Robert Phillips, M.D. grew up in New Mexico and went to college and medical school in Albuquerque at the University of New Mexico where he graduated in 1983. He did his OB/GYN residency training in Phoenix at the Maricopa Medical Center. He has been with Desert West OB/GYN in private practice for 18 years, and now serves as president and managing partner of this 12 OB/GYN physician group. Dr. Phillips’ practice interests include general obstetrical care and minimally invasive surgery. He recently has become involved in risk reduction for OB/GYN's. His outside interests include three teenagers, music and reading.
Uterus1: Can you tell us about general obstetrical care and minimally invasive surgery? Describe these fields and explain your role in them.
Dr. Phillips: General obstetrical care:
General obstetrical care is probably self-explanatory for those that have had a baby. The whole pregnancy experience is exciting with the growth and development of the baby, the detail of ultrasound now, the culmination in delivery and taking home a baby. I think that’s why the majority of OB/GYNs get into their career. That’s the hook that attracts most young doctors. OB is very exciting. 3D and 4D ultrasound are giving us an even more fascinating look into the womb.
Pap smears are part of OB/GYN that isn’t much fun for the patient. I’m continually amazed that some people hate the dentist more than they hate the GYN. The pap smear is really essential for screening for precancerous activity. We’ve learned a lot about them in the last 5-10 years, though, and if we test for the human papilloma virus, the pap smear might not be needed every year. It doesn’t get you off the hook for your pelvic exam, though. That’s still necessary annually to have your ovaries, uterus and breasts checked, as well as to see how your periods are, and talk about birth control or menopause.
Minimally invasive surgery:
Laparoscopic surgery is basically a telescopic surgical procedure done through a small incision in the belly button and lower abdomen. So these days if patients have problems like cysts on their ovaries, scar tissue from previous surgeries that causes pain, or if they need a hysterectomy, we can treat some of them through incisions less than an inch long instead of the bikini- style incision that was the standard in years past. The recovery time drops to days as opposed to the four to six weeks that traditional surgery requires.
Endometrial ablation, or destroying the lining of the uterus to treat heavy bleeding, is another type of minimally invasive surgery that is coming on strong. Imagine the lady who has periods so heavy she has to stay home for three days each month. She comes back in six months after having had endometrial ablation, and says,” I haven’t had a period since the treatment.” What a happy day. It’s a very nice outpatient procedure, and the recovery time is a day.
We can also do sterilization now under local anesthesia in the office, placing tiny coils into the tubal opening by working through the vagina and up into the uterus. It’s crampy, but nothing like the recovery from laparoscopic tubal sterilization surgery where you need general anesthesia and feel crummy for at least two to three days. This new way of getting your tubes tied is starting to catch on, since patients can go home in an hour from the office. I think it will be a very popular procedure before long.
Uterus1: You’ve recently become involved in patient safety/risk reduction for OB/GYN’s. Why does this interest you?
Dr. Phillips: I think that people are becoming more interested in the idea of precautions in the practice of medicine. There have been some seminal articles in the last five years about the medical industry and patient safety. I think patient safety and risk reduction go together. The idea is to use a checklist of sorts so that little things that sometimes turn into big things don’t fall through the cracks. We all like to think that we’re completely sharp all of the time, but in reality we know that’s not true.
All of our expectations of pregnancy these days are unrealistic. In the medieval and covered wagon days, people realized that life is not perfect and that sometimes babies (and adults) have terrible problems and/or die. Now patients, nurses and even the doctors expect perfect outcomes every time. That’s just not realistic and to some degree keeps our medical liability system (not malpractice, we don’t say that) busier than it ought to be. There are many opportunities through modification of our systems to closer approach that desired perfect outcome.
For instance, there are some new labor monitoring systems where you enter the preliminary data, and the system helps you to draw conclusions. Also it helps remind you that if there is a certain laboratory result, then your patient will need antibiotics during labor. The program even remembers to ask you what that lab result was in case you forgot to enter it in the computer in the first place.
Uterus1: What questions do patients typically ask you? And what are your answers?
Dr. Phillips: Do I have to have an episiotomy? That’s a very common question because all the pregnancy books say to ask. That also is something that’s changing, so I think that the answer in most instances should probably be no. The chances that you would get one are decreasing year by year. There are good studies that support that.
Do I have to take hormones? And that’s about a half an hour debate. These days it’s such a complex question. What to actually do about hormones, is very much an individual decision. It depends on many factors; including your symptoms, and your personal and family history (breast or colon cancer, osteoporosis, etc.). It should be a matter of discussion and a collaborative decision between you and your doctor.
Do you need to find a doctor near you? Click here to start your search