Perinatal HIV and syphilis, diabetic ketoacidosis, obesity and P4 receptor dysfunction are just a few of the complications OB osteopaths can face in a clinical setting, and all were topics of study at the 93rd annual conference of The American College of Osteopathic Obstetricians and Gynecologists (ACOOG).
More than 400 headed to Orlando, Florida, for the conference, with the theme “Navigating Women’s Health Across the Lifespan,” in early April. In addition to clinical scenarios, other sessions centered on topics like physician wellness, advocacy and engagement, health equity and human trafficking.
A chance for professional growth and validation
The conference was a chance to network and share ideas for many Ob Hospitalist Group (OBHG) osteopaths, including Christopher Ackerman, DO, an OBHG clinician and site director at Frederick Health Hospital in Frederick, Maryland.
As a “little brother” to the American College of Obstetricians and Gynecologists (ACOG), an ACOOG gathering has somewhat of a family reunion vibe, said Dr. Ackerman.
“You’re not just there to get information,” he said. “You are going to learn a lot and grow in your profession, but at the same time it’s an emotional refresher, just to see friends and realize, ‘Hey, we’re all in this together.’”
The conference is also a chance to share concerns during frank discussions with colleagues.
“The big thing that I heard was, ‘I’m burnt out. I’m tired. I want to practice medicine, but I don’t want to do the daily grind of private practice,’” said Dr. Ackerman. “And the question I always ask everybody – medical students, residents, attendings – is, ‘You know you want to practice medicine, but the real question is, how do you want to practice medicine?’”
Younger clinicians seeking work-life balance may not have considered hospitalist work as an alternative to the well-established pipeline leading from residency to private practice or academics.
“No one ever says, ‘Hey, you can be a hospitalist,’” Dr. Ackerman said. “You can have a successful career, you can be part of a fantastic company, and you can also focus on yourself.”
Building rapport, trust and camaraderie
In keeping with the holistic tenets of osteopathic practice, much of the ACOOG meeting reflected a commitment to patient-centered care. Pain management during IUD insertion was the focus of a presentation by Dr. Ackerman.
The primary barrier to IUD uptake is pain, he noted. Not only can negative procedural experiences affect continuation or even initiation, pain can impact the patient’s trust in gynecological care in general. The OB clinician should also keep in mind the ways gynecologic procedural pain has historically been minimized or dismissed by physicians.
Tiered protocol example for pain management during IUD insertion:
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Low-risk: NSAID + counseling
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Moderate-risk: NSAID + counseling + topical +/- offered block
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High-risk (trauma history): NSAID + counseling + topical +/- block +/- anxiolytic/opioid
Source: Christopher Ackerman, DO
The time constraints of practicing in a busy clinical setting can also limit an OB/GYN’s ability to perform counseling and other aspects of patient-centered care. The goal is to balance efficiency with patient comfort, said Dr. Ackerman.
“Osteopathic physicians quickly learn how to build that rapport, trust and camaraderie,” he said. “So even though you’re not seeing that patient over and over like you do in a private setting, it’s more about the quality of that moment I get with the patient.”
Clinicians have an ethical obligation to offer evidence-based options for pain management, whether they be oral analgesics, opioids and sedatives, topical anesthetics or blocks. A paracervical block is the local intervention most supported by the evidence, Ackerman said, although it does require technical proficiency.
Although it can be challenging to maintain a patient-centered approach in a busy clinic, many of the ACOOG attendees would agree that the rewards are worth the effort, Dr. Ackerman said.
“Always, when I meet someone for the first time in a medical setting, my goal is to treat them as I want to be treated – treat them like family,” he said. “And with our osteopathic tenets, we’re treating a person. We’re not treating a disease. So we’re building that rapport right away to say, ‘Hey, you are a human. You have needs. Let’s find a common ground.’”
Keys to patient-centered care for OB hospitalists:
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Setting expectations: Describe each procedural step and explain what the patient might feel and for how long.
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Shared decision-making: Discuss the available pain control options and honor the patient’s preference. Document the individualized plan.
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Anxiety reduction: Along with adequate pre-procedural counseling, guided breathing exercises, a calm clinical environment, and the presence of a support person can be useful.
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Trauma-informed care: Ask permission before touching the patient, and empower her with as much control as possible. Pause when requested, and ensure privacy and dignity.
Source: Christopher Ackerman, DO