Dr. Doreen Moser is a board certified Ob/Gyn and a Fellow member in the American College of Obstetrics and Gynecology. She attended medical school at The University of North Texas Health Science Center in Fort Worth and completed her residency at Baylor College of Medicine in Houston. She has been in private practice in the Dallas area since 1994. She is married with two sons.
Uterus1: When did you first know that you wanted to be a doctor?
Dr. Moser: Actually when I first went into nursing school. My brother was trying to get into medical school and I thought I wanted to do something similar. Several different counselors discouraged me from going into medical school and suggested I go into nursing instead. After four years in nursing I still wanted to be a doctor so I went into pre-med.
Uterus1: Did you find the transition from nurse to doctor difficult?
Dr. Moser: It wasn’t that difficult at all because you get such good training as a nurse in caring for patients, how to feel for them, treat them and listen to them and how to really focus in on the problems. You see the whole person. I can walk in and assess the whole patient, not just focus on one particular problem. Having that human touch really helps.
Uterus1: What attracted you to the OB/GYN field in particular?
Dr. Moser: When I was a nurse I floated around all the different areas. All the doctors were telling me not to get into OB/GYN because it was getting worse, harder to collect money and that kind of thing. So they were trying to discourage me but I liked it. I knew that was what I wanted to be.
Uterus1: You have a family and are juggling home and work. Do you find this helps you connect with your patients?
Dr. Moser: Well, I’m going through exactly the same thing they are. Especially my perimenopausal thing because that’s the age I’m at right now. I went through infertility and had IVF for my second baby. So I can relate to all my patients and I think they can understand that. That does increase your rapport with them if you can say, “I’ve been there. I know where you are at right now.” I think they appreciate that.
Uterus1: What do you find is the biggest challenge currently in your field?
Dr. Moser: I think it’s the insurance companies. It’s harder to collect your money. You spend a lot more time and money trying to get your pay. It’s harder than it used to be. You just have to see more patients to make the same amount of money you made in the past.
Uterus1: Does that make it more difficult to give the kind of care you would like to give each patient?
Dr. Moser: It does. You have less time to spend with patients. I have two other providers who help me. I hired a nurse practitioner and physician assistant and so we have split the patients between the three of us. That makes it a lot easier for the patients. I can spend more time with the ones who are really sick and the ones who really need my time. They can see the ones that need a normal Pap smear and that kind of thing. It works really well. They can tune into what is really going on and send them to me and then I don’t have to waste any time going through the whole history again. I can focus in on whatever their problem is.
Uterus1: Are you finding that your patients are better informed than 10 or 15 years ago?
Dr. Moser: Oh yes! Definitely. They come in and say “I want to do this” or “I read in the newspaper about this.” Sometimes you have to re-educate them. I always give my patients options and recommendations about what I think they should do.
Uterus1: Do you think we expect more from our doctors because of all the new technology and new procedures that patients know about?
Dr. Moser: I think so. I do a lot of non-invasive surgery and patients do come in wanting their problem taken care of and to be back at work next week. They come in expecting that and I try to give that to them.
Uterus1: How do you juggle having a full-time practice with the need to keep abreast of the new technology?
Dr. Moser: They send you stuff all the time and you just have to pick and choose. I try to keep a balance. Fit something in on a Saturday or take off a Thursday and Friday. This Saturday I’m going to a cadaver lab to try and learn how to do a new procedure on bladder suspension. So I want to practice on a cadaver first and learn the procedure.
Uterus1: What is their number one concern when they come to see you?
Dr. Moser: It really depends. The younger patients, like teenagers, are concerned about birth control. The 20s to 30s those patients are trying to get pregnant. The 40s to 50s are all perimenopausal and have abnormal bleeding. Most of the problems I deal with are all age related.
Uterus1: How you discuss the more difficult problems like fibroids or the need for a hysterectomy?
Dr. Moser: Whenever I talk about a hysterectomy I always offer very conservative treatment. If I think they need surgery I try to offer them very conservative surgery first. I don’t do a lot of hysterectomies because things are really changing. People just can’t afford to take six weeks off from work to recovery from a hysterectomy. You can do an endometrial ablation on a patient who has abnormal bleeding from fibroids and get the bleeding under better control and they go back to work in two days.
Uterus1: So is the drop in hysterectomy procedures because of these new procedures like endometrial ablation?
Dr. Moser: Definitely because you are taking care of their problem and you are not doing major surgery and they will keep coming back to see you. If all that fails then we will offer a hysterectomy. But I don’t do them as much as I used to and I don’t even offer them to my patients unless they walk in and say, “This is what I want.” Most don’t want surgery. I have patients who I’ve been treating for 10 to 15 years for fibroids and they want to have them dealt with but they don’t want a hysterectomy
Uterus1: How would you explain the endometrial ablation to your patients?
Dr. Moser: I usually tell them there is day surgery we can do. We have to put you to sleep because it would be too painful otherwise. We use hot water and we burn out your endometrium that actually produces the blood. Fifty percent of my patients will have amenorrhea, which means they will not have any more periods. Another 40 percent of the rest will get periods that are lighter and not painful. I still consider that a cure. So I have only had a 10 percent failure rate using the procedure. When I have to recommend birth control or a hysterectomy afterwards, there is usually something else going on.
Uterus1: Who would be the best candidate for this kind of procedure?
Dr. Moser: I have a lot of patients but it’s mostly the perimenopausal patients. They often have abnormal bleeding because of the hormones. Another big group is the patients having abnormal bleeding because of their fibroids. But I get polyps as well. I do the sono hysterography and I find those polyps and those patients are having abnormal bleeding as well. So it’s that 40 to 50 year old group that I usually see all this with.
Uterus1: So most of them are not concerned about having children.
Dr. Moser: That’s right. When they get to that point I tell them, “OK when we do this you cannot have any more children.” Most of them are at that point are ready. They don’t want any more children. If I have a younger patient with problems like that, then we will go in and do a hysteroscopy, remove the fibroids or polyps and put them on birth control until they get pregnant.
Uterus1: Do you see a lot of young women having problems with fibroids and heavy bleeding?
Dr. Moser: Oh yes. There is no discrepancy with fibroids. But most women just deal with it. They will come in and say “Oh yeah, I’ve been having heavy periods for years and I’ve been having painful periods for years.” They hit about 40 and they say, “I really don’t want to do this anymore.” Even though they have been doing it for 20 years! Many are moving into a different part of their lives and it’s something they just don’t want to worry about anymore.
Uterus1: How long is the recovery period?
Dr. Moser: Most people I tell to take it easy for 48 hours. But they are back to work within two days. Ninety-nine percent are back at work within two days with minimal pain and minimal cramping. If they still do have a period after the procedure it’s usually lighter and less painful. There are no scars
Uterus1: Are there any additional procedures involved?
Dr. Moser: With my patients in the 40 to 50 year range, I usually do a tubal ligation at the same time. You just cannot get pregnant with this procedure. We had a patient not too long ago who came in at 25 weeks. She didn’t take a tubal and got pregnant. It was a bad outcome. So I tell my patients either your husband is getting a vasectomy or we do a tubal at the same time.
Uterus1: Why can’t you become pregnant after the procedure?
Dr. Moser: Because you are burning out the endometrium and if you have an implantation, the baby can’t grow. It can’t get enough nutrients. This last patient got to 24 weeks and ended up delivering the baby but it didn’t make it. So you just don’t want to go there.
Uterus1: Why has it taken so long to get these non-invasive treatments?
Dr. Moser: I don’t know because they are saying that the number one surgery in the United States is still the hysterectomy. It’s not my number one procedure. I just think the techniques are better, there are lesser risks and doctors are becoming more aware that patients want that. So they are learning how to do these non-invasive procedures. I think it’s driven by the public. They are pretty open to the idea because they just can’t take the six weeks to recover from a hysterectomy. They have bills to pay and a family to take care of.
Uterus1: How do you develop the treatment plan?
Dr. Moser: I will show them all options. Most come in with heavy bleeding so I will start off with the birth control pill and I talk to them about the progesterone intrauterine device, which works really well for abnormal heavy bleeding. Then I give them the information about ablation and tell them these are the options to make it better. Then I ask them to let me know how they would like to proceed.
Uterus1: Are there any women who choose the hysterectomy over the uterine ablation procedure?
Dr. Moser: Actually some of them do. There is another type of hysterectomy if you have the right-sized uterus called the laparoscopic supra-cervical hysterectomy. You can laparoscopically remove the uterus leave the ovaries and leave the cervix. They go home the next day and they are back at work in six days. But if the uterus is too big it’s difficult to do laparoscopically. I’ve done it a couple of times on big uteruses and it was very difficult. I just don’t go there anymore. When you have to spend three hours to do surgery, it’s just too long.
Uterus1: What do you do with a patient pushing for a treatment that is really not going to help her condition?
Dr. Moser: A perfect example of this. I have a patient who comes in with abnormal bleeding with fibroids so an ablation would be a good option but she is also in pain. Because her uterus is so big she had bladder symptoms, constipation and pelvic pain. Well ablation is not really going to solve the pain. I will tell this patient that if she wants me to try the ablation we will but that you are probably still going to be symptomatic from the fibroids – if they are that big. But I still give them the option. If they want to try one way over the other, that’s fine. If it doesn’t work I will see you back here in three months. What happens is that most patients will call me when they are ready. A lot of patients haven’t really made up their minds yet. So, I give them the information and they take it home. They talk about it with their husband, they think about it and come back telling me they are ready.
Uterus1: What resources do you use to educate your patients about ablation?
Dr. Moser: Well I’ve got handouts on the ablation. I’ve got Web sites for my polyspecfic ovarian patients for them. I’ve got a lot of material in my office that shows them where and how I will be burning. Then when they come in for the pre-op visit we spend about an hour with them. We go over all the risks involved, actually how the procedure is going to be performed, how long they will be in surgery, how long they will be in the hospital. That kind of stuff. The pre-op visit is an educational visit.
Uterus1: What’s the biggest change that you’ve seen in your field in the last few years?
Dr. Moser: That’s a tough one because everything changes. Everything is really moving towards non-invasive and conservative. But I think everyone is heading in that direction not just OB/GYN. The surgeons are getting trained in newer ways to provide care and do the procedures so there is less risk and people have less pain and are getting back to work quicker.
Uterus1: Do you have a favorite piece of equipment or technology?
Dr. Moser: My sonogram. I would never be able to practice without my sonogram machine. I do my own sonograms. So the patients comes and I do it all at once. I do the sonogram, make the diagnosis and then give my recommendations. Then the patient decides what they want to do. You don’t have to see the doctor, go to radiology and wait for another visit. You can pick up so much pathology with the sonogram. I would be lost without it.
Uterus1: What words of advice would you give to new doctors entering this field?
Dr. Moser: Keep educating yourself. It never ends because it changes so much every year. When I got out of residency I didn’t know how to do a transvaginal sonogram. I taught myself. Now that’s all I do. Some of the newer procedures like the laparoscopic supra-cervical hysterectomy – you have to keep learning and keep educating yourself on how to do these new procedures. If you don’t keep up with the education and going to the conferences you will get behind very fast.
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