Welcome to this month’s column, which follows up on a recent piece. Last July, I interviewed cardiac surgeon Jack Pirris, who shared his insights and opinions in a well-received article. Judging from the positive feedback I received, this type of article is valuable and entertaining for ASA members, and so this month we have a “2.0” version. There may be “Beyond 2.0” versions in the future as well, getting the viewpoints of the various proceduralists we work with.

March’s Expert is Dr. Gregory Kainz, an OB/GYN physician with experience in the military and private sector and currently in academic practice. Dr. Kainz is a man of many talents and currently maintains a busy surgical practice as well as an active obstetric practice. I believe his insights and wisdom will be as well received as those of Dr. Pirris.

I was born in Guttenberg, Iowa. My father’s family were farmers, but he decided to work in manufacturing. He got a job with the construction arm of John Deere. However, there were frequent layoffs, so he took a job in aerospace manufacturing and moved our family to California when I was in middle school. I attended Loyola Marymount University, where I studied biology and religious studies, then went on to Loma Linda University to study biomedical ethics. I decided to join the Navy, which led me to the University of Michigan to study health care administration. I was stationed in Hawaii, then on the USS John F. Kennedy in Mayport, Florida. My mentor was a flight surgeon who encouraged me to go to medical school. I attended the Philadelphia College of Osteopathic Medicine and then went on to complete my OB/GYN residency at Lehigh Valley Health Network in Allentown, Pennsylvania. I was the first person in my family to go to college, so I guess I felt compelled to get a bachelor’s, two master’s degrees, and my DO.

I am Medical Director for Patient Safety and Quality for the OB/GYN Department at University of Florida College of Medicine-Jacksonville. I am a full-scope OB/GYN (surgery plus deliveries), and my practice is based at our North Campus. I am part of the GYN Ultrasound program as well as active in minimally invasive gynecology. I run the patient safety rounds and the Women’s and Children’s Process Improvement Committee. Finally, I am a member of the Surgical Process Improvement Committee and the institutional Process Improvement Committee.

I considered a military scholarship for college but eventually decided against it. That thought lingered until I went to grad school, where I stumbled across a program that was trying to get graduate-trained health administrators in the military. Pursuing that was one of the best professional decisions I have made. It doesn’t really matter your specific job – in the Navy you have to function as a line officer. This was especially true on an aircraft carrier. I had to stand watches and participate in readiness training and inspections. I also got my medical surface warfare qualification, which allowed me to know much more about being an officer. The Navy has all types: rich, poor, educated (and not), urbanites, rural people, and even international members. But we all trained to do our jobs and support our shipmates. I could counsel a junior sailor about important life decisions, serve as a summary court martial officer adjudicating an issue, or be in a small boat doing patrols while in port. I was a natural leader, but the Navy made me into a professional leader.

I love being an OB/GYN. I do surgery, I take care of patients longitudinally, as well as provide crucial emergency care. When practicing obstetrics, I get to be part of one of the most important days in any family’s life. In my current position, we were able to build a great team. We have office and hospital staff who are top notch, and a very strong midwifery practice. Our anesthesia team (including physicians, CRNAs, and CAAs) is highly patient-focused, which allows us to offer outstanding patient care. So each day when I come to work, I know that I am part of a team that I trust to handle anything.

The hours. As you age, nights and weekends get harder. I am also less tolerant of administrative barriers to care, i.e., “red tape.”

It’s very clear that anesthesia and OB/GYN frequently share the responsibility for taking care of patients in high-stakes situations. Therefore, communication is key. Since I am particularly interested in patient safety, I make a conscious effort to communicate at each junction of care. This starts with the preprocedure huddle, extends to the pre-incision time-out, and, when appropriate (as in the case of ongoing hemorrhage), the intraoperative huddle. I also make it a point to debrief each case. I think that if this standard is set, then a lot of adverse outcomes can be avoided. As I review cases for our hospital and health system, many of the breakdowns come from communication. So being on the same page with my anesthesia colleagues is essential and allows for a high-functioning team.

Most of my interactions have been positive. I have a deep respect for the level of responsibility that anesthesia professionals have. Based on this, I know everyone’s names, and I also know (at minimum) a little bit about them. That respect and familiarity complement my desire for effective communication. I like to make a personal connection with patients and colleagues, so I tend to converse a lot. That talking can help to de-escalate tense situations as well as help to communicate important clinical information. In our OR, whether obstetrical or gynecologic, making sure we are all aware and engaged is key. Nothing makes me happier than having a colleague at the head of the bed during a C-section who can chat with the patient and support person, take a picture (or what have you), but, if necessary, can in the next instant push a uterotonic or secure an airway. Together, we manage each other up.

Depending on the region, birth rates have varied significantly. Generally speaking, parturients are older, have more comorbidities, and require more care. I am happy that many hospitals have laborist or hospitalist programs. These models offer a better safety environment and also allow providers to extend their careers by reducing off-hours work. Certified nurse midwives in our practice have been a key reason for our success. I believe these individuals are underutilized in the U.S. It is astonishing that there are still patients who do not get prenatal care despite programs targeted to increase access to that care. This increases risk for all patients while leading to more defensive medical practices in obstetrics. In our facility, we have in-house anesthesia, which allows us to practice at a high level and respond quickly.

I really enjoy boating and inshore fishing. We have a 21-foot center console that we take out as much as we can. The beauty of living in Florida is the water. We have the ocean and intercoastal on the East Coast, scalloping on the Gulf Coast, and lobstering in the Keys.

I am also a big college football fan, and I especially enjoy tailgating. I follow the University of Michigan and Clemson University (I married into a Clemson family). Any time I can tailgate, I take advantage of it. My dream is to outfit a Class B RV to provide the “ultimate” tailgate experience.

At the end of the day, when we come to work, we want to take excellent care of our patients. If we listen to each other, communicate, and execute on this commitment, everyone on the team is elevated.