The Psychology of Obstetrics and Gynecology

Two new Lexington Clinic OB/GYNs meet more than their patients’ physical needs

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LEXINGTON It might not surprise you that most OB/GYNs perform surgery, but it will likely surprise you how much counseling some perform. Lexington Clinic’s Tracy Arghavani, DO, says “We are marriage counselors and parental counselors. We are a shoulder to cry on, infertility counselors, and sexual dysfunction counselors.” Ramon Thomas, MD, adds “I call it ‘psychiatry light.’ If I have 20 minutes with a patient, only five minutes of it is actually examining them; the rest is listening and giving input.” Both bring reflective and personable affects that complement their empathetic and attentive approach to meeting patient needs in the OB/GYN department of Lexington Clinic. Arghavani and Thomas’s willingness to counsel women, coupled with access to St. Joseph East’s da Vinci surgical robot, are furthering Lexington Clinic’s reputation for responsive care and providing a maximally comfortable experience for patients.

Preparing for On the Job Training

Both doctors sought positions at Lexington Clinic because they knew what they were getting: a strong specialty group with regional reputation and the opportunity to train on St. Joseph’s surgical robot. They emphatically agree, however, that their OB/GYN residencies did nothing to prepare them for the counseling aspect of the specialty. Thomas notes, “When you are a resident, you are working through patient problems quickly. But once you are on your own, these patients are yours. It’s a very personal relationship. You have to deal with the counseling part to get the comfort level, which allows them to trust you enough to look at those most intimate parts of their bodies.”

Fortunately, flexible thinking about where valuable experiences might lie prepared both physicians to recognize and handle this revelation about their specialty; each perceived opportunity in non-traditional settings. During medical school at University of Louisville, Thomas received his MBA because, “You don’t get business education in medical school and understanding the business side in private practice allows me to see the big picture.” Following his residency at St. Louis University, he spent four and a half years in the Air Force. For Arghavani, after she received her DO degree at Des Moines University Osteopathic Medical Center, residency and internship were followed by four years practicing in an underserved area in eastern New Mexico. “You learn a lot when you are out in the middle of nowhere,” she notes. Her DO training to consider the body as a whole has prepared her well to meet the subtle needs of her patients: “As an OB, often I need to think about how the body is functioning as a whole to figure out how to best help the patient.”

Treating with Honesty and Technology

Like most new OB/GYNs, their patient population is primarily young, healthy woman coming for annual exams or experiencing their first pregnancies. The nature of their work, however, is evolving as the obesity epidemic deepens and more women choose to have children later in life. Many obese woman experience infertility due to irregular menstrual cycles (as few as two a year) and more hypertension and gestational diabetes when they do get pregnant. Thomas prefers a direct approach, consistent with his counselor attitude, with these patients. He says, “I have no qualms about telling a pregnant woman she is obese. We have to broach that subject to minimize the many risks that they are already facing.” This is also the first step to truly fixing problems such as infertility, in which the patient must play an active role. He tells his patients: “My job is to identify your issue and give you an adequate plan to fix it; your job is to see that plan through.” High-risk pregnancies have become the norm, according to Arghavani, “We see more hypertension, obesity, gestational diabetes, and multiples. With more older women having children, the number of factors that make a pregnancy high-risk increases.” It’s no wonder then, that both doctors value time to talk with patients, given the increased number of concerns they bring to the office.

The Surgical Options

The da Vinci surgical robot is an innovation brought to OB/GYN’s practices, and the opportunity to use it at Lexington Clinic helped both doctors choose employment there. Arghavani and Thomas have been proctored in their training by the senior physician of the practice, Tamara James, MD. Arghavani, who complements more traditional laparascopic methods with it, says “the da Vinci has changed gynecological surgery. For major surgeries, such as hysterectomies, because it is minimally invasive, it results in shorter hospital stays and reduces risk of post-operative infection.” Thomas is sensitive to the value of such minimally invasive robotic surgery to his patients, citing, “We do get people who ask ‘Am I going to get a big incision or a small incision?’” That’s just one more way that patient concerns are being alleviated in this practice.

Ensuring Patient Comfort

Patient education has primacy for both doctors; it’s another way they build the trust. A full wall in the practice is devoted to informational brochures, and each seeks opportunities to inform patients. Thomas takes pride in offering troubled patients something that his partners cannot, “Giving them the male perspective provides another slant when discussing relationship and infertility issues.” Arghavani sees empowerment through clear information as valuable. “I love to educate patients,” she says. “They need to understand what the norm is for their body to understand what is abnormal. I want them to understand our reasoning; I think they will be more satisfied if they understand what was done.” In fact, when asked the biggest challenge she faces as an OB/GYN, she quickly responds, “Not enough time. We just don’t have time to do all the education we want.”