doctor!’” Her surgical partner, a large man, is most often the center of attention when they visit patients before or after surgery. “They usually assume I am the assistant and he is the surgeon,” she explained. Dr. Iman Tawheed, the only female gynecologic oncologist in the entire country of Kuwait, hasn’t met with that particular prejudice. Her patients are relieved that a man won’t be examining them. “Being in a Muslim community, women place a high priority on having a lady doctor,” she said. “And since I’m the only gyn-oncologist in my country, I always have a very busy clinic!” As in Europe, however, surgery in Kuwait is a male-dominated field. When Infection Prevention Scrutinized BY BRUCE JANCIN Else vier Global Medical Ne ws Dr. Iman Tawheed is the only female gynecologic oncologist in Kuwait. from my work, surgery still seemed the perfect choice for me.” She also received support from her family, including her mother, who encouraged her to study medicine, and her husband, who is very proud of her accomplishments. The couple has one child, a 6-year-old girl. But because of Dr. Tawheed’s new project—establishing Kuwait’s first gynoncology center—there might not be another. “I’m feeling very guilty about this,” she said. Large families are still important in Kuwait, and the male-dominated society places a very high value on sons. “I don’t quite know what to do about the situation.” It’s impossible to have any meaningful dialogue about women in surgery without discussing the issue of childbearing, said Dr. Patricia Turner, a general surgeon and assistant professor of surgery at the University of Maryland, Baltimore, and an ACS Fellow. “We are taking women at the most fertile time of their lives and putting them in training that can easily last 9 or 10 years. It’s disingenuous to ignore this issue,” she said. The problem is multifactorial, added Dr. Turner, who worked up until the day she went into labor with both of her children. The logistics of childbearing can make completion of a residency difficult. “You need to complete a certain number of weeks in order to sit for the Board D A L L A S — Fewer than half of U.S. hospitals—with the notable exception of those in the Veterans Affairs system—utilize all three widely recommended practices for preventing central venous catheter–associated bloodstream infections, according to results of a national survey. The VA system stands head and shoulders above the pack with regard to implementation of these preventive measures. According to the survey, 62% of VA hospitals take a comprehensive approach to prevention of central venous catheter–associated bloodstream infections, utilizing all three preventive practices. That’s true of only 44% of the nation’s non-VA hospitals, Dr. Sanjay Saint reported at the annual meeting of the Society of Hospital Medicine. Dr. Saint and his colleagues conducted a survey of catheter-associated infection prevention practices at all 119 VA medical centers as well as a random national sample of more than 400 nonfederal hospitals with more than 50 beds and an intensive care unit. Central venous catheter–associated bloodstream infections constitute a significant cause of morbidity, mortality, and hospitalization costs. Despite the fact that guidelines strongly recommend the three proven preventive strategies, until now there have been no national data characterizing the extent to which hospitals are using them. The lack of data was the impetus for conducting the survey, explained Dr. Saint of the University of Michigan, Ann Arbor. The three key evidence-based preventive practices are as follows: Use of maximal sterile barrier precautions, routinely employed in 84% of VA and 71% of nonfederal hospitals. Chlorhexidine gluconate as an injectionsite antiseptic, utilized in 91% of VA and 69% of non-VA hospitals. Avoidance of routine central line changes. The survey also included semistructured telephone interviews with hospital infection control officers and on-site visits. The purpose was to identify facilitating factors

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Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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