New to Meducation?
Sign up
Already signed up? Log In
DR William LeMaire

DR William LeMaire

DR William LeMaire Icon inverted

DR William LeMaire

Icon Moderator
I am a retired obstetrician and gynecologist. I started my career as a faculty member at the University of Miami, Medical School. I left that position at the age of 55 not because I was unhappy or did not like my job. In fact I liked it a lot and was successful in teaching , clinical practice and research (the three hats in academia). My wife and I just wanted to do something else and see the world. That we did indeed. I worked as locums in Japan, Pakistan, Australia, New Zealand, Tasmania, Alaska, Mexico and the Caribbean. I worked hard, travelled a lot and learned a lot (medical and non-medical) about many different cultures. At the prodding of many of my friends and colleagues I ended up writing an e book about our experiences. That can be downloaded for free from Smashwords. The link is: http://www.smashwords.com/books/view/161522. To learn more about me one can go to my website at: http://www.freewebs.com/wimsbook/
Foo20151013 2023 rx9yc2?1444774277
7
140

Early Retirement and Career Change

This is my first blog on Meducation. I decided to tell the reader a bit about myself, so that future blogs will make sense. At age 48 and in an active and successful academic practice of OB & GYN, my best friend died from a complication of cardiac surgery. This tragic event made my wife's and me consider other things in life than just work, thus at age 55, I decided to retire from my academic position and to start working as a locum in many different cultural settings. The plan was to work somewhere in an area of need for six months and alternate this with travel for six months. It did not quite work out exactly that way, but close enough. I worked in Japan, then Pakistan, Tasmania, Australia, New Zealand, Alaska, St Lucia, and Chiapas in Mexico. Much earlier I had had a two year experience in Africa. It was a very satisfying experience and my wife and I have never looked back. Many of my friends and colleagues kept urging me to write a book about our experiences and how we accomplished them. For a long time I kept resisting, probably because I felt that no one might be interested, and because I might have been lazy, and most likely for both of these reasons. I finally gave in, started writing and published an e book. The title is "Crosscultural Doctoring. On and Off the Beaten Path." the book can be down loaded for free from Smashwords at: http://www.smashwords.com/books/view/161522 The book is meant for medical as well as non medical people. It is written as a series of loosely connected anecdotes, some medical, some non medical, some funny, some not so funny. The book describes the immense satisfaction my wife and I experienced from our decision and I hope that reading the book might inspire others, medical or non medical people, who might be thinking about a career change or early retirement to jump of the beaten path. The book might also inspire other with similar experiences to write about them. I would love to receive some comments. William J. LeMaire JUNE 2014 Learn more about me please visit my website at: http://www.freewebs.com/wimsbook  
DR William LeMaire
over 5 years ago
%3fr=0
27
1008

Confidence Building During Medical Training

My fellow medical students, interns, residents and attendings: I am not a medical student but an emeritus professor of Obstetrics and Gynecology at the University of Miami Miller School of Medicine, and also a voluntary faculty member at the Florida International University Herbert Wertheim College of Medicine. I have a great deal of contact with medical students and residents. During training (as student or resident), gaining confidence in one's own abilities is a very important part of becoming a practitioner. This aspect of training does not always receive the necessary attention and emphasis. Below I describe one of the events of confidence building that has had an important and lasting influence on my career as an academic physician. I graduated from medical school in Belgium many years ago. I came to the US to do my internship in a small hospital in up state NY. I was as green as any intern could be, as medical school in Belgium at that time had very little hands on practice, as opposed to the US medical graduates. I had a lot of "book knowledge" but very little practical confidence in myself. The US graduates were way ahead of me. My fellow interns, residents and attendings were really understanding and did their best to build my confidence and never made me feel inferior. One such confidence-building episodes I remember vividly. Sometime in the middle part of the one-year internship, I was on call in the emergency room and was called to see a woman who was obviously in active labor. She was in her thirties and had already delivered several babies before. The problem was that she had had no prenatal care at all and there was no record of her in the hospital. I began by asking her some standard questions, like when her last menstrual period had been and when she thought her due date was. I did not get far with my questioning as she had one contraction after another and she was not interested in answering. Soon the bag of waters broke and she said that she had to push. The only obvious action for me at that point was to get ready for a delivery in the emergency room. There was no time to transport the woman to the labor and delivery room. There was an emergency delivery “pack” in the ER, which the nurses opened for me while I quickly washed my hands and put on gloves. Soon after, a healthy, screaming, but rather small baby was delivered and handed to the pediatric resident who had been called. At that point it became obvious that there was one more baby inside the uterus. Realizing that I was dealing with a twin pregnancy, I panicked, as in my limited experience during my obstetrical rotation some months earlier I had never performed or even seen a twin delivery. I asked the nurses to summon the chief resident, who promptly arrived to my great relief. I immediately started peeling off my gloves to make room for the resident to take my place and deliver this twin baby. However, after verifying that this baby was also a "vertex" without any obvious problem, he calmly stood by, and over my objections, bluntly told me “you can do it”, even though I kept telling him that this was a first for me. I delivered this healthy, screaming twin baby in front of a large number of nurses and doctors crowding the room, only to realize that this was not the end of it and that indeed there was a third baby. Now I was really ready to step aside and let the chief resident take over. However he remained calm and again, stood by and assured me that I could handle this situation. I am not even sure how many triplets he had delivered himself as they are not too common. Baby number three appeared quickly and also was healthy and vigorous. What a boost to my self-confidence that was! I only delivered one other set of triplets later in my career and that was by C-Section. All three babies came head first. If one of them had been a breech the situation might have been quite different. What I will never forget is the implied lesson in confidence building the chief resident gave me. I have always remembered that. In fact I have put this approach in practice numerous times when the roles were reversed later in my career as teacher. Often in a somewhat difficult situation at the bedside or in the operating room, a student or more junior doctor would refer to me to take over and finish a procedure he or she did not feel qualified to do. Many times I would reassure and encourage that person to continue while I talked him or her through it. Many of these junior doctors have told me afterwards how they appreciated this confidence building. Of course one has to be careful to balance this approach with patient safety and I have never delegated responsibility in critical situations and have often taken over when a junior doctor was having trouble. Those interested, can read more about my experiences in the US and a number of other countries, in a free e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path" can be downloaded at this link. Enjoy!  
DR William LeMaire
over 5 years ago
Foo20151013 2023 1agiiai?1444774290
1
119

A curious epidemic of superficial accesses in Africa

This anecdote happened many years ago when I was a brand new (read: inexperienced) physician doing my stint in the Colonial Health Service of the former Belgian Congo. I was assigned to a small hospital in the interior of the Maniema province. Soft tissue infections and abscesses were rather common in this tropical climate, but at one time there seemed to be virtual epidemic of abscesses on the buttocks or upper arms. It seemed that patients with these abscesses were all coming from one area of the territory. That seemed rather odd and we started investigating. By way of background let me say that the hospital was also serving several outlying clinics or dispensaries in the territory. Health aides were assigned to a specific dispensary on a periodic basis. Patients would know his schedule and come to the dispensary for their treatments. Now this was the era of “penicillin.” The natives were convinced that this wonder drug would cure all their ailments, from malaria and dysentery, to headaches, infertility, and impotence. You name it and penicillin was thought to be the cure-all. No wonder they would like to get an injection of penicillin for whatever their ailment was. As our investigation demonstrated, the particular health aide assigned to the dispensary from where most of the abscesses came, would swipe a vial of penicillin and a bottle of saline from the hospital’s pharmacy on his way out to his assigned dispensary. When he arrived at his dispensary there was usually already a long line of patients waiting with various ailments. He would get out his vial of the “magic” penicillin, show the label to the crowd and pour it in the liter bottle of saline; shake it up and then proceed to give anyone, who paid five Belgian Francs (at that time equivalent to .10 US $), which he pocketed, an injection of the penicillin, now much diluted in the large bottle of physiologic solution. To make matters worse, he used only one syringe and one needle. No wonder there were so many abscesses in the area of injection. Of course we quickly put a stop to that. Anyone interested in reading more about my experience in Africa and many other areas can download a free e book via Smashwords at: http://www.smashwords.com/books/view/161522 . The title of the book is "Crosscultural Doctoring. On and Off the Beaten Path"  
DR William LeMaire
over 5 years ago
Foo20151013 2023 e7fpn8?1444774293
3
339

The Importance Of Clinical Skills

In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees. Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this. In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment. In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room. What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it? Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important. Those wanting to read more similar stories can download a free e book from Smashwords. The title is: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH." You can access the e book here.  
DR William LeMaire
over 5 years ago
Foo20151013 2023 1m9x1i7?1444774296
1
147

Creative Administration

Like may of you who work for a hospital, HMO or other organized medical care, I have often been frustrated by the rigidity and dullness of administrators. Many of them go by the rules and seem to be unbending. Once in awhile one comes across some one who does not fit into that category. A personal example will illustrate this. After I had retired from my academic position at the University of Miami I was doing intermittent "locums" work. I had just finished a six month assignment in Okinawa, Japan and was in my traveling mode. I needed to find my next "job" and had applied to an add from Mount Edgecumbe Hospital in Sitka, Alaska. That Indian Health Service Hospital was looking for an obstetrician and gynecologist. I was interested, applied and was invited for an interview. I liked the job and they must have liked me as I was offered a two year contact. However as a new hire they offered me only two weeks of vacation and one week of Continuing Medical Education leave. For someone with my seniority, I thought that that was insufficient and said so. I left Sitka in a sad mood as I really would have liked that job, but was not ready to accept their offer of only two weeks of vacation time. I was told that that was the Company's policy, and that they were not ready to start a precedent. Some days later, I received a phone call from the medical director of the hospital. She started off by apologizing again that she could not offer me more vacation, as that was the Company's policy for new hires. Right away I felt discouraged, but then she added: "We really would like to have you work for us and what I can do is give you two addition weeks of unpaid leave and raise your salary by two weeks (which, by company rules she was free to do). I was elated and accepted the offer for two years. We liked it there so much that we ended up staying seven years. I thought that this hospital administrator was using her authority to make a very creative and imaginative decision. We all benefitted. There should be more administrators like that. Those interested in reading more about my experiences can download an e book for free from Smashword at: http://www.smashwords.com/books/view/161522 or just Google: "Crosscultural Doctoring. On and Off the Beaten Path".  
DR William LeMaire
over 5 years ago
Foo20151013 2023 bpq0mk?1444774302
2
439

Clinical Exam Still Matters

After I retired from my academic position at the University of Miami, I started working as an intermittent ob & gyn in various cultural settings in the US and abroad. In 2006 I practiced in a hospital in New Zealand. I saw many interesting cases during my six months at Whangarei Hospital. One stands out in particular. This was a middle aged native Mauri woman who had been seeing her family doctor for several years because she was gaining too much weight, her abdomen was getting bigger, and she was constipated. Each time the family doctor saw her, he did not examine her but patted her on the back and encouraged her to eat less, eat more fruit and vegetables and be more active so that she would lose weight. When much later he finally examined her, he noticed a large tumor in her abdomen and referred her to the hospital. To make a long story short, we operated on her and removed a large ovarian cyst weighing more than 18 kilograms (about 40 pounds). This cyst fortunately turned out to be benign and the woman did well. The operation itself was something else as we needed an extra assistant to hold the tumor in her arms while we removed it without breaking it. Even though this large tumor was certainly not a record, we ended up publishing the case in a New Zealaned medical journal for family practice (see reference below), not so much for the nature of the tumor itself as for pointing out to family doctors (all doctors, in fact) that examining patients before giving them advice is most important. Alison Gale, Tommy Cobb, Robert Norelli, William LeMaire. Increasing Abdominal Girth. The Importance of Clinical Examination. New Zealand Family Physician. 2006; 33 (4): 250-252  
DR William LeMaire
over 5 years ago