Experiences of an OB/GYN

Dr. Nabil Khoury-Yacoub is an obstetrician and gynecologist who founded White Plains Obstetrics and Gynecology Partners in 1998.  Dr. Khoury did not complete medical training in the United States but rather in Paris, France at the Faculte de Medecine.  When asked what inspired him to become an OB/GYN, he said that he had always been interested in surgery and during one of his rotations with the OB/GYN department, he felt a connection to the field. He went on to discuss that although men in the field are not very common, this did not turn him away from a specialty that he knew he could give his all to.  It also helped that one of the doctors that he shadowed during residency at New York Medical College, was a male as well offered him guidance and advice. 

Dr. Khoury was also asked about what he believed to be the most challenging part of being an OB/GYN is constantly being on-call.  He explained that since a lot of his patients have high-risk pregnancies, he could be called in at any moment should anything go wrong, or in his favorite scenario, labor.  Dr. Khoury recounted an instance in which he was having dinner after a hard day’s work of back-to-back surgeries but had to return to the hospital due to a patient’s condition.  He admitted that there are days he has to consume an excessive amount of caffeine to stay alert and focused on the task at hand.  Dr. Khoury is not the only physician struggling with outrageous hours and mounds of paperwork.  There have been various studies in which 25%-60% of physicians have reported exhaustion amongst different specialties.(Rikinkumar, et al. 2018). This is one of the many symptoms of what is referred to as physician’s burnout.  The dangers of physician’s burnout extend to not only their patient care skills but also their own personal satisfaction within their lives. Some of work factors that contribute are excessive workloads, comprehensive documentation in electronic medical records, and frequent call duties. (Rikinkumar, et al. 2018).  Dr. Khoury is also one of the many physicians who had to familiarize himself with electronic charts as this medical advancement was not available during his training.  He said it took him quite some time to be able to update a patient’s chart in a timely fashion and still even struggles with it today as more software’s and updates are constantly done.

With being one of the founding fathers of the OB/GYN department at White Plains Hospital, Dr. Khoury is often completely booked months in advance as one of the most sought out physicians in the city.  With that being said, when asked about daily routine, Dr. Khoury could not give a certain answer.  However, when asked how he is able to face every situation thrown at him, he simply responded with by the help of his team.  He continued to explain that no one man is expected to know everything even if it is in regard their specialty which is something that newer generations don’t seem to quite understand yet.   He elaborated by explaining that each new year of interns and residents, the most common trait he sees is their competitive nature.  “Most newbies are afraid to ask for help because they believe it shows weakness, when in fact it is quite the opposite” (Dr. Khoury). Medical errors as a result of self-doubt and humiliation were frequently reported among multiple studies however, 70% of physicians described an improvement in practice because of the error. (Sirriyeh, et al. 2010).  This method of learning from mistakes is one that Dr. Khoury has become very familiar with as he even stated that he would not be the doctor that he is if it weren’t for his mistakes.  Even though some of his mistakes lead to the loss of his patients, Dr. Khoury sees them not as failures but rather stepping stones.  He recalled a time where he was able to apply knowledge the gained from one patient’s loss to another patient’s success.  

In a world where technology has boomed over the last few years, Dr. Khoury was asked if there were any notable changes within his field thanks to technological advancements.  This began his discussion of his use of the da Vinci Xi robot to perform multiple surgeries, one of which was recently on my mother.  While Dr. Khoury admitted that initially he was intimated by the machine, he now views it as an extension of his own abilities and a great asset to his practice.  Dr. Khoury stated that before he even came close to operating on a real patient, he was required to spend hours on end practicing how to control the robot’s movements considering its wide range of abilities.  The use of the robot contains several advantages such as smaller incisions, lower morbidity, and less postoperative pain. (Sinha, et al. 2015). Dr. Khoury often spends his Tuesday’s in the operating room performing routine hysterectomies with the da Vinci Xi machine instead of laparoscopically although he has sufficient training in multiple methods of performing hysterectomies.  Dr. Khoury mentioned that he preferred the use of the robot due to its Endo Wrist technology that allows greater rotation and finite movements than a human wrist.  However, by utilizing the machine an additional twenty to seventy minutes were required to complete the surgery compared to laparoscopic hysterectomies. (Sinha, et al. 2015).   Overall, robotic surgery is becoming one of the primary methods used for multiple surgeries within the gynecology field as technology continues to advance.  

While discussing the da Vinci Xi machine, Dr. Khoury openly shared an experience in which the machine malfunctioned.  He explained that shortly after a routine hysterectomy begun, the robot malfunctioned and completely ceased all function.  Dr. Khoury and his surgical team ultimately switched to an abdominal hysterectomy and completed the surgery that way.  However, this change in surgical plans also meant more stress for the patients as the recovery time and pain was substantially higher than the planned method.  Dr. Khoury did say that the failure of the machine was a result of a power malfunction in which the hospital was able to fix fairly quickly.  Although this was Dr. Khoury’s first encounter with the machine malfunctioning, it has been noted that the da Vinci system itself is reliable with very low rates of error/failure.  In 26% of the reported events within a search of the FDA MAUDE database there were injuries involved as a result of system malfunction and 8.5% included death. From the 26% of reported injuries, only 14% were related to actual technical system failure while the machine itself was not at fault for the remaining cases. (Manoucheri, et al. 2013).  Compared to many other procedures, these rates are relatively low and are considered a success in the surgical field.   

Dr. Khoury’s interview ended with some advice that he had for those wishing to enter the gynecology field: “Do it because you love it, not because you think you’ll make the most money or invent the next breakthrough.  Ask questions and most importantly, ask for help whenever you’re not sure because in some cases you could be saving two lives.” (Dr. Khoury). Throughout the interview with Dr. Khoury it became clear that the field of gynecology is ever changing as new technology emerges, yet the goal remains the same; helping their patients.  

References

Manoucheri, E., MD, Fuchs-Weizman, N., MD, Cohen, S. L., MD, MPH, Wang, K. C., MD, & Einarsson, J., MD, MPH, PhD. (2014, January 28). MAUDE: Analysis of Robotic-Assisted Gynecologic Surgery. Retrieved April 29, 2019, from https://www.sciencedirect.com/science/article/pii/S1553465014000272

Patel, R. S., Bachu, R., Adikey, A., Malik, M., & Shah, M. (2018, October 25). Factors Related to Physician Burnout and Its Consequences: A Review. Retrieved April 29, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262585/

Sinha, R., Sanjay, M., Rupa, B., & Kumari, S. (2015, March). Robotic surgery in gynecology. Retrieved April 15, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290120/

Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2010, December 01). Coping with medical error: A systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Retrieved April 26, 2019, from https://qualitysafety.bmj.com/content/19/6/e43