8/18/2019 toag.8.1.066.27222

http://slidepdf.com/reader/full/toag8106627222 1/1

And finally Speaking as a patient…One of the problems about being a male

obstetrician and gynaecologist is that, no matter

how empathic you are, you cannot fully put

 yourself in the patient’s place. I remember as an

SHO thinking I ought, just once, to lie on a

delivery bed and put my ankles in the stirrups to

find out what it feels like. Of course, I never did. I

couldn’t trust any of my colleagues to get me

down again.

I suppose empathy is almost as difficult in some

other specialties. My dim recollection of hospital

admission for tonsillectomy does not include any 

trace of a surgeon, or a nurse, though we yelled for

them. The main memory, apart from blood in my 

mouth, was of the American comics the boy in the

next bed gave me: my first encounter with

Spiderman, a hero much weirder than Dennis the

Menace.

Under the knife

As a benign gynaecologist (if that’s the right term)

 you can sympathise to some extent with your

surgical patient if you’ve had an operation

 yourself. More so after two. My herniorrhaphy wound, in my teens, was closed with staples and I

assumed removing them would need heavy 

engineering equipment. My appendectomy, at 21,

was followed by relief on my part that a

respectable reason had been found for my sudden

aversion to beer, and by a belief on my colleagues’

part that I could be taken back to the pub within

48 hours. This was not a good idea and may 

explain why I’ve been sceptical about early 

discharge ever since.

But losing an appendix isn’t the same as losing an

ovary or a womb. The nearest internal equivalent

in the male is the prostate and we chaps don’t

want to talk about that, thank you. Our

information on prostatic screening comes from

Billy Connolly’s graphic description of pelvic

examination by a man with a rubber glove and,

quite frankly, we’d rather die.

When it comes to perineal surgery, men haven’t

experienced this since barber-surgeons stopped

cutting for stone. We shudder to think of anyone

seeing that part of our anatomy. For me, the

nearest the surgeons got to it was excising a

pilonidal sinus just before Finals. (Was I a surgery 

addict or what?) Lying prone, all I saw of my 

surgeons was their shoes, which radiated an air of 

amused detachment. All I wanted was technical

competence and, happily, that’s what I got. I still

meet one of them occasionally: I’m surprised he

remembers my face.

Obstetric encounters

My first encounter with an obstetrician was in

1947, in a small nursing home. I don’t know his

name. Mother rarely spoke of him, though sheoccasionally mentioned her labour in hushed

tones, commenting that the pain had been beyond

her worst imaginings and adding kindly that I

mustn’t blame myself. Looking back I think we

should have been more grateful to him and his

forceps. Maternal mortality was 1 in 1000 and

15% of deaths occurred in maternity homes.

Across England and Wales at least 60 women a

 year died of prolonged labour or traumatic

delivery. So thanks, mister, for getting me out.

In the 1970s expectant fathers did not accompany 

their partners to the booking clinic. There was noreal-time ultrasound to attract them. These days

dads want to see the first scan but why they come

to follow-up clinics remains a mystery to me. My 

emancipated wife did not want me in the corner

during her consultations. And as an obstetric

registrar I felt superfluous during her labours,

particularly when the midwife was pushing the

baby back to give the consultant time to arrive and

do a normal delivery. Gosh, how things have

changed.

Crumbling together

As you get older, gender differences seem less

important but they don’t disappear, as the NHS’s

disastrous experiment with mixed-sex wards

proved. Mind you, when I spent time in a unisex 

intensive care unit I didn’t bother about who was

in the next bed. That admission was the result of 

spectacular travel-induced thromboembolism

(have I shown you my CAT scan?) and, I notice, it

was exactly seven years ago as I write. I’m not sure

that it made me more sympathetic but it has at

least cured me of any lingering desire to assume

the lithotomy position.

Author details

James Drife  MD FRCOG FRCPEd FRCSEd

HonFCOGSA

Professor of Obstetrics and Gynaecology

University of Leeds, UK 

 And finally   2006;8:66   10.1576/toag.8.1.066.27222 www.rcog.org.uk/togonline The Obstetrician & Gynaecologist

66   ’   2006 Royal College of Obstetricians and Gynaecologists