Delivering full-spectrum care

Recently I noticed that I had begun delivering the babies of women whom I had delivered early in my career. My first reaction was that I was getting old; I was beginning to take care of a second generation of patients. While the realization was not altogether comforting, it did give me a chance to reminisce on my past 19 years of practice in rural south Texas.

When I started practice in 1988, we used a pegboard system for our billing. We had to change to computer billing a few years later because we kept misplacing our ledger cards. Five years ago, we finally converted to electronic medical records. It was a difficult transition period, but it was all worth it in the end. We no longer misplace patient charts and my staff does not have to wear back belts to carry some of our 20-pound charts.

Obstetrics has also changed since I started practice. When I began, we tried to do as many VBACs—vaginal births after cesarean—as we could. We perform more c-sections now; probably because we stopped doing VBACs and more women are now requesting c-sections. I keep in touch with some of my obstetrics and gynecology friends in San Antonio and they are seeing the same trends.

Some of my friends ask me how much longer I plan to do obstetrics and hospital work. It is difficult to respond to that question because I think that I have had a wonderful experience in my medical career. During my training at the Medical College of Wisconsin, I attended lectures in cardiac physiology by Arthur Guyton, M.D. It was wonderful to attend a lecture given by the professor who actually had written the textbook. My family medicine residency in Lubbock was also a great experience because I had mentors such as Berry Squyres, M.D., Charles Shields, M.D., and Clark Johnson, M.D. All these physicians demonstrated that they were caring and very dedicated. They had also practiced in rural areas. Both Dr. Squyres and Dr. Johnson had active obstetrical practices prior to joining the staff at the residency program in Lubbock. Dr. Johnson was the first to teach me how to use forceps and I performed my first c-section with Dr. Squyres as the attending physician. These role models drove me to include obstetrics in my practice.

I also recall having discussions with my classmates during medical school. We were all idealists who wanted to go out and make a difference in our patients’ lives. One of my classmates, Mario Jimenez, M.D., also went on to practice the full scope of family medicine in rural Rio Grande City. We used to talk from time to time after we had both entered practice in the rural areas and compare notes about our practices and our prior convictions. Unfortunately he died two years ago but I know that his patients in Rio Grande City miss him very much and that he made a difference in their lives.

I still think that obstetrics should be an integral part of family medicine especially for us practicing in rural areas. In some areas, our patients have to travel long distances to obtain obstetrical care. Family medicine should try and fill the gaps in our patients’ care, thereby providing the full scope of comprehensive care to our patients.

I hope the next 19 years of practice will be as rewarding as the first 19. My oldest son was four months old when I started practice and now he is a freshman at Texas State University. Time has gone by very fast. I hope I can continue with the same commitment and dedication as my mentors.