Uterus1: When did you decide you wanted to go into obstetrics and gynecology?
Dr. Crowder: I was very influenced in my rotation in obstetrics and gynecology as a third year student and knew I liked it, but I was also very interested in general surgery. So it was quite a toss-up until right at the end, when I chose obstetrics and gynecology over general surgery. I enjoyed dealing with new life; it’s a very happy specialty in general, and while I enjoyed the fast-paced atmosphere of surgery, obstetrics and gynecology has a lot of surgery in it as well. In doing this dealing in obstetrics and gynecology, you’re dealing with the lives of people – not only their problems, but also their happiness and their joy. That’s very different than what can happen in other specialties.
Uterus1: Another doctor we interviewed commented that one of the things he thought was unique about obstetrics and gynecology as a specialty is that the OBGYN is a specialist but also a general practitioner; that in fact they’re often a woman’s only doctors, and this makes the specialty uniquely rewarding. Do you agree?
Dr. Crowder: Well, let me put it this way – you surely feel like you’re dealing with the whole person in obstetrics and gynecology, instead of one isolated portion of their health, and that makes a difference.
Uterus1: What are some of the things you find difficult in practicing obstetrics and gynecology?
Dr. Crowder: Probably the largest difficulty in practicing OBGYN is the influence of non-patient relations, such as dealing with third-party payers, dealing with the legal system, and the constant worry about liability and malpractice. These are the things that are very difficult. There’s a lot of pressure – which comes from areas that are not part of taking care of patients – put on doctors.
Uterus1: What are some of the specific things you’re focusing on now, in terms of both research and patient care?
Dr. Crowder: My current practice is indeed in the care of patients. My dealings with clinical research are really only as an enjoyment. I’m not in an academic practice; I’m not in a research institution where my livelihood depends on the research I do, but I do research anyway because I enjoy it. The type of research I do, typically, depends on either interests that I already have or simply being in the right place at the right time, where I find something that needs to be reported to other physicians so they can use it and understand what the experience has been. So I try to take those opportunities. When I come across situations that need to be recorded, I try to do that, so that it helps other physicians in their practice.
I’ve been very active in dealing with new technologies. I’ve done work in trying to develop new technologies, but to be honest I’m much more interested in taking technologies that have been developed, that are not widely accepted, and trying to understand what their value is and apply them in a way that the patients can benefit from them.
My primary goal in my practice has been to decrease the amount of invasion. Invasive procedures, surgery – this takes time and causes some disability in the short term though it may help a problem after recovery. If we can make that surgery simpler and less invasive, that is something that is a big goal of mine.
Uterus1: You must be particularly excited about some of the newer technologies in endoscopic surgery – one that comes to mind is endometrial ablation among other new minimally invasive treatments – which have been seen in general use in the past few years and started to gain recognition as really viable treatments for a lot of women suffering from a large variety of disorders of the reproductive tract.
Dr. Crowder: That’s true. I have been particularly active with endometrial ablation with the Hydro ThermAblator®. And in addition to some of the ones you mentioned, there are others still on the way. An example of that might be the treatment of fibroids. Typical treatment for fibroids has always been surgery: you remove them, and often remove the uterus. We’re finding out now that there are ways we can either negate the problems that the fibroids may cause, like excess bleeding or pain, without surgical treatment. Or, we’re trying minimally invasive surgery where we destroy the fibroid itself but not the tissues surrounding it.
Uterus1: A lot of patients and doctors alike have reported that hysterectomy is a very commonly recommended treatment for fibroids, but now these minimally invasive treatments seem to be providing options that both patients and doctors see as viable alternatives which give the same end result without so many of the drawbacks.
Dr. Crowder: Yes, and I think that’s the key. You want to give the same result while not being as invasive in doing it. There’s nothing wrong with surgery; surgery is an appropriate thing, and sometimes even invasive surgery may be very important. If a patient has a condition where the heart is not working and they must have a heart transplant, well that’s a very invasive surgery but that patient may not live without it. In our situation, in obstetrics and gynecology, we’re not dealing with life or death situations nearly as much, at least outside of cases that involve cancer. But we are still seeing situations where we must continue to look for even less invasive options, for more comfortable procedures, that can be done to take care of the problems that are still being taken care of with bigger surgeries.
Uterus1: Do you think that patients who are well-informed about the range of treatments are more likely to be cooperative in the event that their doctor recommends a less invasive procedure as the best option, because they will have had a chance to see the more invasive procedure as not the only available treatment, but one of a large range of options?
Dr. Crowder: Exactly, I think that’s completely correct. And there’s the satisfaction of seeing a patient go home after only three hours and be comfortable, because you weren’t thinking that the only way was two weeks in the hospital and six weeks of disability, where the end accomplishment is the same thing.
Uterus1: In considering these technologies that make the less invasive procedures possible, when you look to the future, what are some of the most exciting things you see on the horizon?
Dr. Crowder: Well, that takes some thought. I’m stuck thinking of just how amazing the things are that have happened already in the last five years, and the types of procedures that we do now, for example for pelvic reconstruction in urinary stress incontinence, which is an incredibly common problem after pregnancy. We get children from pregnancy, of course, and children are wonderful. But at the same time, pregnancy is a huge stress on the body, and what we find is that if we look to the future, meaning after child bearing, there are certain things that are predictable in terms of wear and tear of having that baby. The difference today is that whereas there were problems that used to be considered things that one would just live with, things like loss of urine when one coughs or sneezes or jumps, we now don’t think of these as things to just be put up with. There were surgeries to help it, but they were so major that doctors would save them until the last possible moment, when nothing else had worked. Now we’re able to use procedures that allow women to take twenty minutes as outpatients and go home two or three hours later, with very few complications and almost total correction.
The same thing applies to abnormal bleeding and a treatment for it, the uterine or endometrial ablation that we were talking about. These techniques have been around for twenty or thirty years, and before that there were attempts that didn’t work at all – the cure was worse than the problem. But with technology that has come about in the last twenty years and very specifically in the last three years, there’s a very simple way to end it, in an outpatient setting. But even five years ago it was common to say that abnormal bleeding should be treated with removal of the uterus.
Uterus1: What those two examples you mentioned just now have in common is that while neither is life threatening in nature, both have the ability to substantially impact a patient’s quality of life. It seems like learning how to improve a patient’s condition in a way that improves her quality of life is really your most important goal, in the absence of a life-threatening situation.
Dr. Crowder: Absolutely. The focus now is probably as much on the quality of life as it is on life itself. I have to be careful here; I mean to say that this is in my specialty in particular, because there are specialties (cardiology and a couple of others come to mind) where doctors really are dealing with life threatening illness more often than not. In obstetrics and gynecology, we’re working not so much with life-threatening illnesses or problems, but lifestyle-threatening illnesses and problems. If we continue going this way, where we’re really trying to make sure that the quality of life figures into ideas of illness or wellness, wellness can encompass a lot more than whether one does or doesn’t have an infection or does or doesn’t have a particular disability.
Uterus1: For our patients who are looking for a good OBGYN, what questions would you suggest asking when searching potential doctors?
Dr. Crowder: These are very difficult, because most people generally work on very superficial information about doctors. For patients who are moving to a new town and want to know how to choose another physician in a distant city, the first thing I’d is that in order to look for technical competence, they should look for board certification. At least these doctors have passed a set of rigorous qualifications to achieve that level. Now that doesn’t mean that they’re good people and it doesn’t mean that they have good personalities; it just means that they have technical competence. And from a surgical perspective, it doesn’t say that they have good technical ability, it just says that they know enough to be able to pass examinations. I think the second most appropriate information to seek is whether the doctor in question is personable: is this doctor one the patient can get along with. For that question, I would say that the best thing to do is develop some friends and ask those friends, “Who is your physician and do you like him?” That’s a very important question, because some people will stay with physicians they really don’t like very much.
Uterus1: That could be a danger because disliking the physician could really undermine the important component of trust in the doctor-patient relationship, couldn’t it?
Dr. Crowder: Exactly. And I think that it’s a very important thing, if people are very interested in going further – and they’re going to have to work a little harder when it comes to this step – to look for special expertise and special competence for their particular disorder. They’re going to have to look for special expertise by looking at special interest research or areas where other physicians have reviewed these doctors.
Uterus1: Are there any final thoughts you’d like to share with our readers?
Dr. Crowder: I think a lot of it has been said, but saying it in a different way once more may help to really emphasize it. I really see that the specialty of obstetrics and gynecology, the big advances in the past ten or twelve years, and I see the big advances in the next five years, as being advances in our ability to interfere less in lives and lifestyles by becoming even less invasive. We have the engineering skills to do that now. I say "we" because it may not be me who does the engineering work of developing the instrumentation, but if I can explain myself well enough and develop techniques where instrumentation will help us do minimally invasive things, we now have people who are willing to come in and use engineering skills in concert with what physicians are saying they can and want to do. I think that’s the direction in which we’re going, and that direction is a good direction and one that I am very comfortable with.
For Additional Information:
Visit Dr. Crowder's website at www.wha-obgyn.com