Dr. del Rosario practices ObGyn in Camp Hill, Pa.
4. Evolving technology boosts value-added care
Soheil Hanjani, MD
Without a doubt, the biggest practice changer for me has been increasing use of the Essure device (Conceptus) for office hysteroscopic tubal occlusion. I place about four or five of these devices each month, after giving the patient the full range of contraceptive options. Those seeking permanent contraception appreciate this 5-minute, very-low-risk procedure, which offers minimal discomfort and a return to normal activity in 1 day.
Dr. Hanjani practices ObGyn in Brockton, Mass.
About 2 years ago, I began using a device called INSORB absorbable skin stapler (Incisive Surgical). This device places subcuticular staples for skin closure. Since I began using INSORB, I have noticed several benefits:
- The cosmetic result is as good as—and usually better than—that seen with skin staples.
- Seromas are less likely because this form of closure allows spontaneous wound drainage during the first 24 hours.
- Staple removal is not required, so patients are happier!
Dr. Clow practices ObGyn in Chillicothe, Mo.
Ponce D. Bullard, MD
Over the past year, I have increased my insertion rate for the Implanon contraceptive device (Schering-Plough). In my practice, Implanon has almost completely replaced the intrauterine device (IUD), thanks to issues of cost and a lack of interest in a 10-year method of contraception.
Dr. Bullard practices ObGyn in West Columbia, SC.
John Armstrong, MD, MS
In my 34-year career, high-resolution two-dimensional US has been the most significant breakthrough. Transvaginal US (office-based) for pelvic screening and diagnosis, and breast US for screening and diagnosis, have dramatically increased the accuracy of what we do on a daily basis. The technology is extremely accurate, painless, and cost-effective. I just hope that it becomes more widely available soon despite the bureaucratic nonsense we face at every turn.
Dr. Armstrong practices gynecology and women’s health in Napa, Calif.
5. Offer this simple remedy for refractory bacterial vaginosis
Mark A. Firestone, MD
Patients who experienced repeated bouts of bacterial vaginosis (BV) used to be an especially frustrating population for me. I would prescribe a myriad of antibiotics, both oral and vaginal. The patients would experience a short interval of relief, then return to my office 1 month later with the same complaints. Even prolonged courses of antibiotic therapy were of limited benefit and a great cost to them. Patients were encouraged to alter their sex habits, use yogurt formulations, and were instructed on how to properly wash themselves. These patients called my office often, demanding to be treated over the phone to avoid the expense of an office visit. As they became more frustrated, they began to doubt my abilities and sometimes sought medical care elsewhere.
One day, I discovered a probiotic blend containing 8 billion colony-forming units of various lactobacilli. I instructed my patients who were bothered by recurrent BV to use this product at least twice daily. Although the probiotic is usually taken orally, I had several patients who used it vaginally. The results have been astounding!
Now, I rarely see a patient who has recurrent BV complaints. Patients also report that they experience less abdominal bloating and improved bowel function after using the product.
This approach seems to me to be much more effective and safer than serial antibiotics. What a pleasure not to receive so many telephone calls with complaints of recurrent vaginal discharge and odor!
Dr. Firestone practices Gynecology in Aventura, Fla.
6. A change in practice can boost your quality of life
William H. Deschner, MD
About 18 months ago, I made a decision to leave private practice (after 33 years!) and take a position as an OB hospitalist. The move turned out to be a good one. I now enjoy freedom from the daily worries of running a business and securing reimbursement. The tradeoff? I no longer have my own patients or perform gynecologic surgery. Although I miss these aspects of practice, the change has been worthwhile. With the OB hospitalist model, patient safety is enhanced, as are the lifestyle of the attending physician and job satisfaction for the hospitalist.
I am glad to be involved in this model of care from the early days of its evolution. Although many questions remain unanswered—not the least of which is whether the model can achieve long-term economic viability—I believe the improvement in safety justifies its existence. In the long run, if we are truly committed to improving safety, then economics will have to become a secondary consideration.