American College of Physicians: Internal Medicine — Doctors for Adults ®

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PRESIDENT'S COLUMN

Why doctors of internal medicine are the best choice for women's health

From the May 2000 ACP-ASIM Observer, copyright © 2000 by the American College of Physicians-American Society of Internal Medicine.

Women account for more than half the population, yet some women—and even some doctors—think that primary care for women consists of nothing more than a Pap smear and a mammogram. Nothing, however, could be further from the truth.

Statistics show that most women's health issues are not obstetric, even among women of childbearing age. Actually, most women in their reproductive years go to the doctor not for prenatal care, but for acute and chronic conditions such as hypertension, upper respiratory infections and diabetes.

A 1993 study showed that reproductive care accounted for only one-third of health care expenditures for women of reproductive age, and that less than 60% of that one-third (less than one-fifth overall) was spent on pregnancy-related care. Clearly, women in their reproductive years need primary care to address more than just reproductive issues.

Once women reach menopause, their care involves more than a decision about whether to take hormone replacement therapy. Most women transition into menopause at a time when they are at increased risk for heart disease, colon cancer, breast cancer and osteoporosis. After age 65, chronic problems like hypertension, digestive disorders and thyroid disorders are more common in women than in men of the same age.

Internists' role

Doctors of internal medicine are uniquely positioned to address the primary care needs of women. As "Doctors for Adults—the Adult Health Experts," we care for adult women and men. As primary care providers, internists can offer women not only screening for breast cancer and cervical cancer but also help with other complex disorders—e.g., colon cancer, heart disease and diabetes—that rob quality of life and can result in premature death if not addressed. The great tragedy is that many of these potential problems may be overlooked when physicians focus only on women's reproductive health.

Medicine has taken great strides to encourage women of all ages to visit an internist for their primary care. A College ad hoc committee on women's health published a position paper on the role of internal medicine in women's health and the priorities in that discipline for internists. (See the December 1997 issue of The American Journal of Medicine for more information.)

The unique ability of internists to deliver primary care to women will also be part of this year's "Internist Today" public awareness campaign.

In addition, the American Board of Internal Medicine has developed a list of core competencies in women's health and added test questions on women's health issues to its certification exam. And articles on women's health issues regularly appear in internal medicine journals such as Annals of Internal Medicine.

The College's educational programs also reflect an increasing emphasis on women's health. This year's Annual Session hosted a special women's health track, and the meeting's clinical skills courses included teaching skills in physical examination, procedures and communication to help internists better care for female patients.

What you can do

Despite all these efforts, patients will learn that internists are the best doctors for women's health only if each of us takes the following steps to improve how we care for women:

  • Spread the word. Encourage your male patients to have their wives, daughters, mothers and female friends see an internist for primary care. Although the College conducts a public awareness campaign, word of mouth is very effective.
  • Ask the right questions. For women you already care for, be sure to address all their primary care needs and questions. When measuring their vital signs, for example, be sure to ask about their last menstrual period.

Consider the possibility of pregnancy in all women of childbearing age, as this affects your choice of medications. And always ask about the last Pap smear and mammogram at every patient encounter. Encourage all women of childbearing age to take a multivitamin containing 400 mg of folic acid, which has been shown to help prevent birth defects.

  • Promote screening. Help women get the screening they need. Make every attempt to get necessary screening scheduled (and if possible, completed) that day.
  • Hone your skills. Renew your skills in the breast and pelvic exams at clinical skills courses and update your knowledge at local chapter meetings and Annual Session.
  • Make yourself available. Establish yourself as a reliable and interested source of information. Let your female patients know that they can turn to you with questions. Once a woman turns 40, talk to her about the hormonal changes she may experience in the following decade. This establishes you as someone to whom she can turn with questions as those changes take place. Most importantly, tell your female patients what you as an internist can do and talk about the myriad of medical issues that you can help them through.

Internists deliver comprehensive health care from adolescence to senescence, to men and women. All women should have the opportunity to receive comprehensive primary care from a single source, a physician who is competent and comfortable in delivering such care: doctors of internal medicine.

I invite you to join the College, in the words of our position paper, in reaffirming the "commitment to women's health care, to the central role of internal medicine in delivering comprehensive primary care to women, and to fostering improved access to this care through education of women and the public." *

--Sandra Adamson Fryhofer

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